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Turner v. Hartford Life & Accident Insurance Co.

United States District Court, N.D. Mississippi, Greenville Division

March 10, 2017




         Hartford Life & Accident Insurance Company terminated Timothy L. Turner's long term disability benefits based on its determination that Turner was able to perform a job with comparable pay commiserate with his functional capabilities. Following an unsuccessful appeal to Hartford, Turner initiated this suit against Hartford, alleging a wrongful denial of benefits under the Employee Retirement Income Security Act. Turner and Hartford have filed cross-motions for summary judgment, both of which, at the parties' request, this Court interprets as motions for judgment on the record. Because the Court finds Hartford's termination of Turner's benefits supported by substantial evidence and not arbitrary and capricious, the Court may not overturn Hartford's decision to terminate Turner's disability benefits.


         Procedural History

         On June 26, 2015, Timothy L. Turner filed a complaint in this Court against Hartford Life & Accident Insurance Company (“Hartford”), asserting three claims under the Employee Retirement Income Security Act (“ERISA”): (1) wrongful denial of benefits; (2) breach of fiduciary duty; and (3) intentional interference with ERISA rights. Doc. #1. On July 28, 2015, Turner amended his complaint as of right. Doc. #6. The amended complaint asserts only a single ERISA claim - wrongful denial of benefits. Id.

         On April 12, 2016, Hartford moved for summary judgment on Turner's remaining claim. Doc. #24. The same day, Turner filed a cross-motion for summary judgment. Doc. #27. On April 22, 2016, Turner filed an unopposed motion seeking an extension of the deadline to respond to Hartford's summary judgment motion. Doc. #29.

         On April 26, 2016, Hartford responded in opposition to Turner's summary judgment motion and filed a motion to strike certain exhibits attached to it. Doc. #30; Doc. #32. Two days later, this Court denied Turner's motion for an extension.[1] Doc. #33. Turner responded in opposition to Hartford's summary judgment motion on May 2, 2016, [2] Doc. #35, but did not respond to the motion to strike. Hartford replied in support of its summary judgment motion on May 9, 2016. Doc. #39.

         On August 11, 2016, the parties, after consultation with United States Magistrate Judge Jane M. Virden, submitted to the Court a proposed pretrial order which waives the right to trial and asks the Court to convert the cross-motions for summary judgment to motions for judgment on the record. See Doc. #43. The Court approved and entered the pretrial order on March 10, 2017. Doc. #44.


         Motions for Judgment on the Record

         The parties have asked the Court to treat the cross-motions for summary judgment as motions for judgment on the administrative record. A “motion for judgment on the administrative record” is “a motion that does not appear to be authorized in the Federal Rules of Civil Procedure.” Muller v. First Unum Life Ins. Co., 341 F.3d 119, 124 (2d Cir. 2003) (internal quotation marks omitted). However, “it may be appropriate for the district court to treat such a motion as requesting essentially a bench trial on the papers with the District Court acting as the finder of fact. In that scenario, the district court may make factual findings, but it must be clear that the parties consent to a bench trial on the parties' submissions.” O'Hara v. Nat'l Union Fire Ins. Co. of Pitt., 642 F.3d 110, 116 (2d Cir. 2011) (internal quotation marks and citations omitted).

         It is clear the parties here have consented to a bench trial on their submissions based on the pretrial order submitted. Accordingly, the Court will treat the parties' motions for summary judgment as motions for judgment on the record and will decide them as the finder of fact.


         Factual Background

         A. The Group Long-Term Disability Policy

         Turner is an approximately 48-year old male who was employed in the security and alarms business from 1994 until 2011. AR-308, 743.[3] During the time period relevant to this suit, Tyco International Management Company maintained a Group Long-Term Disability Policy (“Policy”) through Hartford applicable to Turner. Id. at 001.

         Under the terms of the Policy, Hartford had “full discretion and authority to make an initial determination and interpretation of the terms and provisions of The Policy.” Id. at 030.

         Of relevance here, the Policy includes the following provisions:

Disability Benefit: What are my Disability Benefits under the Policy?
We will pay You a Monthly Benefit if You:
1) become Disabled while insured under The Policy;
2) are Disabled throughout the Elimination Period;
3) remain Disabled beyond the Elimination Period; and
4) submit Proof of Loss to Us.
Termination of Payment:
When will my benefit payments end?
Benefit payments will stop on the earliest of:
1) the date You are no longer Disabled;
2) the date You fail to furnish Proof of Loss;
3) the date You are no longer under the Regular Care of a Physician;
Any Occupation means any occupation for which You are qualified by education, training or experience, and that has an earnings potential greater than the lesser of:
1) the product of Your Indexed Pre-disability Earnings and the Benefit Percentage; or
2) the Maximum Monthly Benefit.
Disability or Disabled means You are prevented from performing one or more of the Essential Duties of:
1) Your Occupation during the Elimination Period;
2) Your Occupation, for the 24 month(s) following the Elimination Period, and as a result Your Current Monthly Earnings are less than 80% of Your Indexed Pre-disability Earnings; and
3) after that, Any Occupation.
Essential Duty means a duty that:
1) is substantial, not incidental;
2) is fundamental or inherent to the occupation; and 3) cannot be reasonably omitted or changed.
Your ability to work the number of hours in Your regularly scheduled work week is an Essential Duty.
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 022, 024, 030-031, 034.

         B. Turner's Initial Health Problems

         In May 2005, Turner underwent cervical spine surgery. Id. at 360. Following surgery, Turner developed moderate paresis of the right true vocal cord. Id. On June 9, 2006, Turner was seen by John Schweinfurth, M.D., for a follow-up of the right true vocal cord paresis. Id. Schweinfurth observed that the vocal cord paresis had resolved but noted that Turner had “problems with inflammation of both vocal cords.” Id. at 361. At a follow-up appointment three weeks later, Schweinfurth diagnosed Turner with dysphonia, “likely secondary to right vocal strain and synkinesis.” Id. at 362. Approximately one month later, on July 25, 2006, Turner returned to Schweinfurth. Id. at 365. Schweinfurth found that Turner “seems to be doing well at this point and progressing well. We will have him follow up in our clinic on as needed basis.” Id.

         On February 22, 2008, Turner was evaluated by Rahul Vohra, MD, based on “complaints of back pain and intermittent bilateral leg tingling.” Id. at 645-46. Turner saw Vohra throughout 2008 and, sometime between October 31, 2008, and January 15, 2009, underwent surgery and decompression on his back. Id. at 638-646. On January 15, 2009, Vohra observed that Turner “is doing significantly better from a radicular perspective status post lumbar decompression.” Id. at 638. Throughout 2009 and into 2010, Turner returned to Vohra with a variety of complaints, including neck pain, back pain, leg pain, and depression. Id. at 631-38.

         C. Long Term Disability Approval

         In 2010, Turner held the position of a Rep-Core Account Executive with Tyco. AR- 861. On April 6, 2010, Turner presented to Vohra with “increasing neck and back pain.” Id. at 631. Turner reported to Vohra that “[h]e drives a great deal at work and … has had significant difficulty with this.” Id. Turner told Vohra that “[h]e stopped working about two weeks ago.” Id.

         On June 18, 2010, Turner returned to Vohra complaining “of neck pain as well as low back pain.” Id. at 865. A month later, on July 16, 2010, he presented to Vohra with “axial cervical pain, lumbar pain, and rare tingling in both feet.” Id. at 863. Vohra observed diminished lumbar range and reflexes, and completed a “Release to Return to Work Status: Short Term Disability” form stating that Turner was not released to return to full duty or light duty. Id. at 864. Sometime later, Turner began receiving short term disability benefits. Id. at 242.

         In August 2010, Turner contacted Hartford about obtaining long term disability (“LTD”) benefits. Id. at 150. However, on October 4, 2010, Turner informed Hartford that he had been cleared to return to work with no formal restrictions or limitations. Id. at 148. The same day, Hartford denied Turner's application for long term disability. Id. at 236-38.

         On October 7, 2010, Turner reopened his long term disability claim. Id. at 141. Hartford approved the claim on December 9, 2010. Id. at 232-34. The approval lists a disability date of April 7, 2010, and an effective date of October 30, 2010. Id. at 235.

         D. First Functional Evaluation and Award of Social Security Benefits

         On August 5, 2011, Vohra, at Hartford's request, completed an “Attending Physician's Statement of Functionality” (“APS”) for Turner. AR-718. In the APS, Vohra noted that Turner: (1) could “rarely” lift/carry up to ten pounds; (2) could never lift or carry anything heavier than ten pounds; (3) could never bend at the waist, kneel, or crouch; (4) could occasionally drive; (5) could never reach above the shoulder or below the waist; and (6) could occasionally (defined as 1-33%) finger/handle. Id. at 717. The APS reported that Turner did not suffer from a psychiatric/cognitive impairment. Id. at 716.

         On November 10, 2011, Turner attended a follow-up appointment with Vohra, during which Vohra observed that Turner “continues to have moderate cervical paraspinal spasm with diminished cervical range of motion.” Id. at 586. Vohra noted that Turner reported increasing pain with the change in weather but an improvement in his depression symptoms, which he believed to be due to counseling. Id. Turner informed Vohra that he was attending his children's ballgames and was “going for a walk everyday.” Id.

         On January 31, 2012, the Social Security Administration found Turner to be entitled to monthly disability benefits based on a disability which began April 3, 2010. Id. at 677.

         On March 1, 2012, Turner returned to Vohra. Id. at 585. Turner reported attending counseling and taking hydrocodone and Zoloft. Id. Vohra noted that Turner's “functional level is very good” but that “occasionally, … [Turner] will have to significantly limit his activities secondary to neck pain.” Id. Turner informed Vohra that “[d]riving still consistently causes significant pain.” Id. Vohra concluded that Turner was “stable” and was “doing well from the standpoint of his depression with the Zoloft and his pain is well controlled with the hydrocodone.” Id.

         On March 12, 2012, Vohra submitted to Hartford an “Attending Physician's Statement of Continued Disability.” Id. at 662-63. The statement contains the same restrictions set forth in Vohra's August 5, 2011, assessment, including the conclusion that Turner does not suffer from a cognitive or psychiatric impairment. Id. On March 27, 2012, Hartford wrote to Vohra to ask him to “explain the medical reasoning that [Turner] is only able to reach occasionally at waist/desk level and do occasional fingering and handling.” Id. at 659. Vohra responded, “[Turner] has had a 2 level fusion & anterior ... plate lumbar discectomy.” Id.

         On March 21, 2012, Turner, who was complaining of left knee pain, was examined by Michael G. Holman, MD. Id. at 566-68. Holman found that Turner had “[f]ull range of motion bilaterally but ... limited flexion, ” and noted that the symptoms were “highly suggestive of meniscus tear or a loose body in the knee.” Id. at 567. Holman prescribed an NSAID and use of a brace. Id.

         E. May 3, 2012, Letter and Subsequent Review

         On May 3, 2012, Hartford sent Turner a letter stating, in relevant part:

Your LTD benefits became effective on 10/30/2010. Effective 10/30/2012 you must be considered Disabled as outlined in the second portion of the above definition in order to continue to be eligible for LTD benefits.
Please be advised that this office has initiated a review to determine if you will qualify for benefits on and after 10/30/2012. When we have completed our review, we will notify you regarding our determination.


         Later that month, on May 30, 2012, Turner underwent an MRI on his right knee. Id. at 570. The MRI revealed a “[t]ear of the posterior horn of the medial minisicus” and “[s]ignificant degenerative changes of the patellofemoral joint with joint space narrowing, cartilage loss, and osteophyte formation.” Id.

         On July 20, 2012, Turner presented to Holman with “[p]ainful triggering in the right thumb, ” which Holman attributed to tendonitis. Id. at 557. Holman performed an injection on Turner's thumb and made an appointment for Turner to undergo surgery. Id. at 558.

         On September 28, 2012, Hartford sent Turner a letter stating, in relevant part, that he was determined to have met “the policy definition of Disability and that you will continue to ...

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