Minutello v. Hartford Life & Accident Ins. Co.

964 F.Supp.2d 491

Theresa R. MINUTELLO, Plaintiff,

v.HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

No. 2:12–cv–01240.

United States District Court, W.D. Pennsylvania.

Aug. 12, 2013.

Gregory G. Paul, Morgan & Paul, PLLC, Sewickley, PA, for Plaintiff.

Brian P. Downey, Pepper, Hamilton & Scheetz, Harrisburg, PA, Stephanie K. Savino, Pepper Hamilton LLP, Pittsburgh, PA, for Defendant.

MEMORANDUM OPINION

TERRENCE F. McVERRY, District Judge.

The instant action involves a plan administrator's termination of long-term disability benefits previously paid to a plan participant over the course of ten years. Before the Court for disposition are the Defendant's MOTION FOR SUMMARY JUDGMENT ( ECF No. 18 ), the Defendant's Brief in Support of Motion for Summary Judgment ( ECF No. 19 ), the Defendant's Concise Statement of Material Facts ( ECF No. 20 ), the Plaintiff's MOTION FOR SUMMARY JUDGMENT ( ECF No. 23 ), the Plaintiff's Brief in Support of Motion for Summary Judgment ( ECF No. 22 ), the Plaintiff's Concise Statement of Material Facts ( ECF No. 24 ), the Defendant's Response in Opposition to the Plaintiff's Motion for Summary Judgment ( ECF No. 27 ), the Defendant's Response to the Plaintiff's Concise Statement of Material Facts ( ECF No. 28 ), and the Plaintiff's Response to the Defendant's Motion for Summary Judgment ( ECF No. 32 ). For the reasons that follow, the Defendant's Motion for Summary Judgment will be granted, and the Plaintiff's Motion for Summary Judgment will be denied.

I. Background

Plaintiff Theresa R. Minutello (“Minutello”) was born on February 13, 1960. ECF No. 17 at 1. In 1979, at the age of nineteen, she started to work as an Assistant Manager for the Holiday Inn. ECF Nos. 24 & 28 at ¶ 1. On December 22, 1986, Starwood Hotels & Resorts Worldwide, Inc. (“Starwood”), hired Minutello to work as an Assistant Banquet Manager. ECF Nos. 20 & 32 at ¶ 1.

Defendant Hartford Life and Accident Insurance Company (“Hartford”) administers a Group Benefit Plan (“Plan”) available to Starwood employees. ECF No. 17–2. The Plan provides long-term disability benefits to eligible employees pursuant to the terms of Group Insurance Policy GLT–673050 (“Policy”). Id. at 5. The language of the Policy that define the terms “disability” and “disabled” provides as follows:

Disability or Disabled means that during the Elimination Period and for the next 18 months you are prevented by:

1. accidental bodily injury;

2. sickness;

3. Mental Illness;

4. Substance Abuse; or

5. pregnancy,

From performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly Earnings are no more than 80% of your Pre-disability Earnings.

After that, you must be so prevented from performing one or more of the Essential Duties of Any Occupation.

Your failure to pass a physical examination required to maintain a license to perform the duties of Your Occupation does not alone mean that you are Disabled.

Id. at 25. The term “Your Occupation” is defined as a particular individual's “occupation as it is recognized in the general workplace,” and “does not mean the specific job [that he or she is] performing for a specific employer or at a specific location.” Id. at 28. The Policy defines the term “Any Occupation” as “an occupation for which [an individual is] qualified by education, training or experience,” and that has an “earnings potential” exceeding an amount calculated in accordance with specified terms. Id. at 24. Hartford has “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.” Id. at 17. As an employee of Starwood, Minutello participated in the Plan. ECF Nos. 20 & 32 at ¶ 2.

In June 2001, Minutello was examined by her family physician, Dr. Gurmit Singh, and her rheumatologist, Dr. Angela M. Stupi. ECF Nos. 20 & 32 at ¶ 7. She complained of fatigue, joint pain, myalgia, night sweats, exhaustion, and fevers. Id. Dr. Singh determined that Minutello was suffering from Mixed Connective Tissue Disease, Systematic Lupus Erythematosis (“SLE”), and Raynaud's Disease. Id. Minutello applied for long-term disability benefits on December 18, 2001, contending that she was “disabled” within the meaning of the Policy. Id. at ¶ 9. Her application was supported by a statement provided by Dr. Singh. Id.

Hartford approved Minutello's application for benefits. ECF Nos. 20 & 32 at ¶ 10. Maryann Iannettone (“Iannettone”), an Examiner for Hartford, communicated the approval to Minutello in a letter dated February 1, 2002. ECF No. 17–1 at 862–863. Although Minutello was deemed to be disabled because of her inability to perform the essential duties of her own occupation, Iannettone's letter explained that the more demanding “Any Occupation” standard would apply as of June 2, 2003. Id. at 863. Minutello was informed that, regardless of her condition, no benefits would be payable beyond February 12, 2027. Id. The amount of her monthly payment was set at $2,400.76. Id. at 864.

A participant seeking benefits under the Plan must apply for benefits under the Social Security Act [42 U.S.C. §§ 401–433, 1381–1383f] when the duration of his or her disability “meets the minimum duration required to apply for such benefits.” ¹ ECF No. 17–2 at 16. Minutello was instructed to apply for Social Security disability benefits if she had not already done so. ECF No. 17–1 at 863. In a decision rendered on February 17, 2002, the Social Security Administration (“SSA”) determined that Minutello had become statutorily “disabled” on June 1, 2001. Id. at 1093. She was advised that benefits under the Social Security Act would be forthcoming. Id.

After investigating Minutello's condition further, Hartford determined that she was “disabled” under the “Any Occupation” standard. ECF Nos. 20 & 32 at ¶ 12. Consequently, Minutello's benefits under the Plan continued beyond June 2, 2003. ECF No. 17–1 at 1061. On June 7, 2005, Minutello verified that nobody in her family had an alternative source of income or an interest in a business. Id. at 42. Between 2007 and 2009, Dr. Singh submitted annual statements to Hartford supporting Minutello's continued eligibility for benefits. ECF Nos. 20 & 32 at ¶ 14. Minutello periodically detailed her abilities and limitations in response to inquiries made by Hartford. Id. at ¶ 15.

At some point, Minutello complained of progressive memory problems. ECF Nos. 20 & 32 at ¶ 17. On October 21, 2009, Dr. Hassan Hassouri performed a neurological examination of Minutello to determine whether she was suffering from a memory impairment. Id. at ¶ 16. He recommended that neuropsychometric testing be conducted to ascertain any deficits that she may have had in specific areas. Id. An outpatient neuropsychological assessment was performed by Dr. Tad Gorske on March 2, 2010. Id. at ¶ 17. In most respects, the assessment yielded normal results. Id. at ¶ 18. Although Minutello's cognitive scores were consistent with those of patients suffering from autoimmune disorders, Dr. Gorske suggested that such cognitive difficulties were attributable to anxiety and depression. Id. at ¶ 19. A magnetic resonance imaging (“MRI”) scan was recommended to rule out intracranial pathology. Id. at ¶ 20. Dr. Gorske also advised Minutello to “seek out a course of psychotherapy to work on stress management.” Id. Minutello apparently declined to follow Dr. Gorske's recommendations. Id.

A participant's payments under the Plan must be decreased by any amounts received under the Social Security Act. ECF No. 17–2 at 10, 26. Minutello contacted Hartford personnel on March 17, 2010, to advise that her daughter, Jacqueline Minutello (“Jacqueline”), had reached the age of eighteen and would soon graduate from high school. ECF No. 17–1 at 43; ECF Nos. 24 & 28 at ¶ 11. These developments evidently decreased the amount of Minutello's payments from the SSA, requiring Hartford to increase the amount of her long-term disability benefits under the Plan. Id. On May 18, 2010, the SSA sent Hartford a fax confirming the change in Minutello's benefits under the Social Security Act. ECF No. 17–1 at 43.

Minutello's file was referred to Hartford's Special Investigations Unit (“SIU”) on May 27, 2010. ECF Nos. 24 & 28 at ¶ 13. Hartford's documentary record of the referral reads as follows:

Siu Referral: Clmt adv HIG on 6/7/2005 that her and her family do not have any income or interest in any business. Internet research shows that clmt's spouse possibly owns Minutello's Restaurant and Lounge. This is possibly the restaurant/lounge that clmt worked at prior to her employment w policy holder. All APS in file are exactly the same. When prior examiner's called to speak to clmt ... clmt is very hard to reach. mj

ECF No. 17–1 at 42. The notation was recorded by Maurice R. Jones (“Jones”), who worked as an Examiner for Hartford. Id. Further internet research apparently led Hartford's investigators to believe that Minutello was a shareholder of Allou Services Corporation, which operated out of the same location as the restaurant mentioned in Jones' notation. ECF Nos. 20 & 32 at ¶ 22. Hartford's suspicions were increased by the fact that Minutello was difficult to reach at home. Id. at ¶ 23.

Minutello was placed under video surveillance during the summer of 2010. ECF Nos. 20 & 32 at ¶¶ 25–32. Videotaped footage taken on June 9, 2010, and July 20, 2010, depicted Minutello walking without assistance, shopping on her own, and carrying bags of groceries. Id. at ¶¶ 26, 29–31. Additional footage taken on July 19, 2010, depicted Minutello and her daughter lifting a large desk from a van and carrying it into their garage. Id. at ¶ 28. Minutello was shown engaging in these activities in a free and agile manner. Id. at ¶ 32.

James M. Fitzgerald (“Fitzgerald”), a Hartford representative, interviewed Minutello in her home on November 29, 2010. ECF No. 17 at 47–67. Although Minutello confirmed...