Abate v. Hartford

• Decision Date: 27 July 2006
• Docket Number: Civil Action No. 1:05-CV-690.
• Citation: 471 F.Supp.2d 724
• Parties: Ronnie ABATE, Plaintiff, v. The HARTFORD, Equiva Services, LLC, and Equiva Services Long Term Disability Plan, Defendants.
• Court: U.S. District Court — Eastern District of Texas

471 F.Supp.2d 724

Ronnie ABATE, Plaintiff, v. The HARTFORD, Equiva Services, LLC, and Equiva Services Long Term Disability Plan, Defendants.

Civil Action No. 1:05-CV-690.

United States District Court, E.D. Texas.

July 27, 2006.

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John Gerard Werner, Reaud Morgan & Quinn LLP, Beaumont, TX, for Plaintiff.

Lisa Kim Basinger, Wilson Grosenheider Morre & Jacobs, Austin, TX, for Defendants.

MEMORANDUM AND ORDER

CRONE, District Judge.

Pending before the court are Defendant The Hartford's ("Hartford") Motion for Summary Judgment (# 46) and Motion to Strike Plaintiffs Summary Judgment Evidence ("Motion to Strike") (# 49) as well as Plaintiff Ronnie Abate's ("Abate") Motion for Summary Judgment (# 47) and Motions to Supplement the Administrative Record (# 43-# 45). Hartford moves for summary judgment on Abate's claim that its decision to terminate payment of his long term disability benefits constituted an abuse of discretion. Abate also seeks summary judgment on his claim that Hartford abused its discretion in terminating his benefits in violation of the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-4461 ("ERISA"). Having reviewed the pending motions, the submissions of the parties, the pleadings, and the applicable law, this court is of the opinion that Hartford's Motion for Summary Judgment should be denied, Hartford's Motion to Strike should be denied, Abate's Motions to Supplement the Administrative Record should be granted, and Abate's Motion for Summary Judgment should be denied as premature in light of the remand of this case to the plan administrator.

I. Background

Abate, age fifty-eight, worked as a pipe fitter/machinist for approximately thirtyfive years. Through his employment with Equiva Services, LLC ("Equiva"), Abate participated in the Equiva Services Long Term Disability Plan ("LTD Plan"). The LTD Plan, which qualifies as an "employee welfare benefit plan" subject to ERISA, is administered by Hartford.

While in the course and scope of his employment as a mechanic for Equiva, Abate sustained a posterior medial meniscus tear of the left knee. He filed a claim for long term disability benefits under the LTD Plan in May 2003. From approximately June 4, 2003, through June 3, 2005, Abate was deemed disabled pursuant to the "Your Job" provision of the plan's group insurance policy and received benefits. Specifically, the policy language defining "disabled" during the initial twentyfour month period states that the plan participant must be prevented by accidental bodily injury "from performing one or more of the Essential Duties of Your Own Job or a reasonable alternative offered to you by the Employer, and as a result your Current Monthly Earnings are less than 100% of your Indexed Pre-Disability Earnings.

Hartford terminated Abate's disability benefits in June 2005 as the result of Hartford's utilization of an alternative definition of disabled, which applies after the initial twenty-four month period expires. In order to continue receiving benefits under the alternative definition, i participant must be "prevented from performing one or more of the Essential Duties of Any Job." "Any Job" is defined in the policy as "a job for which you are qualified by education, training or experience, and that has an earnings potential greater than an amount equal to the lesser of 60% of your Indexed Pre-disability Earnings and the Maximum Monthly Benefit shown in the Schedule of Insurance." In reaching its determination that Abate did not qualify as disabled under the "Any Job" definition, Hartford conducted an Employability Analysis ("EA"). The EA identified three occupations for which Abate was qualified and which had an earnings potential ranging from 62% to 74% of his pre-disability earnings. These occupations were belt repairer, tool repairer, and repairer of hand tools.

As part of the EA, Hartford utilized the Occupational Access System ("OASYS"), a computerized job matching program, to evaluate Abate's capabilities. This program, which analyzes an employee's knowledge, assets, and skills in relation to attaining a job with an earnings potential of at least 60% of the employee's previous salary, requires manual transcription of the employee's relevant information by a rehabilitation case manager ("case manager"). Plaintiff contends that OASYS is a flawed system which produces inaccurate evaluations. Abate alleges that when his case manager, Charysse Chapman-Black ("Chapman-Black"), was inputting his data, she overlooked relevant information and failed to utilize the medical history and records that were available to her. Moreover, Abate asserts that OASYS treated any category receiving the default entry of "Unknown" as though it contained an entry of "Frequently." The "Frequently" code purportedly means that the employee is more than able to perform the given task.

In the instant action, Plaintiff alleges that Chapman-Black, discounted the impact of his carpal tunnel syndrome on his job capabilities when entering his information into the data system. Specifically, Abate contends that OASYS interpreted Chapman-Black's entry of "Unknown" for the categories of reaching, handling, and fingering to mean that Abate was more than able to perform these particular skills, when, in reality, such tasks were difficult for him to perform, due to his carpal tunnel syndrome. According to Plaintiff, a proper input of Abate's data would have prevented him from meeting the standards for belt repairer, tool repairer, and repairer of hand tools, the only three job titles proposed by Hartford for Abate which meet the potential earnings criteria. Therefore, Abate claims that a correct entry of his information into OASYS would have excluded him from any of the jobs that meet the 60% benchmark, thus qualifying him for long term disability benefits.

In a letter to Hartford dated June 6, 2005, Abate appealed the termination of his disability benefits. On July 27, 2005, Hartford upheld its previous decision to terminate Abate's long term disability benefits under the "Any Job" provision of the policy. In response to the termination of his benefits, Abate secured counsel in August 2005. Abate subsequently retained Dr. Carl Hansen ("Dr.Hansen"), a specialist in vocational evaluation, to conduct an analysis of his earning capacity. In his report, dated September 12, 2005, Dr. Hansen concluded that Abate "did not have the capacity as based on the adopted methodology in the field of vocational rehabilitation to return to employment at the wage level of 60% of his former wage earning ability."

On September 14, 2005, Dr. Hansen's evaluation of Abate was sent to Hartford. Hartford, however, returned the documents to Abate's attorney, stating that "the administrative remedies provided by ERISA and the plan have been exhausted. There are no provisions for additional appeals or re-opening the administrative record after a final appeal determination. Therefore, we are returning the additional information submitted."

Abate filed suit in this court against Hartford, Equiva, and the LTD Plan on October 21, 2005, alleging Hartford abused its discretion in administering the benefits plan. Hartford filed a Motion to Dismiss and an Original Answer on November 21, 2005, asserting that the termination of Abate's long term disability benefits was not arbitrary and capricious and did not constitute an abuse of discretion. On December 20, 2005, Abate filed his Amended Complaint, contending that Hartford's, denial of his claim, both in June 2005 and September 2005, constituted an abuse of discretion. Equiva and the LTD Plan were voluntarily dismissed from this case on February 14, 2006. Hartford's Third Amended Answer was deemed filed on May 17, 2006.

Between May 31, 2006, and June 1, 2006, Abate filed a Motion, Amended Motion, and Second Amended Motion to Supplement the Administrative Record and an Objection to Defendant's Submission of Administrative Record. In these motions, Abate objects to Hartford's submission of the administrative record on the ground that it fails to include the report of Dr. Hansen. Hartford, in its response, states that Dr. Hansen's report was not part of the administrative record before Hartford when it made its final decision on July 27, 2005, to uphold the termination of benefits under the "Any Job" provision of the policy. Therefore, Hartford contends that Dr. Hansen's report should be excluded from this court's review of the case. Hartford, in its Motion to Strike, filed June 9, 2006, request§ that Plaintiffs Exhibits E and F be stricken as summary judgment evidence. On June 1, 2006, Abate and Hartford each filed motions for summary judgment. Abate requests that Hartford provide him with long term disability benefits retroactive to the termination date of June 4, 2005, or in the alternative, that the case be remanded to Hartford for consideration of Dr. Hansen's report. Hartford, on the other hand, seeks dismissal of the lawsuit and any further relief.

II. Analysis

A. Standard for Summary Judgment

Rule 56(c) of the Federal Rules of Civil Procedure provides that summary judgment "shall be rendered forthwith if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." FED. R.Civ.P. 56(c). The party seeking summary judgment bears the initial burden of informing the court of the basis for its motion and identifying those portions of the pleadings, depositions, answers to interrogatories, admissions on file, and affidavits, if any, which it believes demonstrate the absence of a genuine issue of material fact. See Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48, 106...