Hulbert v. Hartford Life & Accident Ins. Co.

CHRISTIAN HULBERT, Plaintiff, v. HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

No. 20-cv-03687-BLF

United States District Court, N.D. California, San Jose Division

August 2, 2021

ORDER GRANTING DEFENDANT'S MOTION UNDER RULE 52 AND DENYING PLAINTIFF'S MOTION UNDER RULE 52

BETH LAB SON FREEMAN, United States District Judge.

I. INTRODUCTION

Plaintiff Christian Hulbert (“Hulbert”) filed this ERISA^[1]action against Defendant Hartford Life and Accident Insurance Company (“Hartford”) following Hartford's denial of his claim for long term disability benefits under a group insurance policy that Hartford issued to Hulbert's former employer, Infinera Corporation (“Infinera”). See Compl., ECF 1. The policy in question is Group Long Term Disability Policy No GLT681103 (“Disability Policy†), which is one component of Infinera Corporation Employee Health and Welfare Benefits Plan (“the Plan†). AR 1376, ECF 28. Infinera is the plan administrator, and Hartford is the insurer. AR 1376, 1442.

The Disability Policy outlines what employees must show in order to be deemed “Totally Disabled.” AR 1441. A worker is Totally Disabled when he is “unable to perform with reasonable continuity the Essential Duties necessary to pursue [his Own] Occupation in the usual or customary way” for a period of two years. Id. To continue to receive benefits beyond 24 months, the worker must show that he cannot perform with reasonable continuity in “Any Occupation.” Id. Hulbert left his job on August 15, 2018, after tripping down three stairs and hitting his head, resulting in a concussion. AR 1160 1375. Hartford granted Hulbert short-term disability benefits. AR 175, ECF 27. Hulbert then applied for long-term benefits under the Disability Policy. AR 79. In April 2019, Hartford rejected Hulbert's long-term disability application, finding that Hulbert did not show he was disabled under the Plan. AR 114. Hulbert appealed this decision the following October, supported by new medical evidence. AR 12. Hartford rejected the appeal in December 2019. AR 84.

The parties filed cross motions for judgment pursuant to Federal Rule of Civil Procedure 52. See Pl.'s Mot., ECF 30; Def.'s Mot., ECF 32. The Court heard oral arguments on April 22, 2021. See Min. Entry, ECF 36. For the reasons discussed below, the Court issues the following findings of fact and conclusions of law and GRANTS Hartford's Rule 52 motion. The Court DENIES Mr. Hulbert's Rule 52 motion.

II. LEGAL STANDARD

Federal Rule of Civil Procedure 52 provides that “[i]n an action tried on the facts without a jury ... the court must find the facts specially and state its conclusions of law separately.” Fed.R.Civ.P. 52(a)(1). “In a Rule 52 motion, as opposed to a Rule 56 motion for summary judgment, the court does not determine whether there is an issue of material fact, but actually decides whether the plaintiff is [entitled to benefits] under the policy.” Prado v. Allied Domecq Spirits and Wine Group Disability Income Policy, 800 F.Supp.2d 1077, 1094 (N.D. Cal. 2011) (citing Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir. 1999)). In making that determination, the court must “evaluate the persuasiveness of conflicting testimony and decide which is more likely true” in order to make findings of fact that will be subject to review under a clearly erroneous standard if appealed. Kearney, 175 F.3d at 1095.

The parties agree that California Insurance Code § 10110.6 applies to this case. Pl.'s Mot. 15. The Court thus must determine, based on the evidence in the administrative record, whether Hulbert carries the burden of showing, by a preponderance of the evidence, that he was disabled under the terms of the Plan, without according deference to Hartford's denial of claim. Kearney, 175 F.3d at 1087-90; Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006); Oster v. Standard Ins. Co., 759 F.Supp.2d 1172, 1185 (N.D. Cal. 2011). To prevail, Hulbert needs to prove it is “more likely than not” that he was disabled under the terms of the Plan. Armani v. Nw. Mut. Life Ins. Co., 840 F.3d 1159, 1163 (9th Cir. 2016) (standard of proof in de novo ERISA disability claim is preponderance of the evidence); Sanchez v. Monumental Life Ins. Co., 102 F.3d 398, 404 (9th Cir. 1996) (defining “preponderance of the evidence” as “more likely than not”).

III. FINDINGS OF FACT

A. Mr. Hulbert's Occupation

Mr. Hulbert was employed as a Senior Support Technician (DOT No. 032.262-010, Sedentary, SVP - 7) with Infinera from 2013 until 2018. AR 257. This “sedentary” work is not physically demanding. AR 259. Hulbert spent most of the workday sitting, and he was not generally called upon to lift, carry, push, or pull objects. Id. However, this work had some mental rigor. AR 261. The work “require[d] that [Hulbert] be able to correctly analyze, troubleshoot, and evaluate computer network problems in order to quickly resolve problems [sic] issues.” Id.

B. The Long-Term Disability Plan

While working for Infinera, Mr. Hulbert was enrolled in the Infinera Corporation Employee Health and Welfare Benefits Plan, which is an ERISA employee welfare benefits plan. AR 1442. Infinera is the Plan Administrator of the Plan. Id. Disability benefits under the Plan are insured by Hartford under Group Long Term Disability Policy No. GLT681103 issued by Hartford to Infinera. AR 1376.

In order to qualify for long-term benefits, a policyholder must show that he/she is “Totally Disabled” under the language of the Policy. The Disability Policy defines “Total Disability” as:

Total Disability or Totally Disabled means during the Elimination Period and for the next 2 years, as a result of injury or sickness, you are unable to perform with reasonable continuity the Essential Duties necessary to pursue Your Occupation in the usual or customary way. After that, as a result of injury or sickness you are unable to engage with reasonable continuity in Any Occupation.

AR 1441.

“Your Occupation” means any job that shares the same “Essential Duties” as the job the policyholder worked when he/she became disabled. AR 1441. “Any Occupation” is any job that the policyholder is qualified for, so long as it has an earning potential greater than either (1) the product of the Indexed Pre-disability Earnings and the Benefit Percentage, or (2) the Maximum Monthly Benefit. AR 1438.

The Policy includes a provision for “Mental Illness and Substance Abuse.” AR 1431. If a disability is caused by “Mental Illness” or “Substance Abuse, ” benefits are limited, and only payable for 24 months, unless the policyholder is confined to a hospital at the end of the 24-month period. Id. The policy defines “Mental Illness” narrowly, only recognizing illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. AR 1439.

C. Mr. Hulbert's Medical Treatment History

Mr. Hulbert has reported various symptoms since at least 2014. AR 372. A 2014 MRI of his brain revealed the presence of multiple cerebral cavernous hemangiomas (“cavernomas” or “angiomas”). Id. His sister and son, according to Mr. Hulbert, also have cerebral malformations, but he declined the recommended follow-up with adult genetics. Id. He has seen many medical professionals over the years to treat his various symptoms. Below is a survey of the relevant portions of Mr. Hulbert's medical history, organized in chronological order and by treatment provider. AR 330.

1. Sarim Mir

In March of 2017, Mr. Hulbert began seeing Dr. Sarim Mir, a neurologist. AR 704. Starting in 2017 and continuing until 2019, Mr. Hulbert repeatedly complained of headaches, memory issues, and difficulty reading to Dr. Mir and physician assistants practicing under his supervision. AR 704-745. Mr. Hulbert also complained about vision issues related to his headaches, AR 714, and dizziness, AR 730. Dr. Mir treated Mr. Hulbert's headaches through prescription medication and Botox injections. AR 704-745. Mr. Hulbert reported to Dr. Mir on June 21, 2017, that he “has trouble telling the difference between letters and numbers that look alike” while stressed at work, but he also stated that it has not affected his performance. AR 711. At the same visit, Dr. Mir prescribed Mr. Hulbert medication to deal with anxiety and referred Mr. Hulbert to a therapist. AR 711, 714. Dr. Mir's notes from his March 30, 2018 visit with Mr. Hulbert indicate that he started mental health treatment. AR 727, 730.

Mr. Hulbert agreed in 2018 that his memory issues mainly present when he is faced with stress. AR 719, 727. Dr. Mir further stated that Mr. Hulbert's “intermittent word finding difficulty is likely secondary to anxiety.” AR 722, 730. After working with a mental health professional, Mr. Hulbert stated on August 10, 2018, that his headache and memory issues improved. AR 734. From this point on, Heather Hall, Dr. Mir's Physician's Assistant, reported in subsequent appointments that his headaches were “stable” and noted the continued improvement connected to working with a mental health provider. AR 735-743. In January 2019, Ms. Hall reported to Hartford that Mr. Hulbert's headaches were “not disabling.” AR 1147-1148. In April 2019, Mr. Hulbert characterized his headaches as “tolerable.” AR 740.

2. 2018 Meetings with Laura Hanes

In 2018, Mr. Hulbert began to see Laura Hanes, a psychiatric nurse therapist, for “social phobia” and anxiety. AR 656-57. On July 20, 2018, at a medication management session with Ms. Hanes, Mr. Hulbert reported that he began having auditory hallucinations the day prior. Id. One month later, Mr. Hulbert suffered a mild concussion after tripping down three stairs and hitting his head. AR 1160. While in the hospital getting treatment for his...