Snyder v. Hartford Life Ins. Co.

DONA SNYDER, Plaintiff, v. HARTFORD LIFE INSURANCE COMPANY Defendant.

Civil Action No. 13-461-SLR-SRF

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE

September 18, 2015

REPORT AND RECOMMENDATION

I. INTRODUCTION

On March 21, 2013, Dona Snyder ("Plaintiff" or "Snyder"), filed this action against Hartford Life Insurance Company¹ ("Defendant" or "Hartford") pursuant to the Employment Retirement Income Security Act of 1974 ("ERISA") 29 U.S.C. § 1001 et seq. (D.I. 1) Hartford entered into a contract with Hilb, Rogal & Hobbs ("HRH") to provide Long Term Disability ("LTD") benefits for HRH employees. (D.I. 16 at 8; D.I. 20 at 760) HRH employed Snyder. (D.I. 20 at 699) Snyder received LTD benefits effective November 5, 2008 through September 30, 2012. (Id. at 84, 19, 255) Snyder claims that Hartford's termination of her LTD benefits as of September 30, 2012 was arbitrary and capricious. (D.I. 1 at 5-6) Currently before the court are the parties cross motions for summary judgment. (D.I. 16; D.I. 18)

The court has jurisdiction pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e). For the reasons set forth below, I recommend that the court deny Snyder's motion for summary judgment and grant Hartford's motion for summary judgment.

II. BACKGROUND

A. Plan Details

Snyder began working as director of commercial lines for HRH on October 18, 2004. (D.I. 20 at 699) In 2007, HRH contracted with Hartford for a policy ("the Plan") pursuant to which Hartford would fund and administer claims for LTD benefits. (D.I. 16 at 7-8; D.I. 24 at 1; D.I. 20 at 760, 783-84) The Plan grants Hartford "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy." (D.I. 20 at 783) While the Plan is paid for by HRH, all eligibility decisions are made by Hartford. (Id. at 784)

To qualify for LTD benefits under Hartford's LTD plan, a plan participant must be considered "disabled" under the Plan. (Id. at 765) To be considered "disabled," a plan participant must be "prevented from performing one or more of the Essential Duties of: 1) Your Occupation during the Elimination Period; and 2) Your Occupation following the Elimination Period, and as a result Your Current Monthly Earnings are less than 80% of Your Indexed Pre-disability Earnings." (Id. at 774) "Your Occupation means Your Occupation as it is recognized in the general workplace. Your Occupation does not mean the specific job You are performing for a specific employer or at a specific location." (Id. at 778) Under the Plan, LTD benefits will terminate upon a number of factors, including when the plan participant is considered no longer "disabled." (Id. at 766-67)

If benefits are terminated, a claimant maintains the right to appeal that decision. (Id. at 786-87) Hartford is required to review on appeal "all comments, documents, records and otherinformation submitted by [a plan participant] relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination." (Id.) On appeal, any adverse benefit determination is final and must be in writing. (Id. at 787)

Snyder submitted evidence establishing "disability" under the Plan from May 9, 2008 through September 30, 2012. (Id. at 81-84, 19-23, 255) Snyder was deemed disabled under the Plan as of May 9, 2008, based on her treating physicians' diagnoses which included fatigue and panhypopituitarism.² (Id. at 81-82) Snyder began receiving LTD benefits under the Plan effective November 5, 2008, following the policy elimination period.³ (Id. at 84) Snyder's gross monthly salary at the time of her disability was $8,791.67. (Id.) The Plan provides for payment of sixty percent of an employee's salary, less certain offsets such as Social Security Disability. (Id. at 81) Snyder was approved for Social Security Disability benefits in June 2009. (Id. at 6)

B. Factual Background and Medical History

The present dispute concerns Snyder's claim for benefits under the Plan from September 30, 2012, to date. (D.I. 16; D.I. 18) Hartford notified Snyder by letter dated September 20, 2012, of the termination of her LTD benefits.⁴ (D.I. 20 at 19-24) Snyder pursued an appeal of the termination of benefits through a letter dated October 2, 2012. (Id. at 252-66) In a letter datedNovember 16, 2012, Hartford denied Snyder's appeal and notified her of the exhaustion of her administrative remedies. (Id. at 1-7)

1. Director of Commercial Lines

Snyder was continuously and actively employed as a director of commercial lines for HRH beginning October 18, 2004, through May 9, 2008. (Id. at 84, 699, 918) A physical demand analysis completed by Snyder's supervisor, Ann F. Cool, stated that a director of commercial lines position would require a person to be able to work eight hours a day, five days a week. (Id. at 695-97) The physical demands require a person be able to sit six hours at a time for a total of six hours per day, stand a half hour at a time for a total of one hour per day, walk one hour at a time for a total of one hour per day, and have the ability to alternate sitting and standing as needed. (Id.) The position requires frequent fingering⁵ sixty percent of the time, occasional airplane travel one percent of the time, and driving two percent of the time. (Id. at 696) The essential duties included evaluating and managing staff, attending weekly meetings with managers and co-employees concerning company goals and quality of service, directing marketing, monitoring work flow, and coordinating sales, marketing, and customer service. (Id. at 697)

On November 11, 2010, an Occupational Analysis report was completed by vocational rehabilitation case manager ("RCM"), Marvin K. Bryant. (Id. at 153) The RCM compared the essential duties and corresponding physical demands, environmental conditions, and non-exertional requirements of a director of commercial lines with HRH against the requirements of a Sales Manager as defined and classified in the Dictionary of Occupational Titles ("DOT"). (Id.) The essential duties of a director of commercial lines include planning and administering salespolicies and programs to accounts. (Id.) The RCM could not compare the physical demands of a director of commercial lines, as there were no physical demands noted in the job description he reviewed. (Id.) Environmental conditions required working in moderate noise. (Id.) Non-exertional requirements included "directing, controlling, planning, dealing with people, coordinating, computing, compiling, copying, comparing, supervising, serving, taking instructions-helping, speaking-signaling, negotiating, etc." (Id.)

Based on the nature of the job, the RCM concluded that the essential duties, environmental conditions, and non-exertional requirements of a director of commercial lines and a sales manager are generally equal. (Id.) Although the physical demands could not be compared, the RCM noted that the DOT indicates the occupation of a sales manager is sedentary and requires occasional reaching, frequent handling, fingering, talking, hearing and near acuity. (Id.)

In her appeal letter on October 2, 2012, Snyder informed Hartford that her job as director of commercial lines at HRH included additional duties not listed in the September 20, 2012 denial letter. (Id. at 256) Those additional duties consisted of traveling twenty percent of the time, public speaking fifteen percent of the time, and working over fifty hours per week on a consistent basis. (Id.)

2. Snyder's Medical History

Snyder is presently 60 years old. (Id. at 889) In March of 1988, Snyder had surgery for a non-secreting pituitary tumor. (Id. at 258) Since the time of the surgery, Snyder has suffered from panhypopituitarism and diabetes insipidus. (Id. at 258-65) The symptoms Snyder complains ofinclude panhypopituitarism, IgG deficiency,⁶ urinary tract infections, osteoarthritis, irritable bowel syndrome, fatigue, weakness, depression, and anxiety. (Id.) These symptoms rendered Snyder "disabled" under the Plan in May of 2008, and she received LTD benefits from Hartford terminating on September 30, 2012. (Id. at 81-84, 19, 255)

On May 9, 2008, Snyder stopped working and was examined by her primary physician, Eva Geracimos, M.D., for symptoms of fatigue and dehydration. (Id. at 899) From May 2008 through the Fall of 2008, Dr. Geracimos identified Snyder's primary diagnosis as fatigue with a secondary diagnosis of panhypopituitarism. (Id. at 649, 647, 645, 644, 642, 641) Snyder's additional diagnoses included diabetes mellitus and diabetes insipidus. (Id.) In response to these diagnoses, Dr. Geracimos imposed varying restrictions ranging from near immobility to relaxed restrictions allowing Snyder to work part-time. (Id. at 650, 877)

On October 9, 2008, Snyder met with Steven M. Dellose, M.D., an orthopedist, regarding knee pain. (Id. at 854) X-rays taken revealed end-stage osteoarthritis in Snyder's right knee and less severe osteoarthritis in her left knee. (Id.)

On December 9, 2008, Snyder was admitted to the hospital for a period of three days due to nausea, vomiting, and diarrhea. (Id. at 845)

On January 13, 2009, Hartford approved Snyder's claim for LTD benefits with an effective date of November 5, 2008. (Id. at 81-84)

On January 18, 2010, Snyder visited Dr. Geracimos with symptoms of fatigue, swelling in her extremities, and changes in her bowels. (Id. at 521) Snyder again visited Dr. Geracimos onApril 12, 2010. (Id. at 517) Snyder reported a brief illness while traveling, but her condition had stabilized. (Id.) On May 17, 2010, Snyder saw Dr. Geracimos due to suffering a bout of diarrhea for the previous three weeks, weakness, and weight loss. (Id. at 515)

On July 19, 2010, Snyder was admitted to the hospital with symptoms of dehydration, diarrhea, hypopituitary issues, and diabetes insipidus. (Id.at 584) During her hospital stay, Snyder was seen by Ragu Sanjeev, M.D., Amy Wachter, M.D., and ...