McCulloch v. Hartford Life and Acc. Ins. Co.
| Decision Date | 28 March 2005 |
| Docket Number | No. 3:01 CV 1115(AHN).,3:01 CV 1115(AHN). |
| Citation | 363 F.Supp.2d 169 |
| Parties | Candi MCCULLOCH, Plaintiff, v. HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY and Educators Mutual Life Insurance Company, Defendants. |
| Court | U.S. District Court — District of Connecticut |
John P. Clifford, Jr., Eliot B. Gersten, Gersten & Clifford, Hartford, CT, for Plaintiff.
Barry Chasnoff, Jessica Spangler Taylor, Roberta J. Sharp, Akin, Gump, Strauss, Hauer & Feld, San Antonio, TX, Charles Francis Gfeller, Donald E. Frechette, William E. Murray, Edwards & Angell, Hartford, CT, Joshua Laurence Milrad, Mound, Cotton, Wollan & Greengrss, New York City, Keith D. Post, William J. Gallwey, III, Gillman Curtis & Vento, Miami, Fl, for Defendants.
OMNIBUS RULING ON PENDING SUMMARY JUDGMENT MOTIONS
Plaintiff Candi McCulloch ("McCulloch") commenced this action against Hartford Life Insurance Company ("Hartford") and Educators Mutual Life Insurance Company ("Educators"), alleging breach of contract, bad faith, tortious interference with contractual relations, and statutory violations under the Connecticut Unfair Trade Practices Act ("CUTPA"), Conn. Gen.Stat. § 42-110b, and the Connecticut Unfair Insurance Practices Act ("CUIPA"), Conn. Gen.Stat. § 38a-816.
Pending before the court are: 1) Hartford's motion for partial summary judgment; 2) Educator's motion for summary judgment; 3) McCulloch's motion for summary judgment motion as to Hartford's counterclaim; 4) McCulloch's motion for summary judgment motion on her claim against Educators. For the following reasons, Hartford's motion as to McCulloch [doc. # 136] is granted; Educators's motion as to McCulloch [doc. # 133] is granted in part and denied in part; McCulloch's motion as to Hartford's counterclaim is denied [doc. # 183]; McCulloch's motion as to Educators is denied [doc. # 186].
Based on its review of the summary judgment record, the court finds the following material facts are not in dispute:
McCulloch is a physician with a specialty in internal medicine. Prior to becoming disabled, she worked 16 hours per week practicing medicine as an internist and 30 hours per week as the administrative director at a women's clinic in Florida.
In September 1994, McCulloch purchased disability insurance from Educators under a group plan through the American College of Physicians ("ACP"). Under the policy, McCulloch was entitled to long-term disability benefits of $7,000 per month if she, among other things, became unable to perform the substantial duties of her occupation as they existed at the time a disability began. McCulloch also purchased a disability insurance policy from Unum Life Insurance Company ("Unum").
In October 1995, McCulloch stopped working due to chronic shoulder and neck pain caused by a February 1995 skiing accident. She applied for long-term disability benefits under both the Educators and Unum policies. Unum denied McCulloch's claim but Educators accepted it.
Three provisions of the Educators policy are pertinent here. First, McCulloch was entitled to receive long term disability benefits so long as she remained totally disabled1 and was under 65 years of age. Second, the policy's "PROOF OF LOSS" provision requires McCulloch to provide "[l]ater proofs of the continuance of [her] disability ... at such intervals as [Educators] ... reasonably require[d]." Third, the policy's "EXAMINATION" provision gives Educators "the right to examine, at [its] own expense, any person whose injury ... is the basis of a claim ... when and as often as it may [be] reasonably require[d] while a claim is pending." Pursuant to those provisions, McCulloch continually submitted evidence to Educators showing that she remained disabled, including attending physician statements, independent medical evaluations, and independent medical reviews.
On April 15, 1997, the ACP terminated its relationship with Educators. As a result, Educators stopped underwriting and accepting premiums for professional disability policies. Nonetheless, it continued to administer the open ACP disability claims which, including McCulloch's, numbered approximately 35.
In July or August of 1999, Educators assigned the open ACP claims to Hartford in a document titled "Reinsurance Agreement." In addition, Educators transferred approximately $30 million of reserve funds to Hartford in exchange for an undisclosed amount of money. Under the terms of the reinsurance agreement, Hartford would administer and make benefit payments on the open claims from the statutory reserves that had been set aside for them. However, if the total amount of benefits to which all the claimants were entitled exceeded the total amount of reserves, Hartford would be liable for the excess amount. Conversely, if the total amount of benefit payments was less than the total amount of reserves for all the open claims, Hartford would retain the balance.2 Approximately $1.3 million dollars in statutory reserves were transferred to Hartford for McCulloch's claim.
Following the execution of the reinsurance agreement, both Educators and Hartford informed McCulloch and the approximately 35 other claimants whose claims were subject to the agreement that Hartford would be administering their disability claims. In its letter to McCulloch, Educators explained that it would continue to pay her benefits until October 31, 1999, and that after that date, benefit payments and correspondence would be "[a]dministered by Hartford on Behalf of Educators Mutual Life Co."
Sometime in November or December 1999, a claims examiner at Hartford, Susan Wilk ("Wilk"), reviewed McCulloch's disability claim. On December 15, 1999, Wilk requested McCulloch to provide an up-to-date attending physician statement ("APS"), complete both a claimant questionaire and a personal profile evaluation, and authorize Hartford to obtain medical information from her doctors. On January 19, 2000, Wilk received the authorization and claimant questionaire from McCulloch, but not the physician statement or personal profile.
In the claimant questionaire, McCulloch described her condition as "chronic pain from neck pathology [with] ... herniation at C5-C6." She stated that the "pain affects every aspect of my life [and] ... makes me unable to perform the duties of my specialty of internal medicine [and] ... restricts me in all activities." McCulloch also provided a list of the medical-care providers that she had consulted in the previous 18 months, including her primary care physician, Dr. Carine Porfiri ("Dr.Porfiri"); a neurosurgeon, Dr. Beverly Walters ("Dr.Walters"); and a chiropractor, Bruce Coulombe ("Coulombe").
On January 28, 2000, Wilk telephoned McCulloch and requested a copy of McCulloch's driver's license to clear up uncertainty as to her date of birth. Wilk did not receive the information and renewed her request two more times, again without a response from McCulloch until April 25, 2000.
On February 2, 2000, Wilk received an APS from Dr. Porfiri stating that McCulloch suffered from chronic pain, a herniated cervical disc, TMJ, and migraine headaches. Dr. Porfiri concluded that McCulloch could not perform the material duties of her profession, and indicated that she had last seen McCulloch on November 19, 1999. However, when Wilk contacted Dr. Porfiri's office by telephone, she was told that McCulloch had not visited the office since 1997. Wilk also contacted Unum, McCulloch's other disability insurance company, to inquire why it had denied her claim.3
On April 4, 2000, Wilk requested reports from several of the medical-care providers that McCulloch had disclosed in her claimant questionnaire, including Dr. Porfiri. On April 25, 2000, Wilk received a copy of McCulloch's driver's license and a completed personal profile evaluation. In the personal evaluation, McCulloch stated that she suffered from chronic pain due to a cervical disc herniation, TMJ, and low back pain that required medication and constant care which made working as an internist impossible. McCulloch further stated that she had constant neck, interscapular, and low back pain which limited and restricted all of her ordinary physical activities.4
On May 2, 2000, Wilk received medical records from Dr. Walters, the neurosurgeon that McCulloch disclosed in her claimant questionaire. Dr. Walters' records indicated that McCulloch visited her office twice, first on September 21, 1998, and again on June 10, 1999, and complained of pain in her neck, upper back, and shoulder blades. Dr. Walters stated that she advised McCulloch to have surgery.
On May 22 and 23, 2000, Hartford arranged for covert video surveillance of McCulloch. McCulloch was observed turning her head and shoulders to look behind when she was driving in reverse while drinking coffee; talking on a cell phone while driving; bending into the back of her vehicle; and entering her vehicle with no obvious discomfort. Another video surveillance conducted on June 20 and 21, 2000, showed McCulloch carrying a large plant from her car to her child's school, dancing, stooping, bending, sitting, standing, and leaving a party with no apparent difficulty.
On July 11, 2000, a disability-case manager at Hartford, Joseph Sterle ("Sterle"), arranged for McCulloch to undergo an independent medical examination and functional capacities evaluation with Dr. Asha Garg ("Dr. Garg") in Worcester, Massachusetts. Copies of McCulloch's medical records and the surveillance video were forwarded to Dr. Garg beforehand. Dr. Garg issued a preliminary report which stated that, although McCulloch had slight pain in her cervical spine and lumbrosacral region, she did not show any sign of being in pain during the examination. Dr. Garg noted that McCulloch ambulated well, did not limp, and had a normal range of motion. She later issued a final report which varied from the preliminary report only in that it eliminated the doctor's prior...
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