McSperitt v. Hartford Life Ins. Co.
| Decision Date | 08 April 2005 |
| Docket Number | No. Civ.A.3:04CV1533-G.,Civ.A.3:04CV1533-G. |
| Parties | Ronnie McSPERITT, Plaintiff, v. HARTFORD LIFE INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — Northern District of Texas |
Lanny Perkins, Law Office of Lanny E. Perkins, Dallas, TX, for Plaintiff.
Marcus G. Mungioli, Akin Gump Strauss Hauer & Feld, Dallas, TX, Thomas E. Sanders, Helen G. Moore, Akin Gump Strauss Hauer & Feld, San Antonio, TX, for Defendant.
Before the court is the motion of the defendant Hartford Life Insurance Company ("Hartford") for summary judgment, pursuant to FED. R. CIV. P. 56, on all the claims asserted by the plaintiff Ronnie McSperitt ("McSperitt"). For the reasons set forth below, Hartford's motion is granted.
Hartford, an insurance carrier, issued a group disability policy to Symbol Technologies, Inc. ("Symbol"). Hartford Life Insurance Company's Brief in Support of its Motion for Summary Judgment ("Motion for Summary Judgment") at 2. The policy, which is an integral part of an employee welfare benefits plan governed by ERISA, provides long term disability ("LTD") benefits to eligible Symbol employees. Id.
Under the Symbol Long Term Disability Plan (the "plan"), disability benefits are provided if the employee is covered and if the employee furnishes proof that he is totally disabled. The term "totally disabled," as defined in the plan, means that:
[the employee is] prevented by Disability from doing all the material and substantial duties of [his] own occupation on a full time basis.
After that, and for as long as [the employee] remain[s] Totally Disabled, [he is] prevented by Disability from doing any occupation or work for which [he is] or could become qualified by:
(1) training;
(2) education; or
(3) experience.
Administrative Record ("Administrative Record"), attached to Appendix to Hartford Life Insurance Company's Brief in Support of Motion for Summary Judgment at H00017.
If an employee qualifies for LTD benefits, the plan requires the employee to provide continued proof of his disability and to submit to an independent examination to determine if he is disabled. Motion for Summary Judgment at 2-3; Administrative Record at H00031. The plan also contains a two-year limitation on benefits paid because of any mental disability. Motion for Summary Judgment at 3; Administrative Record at H00025.
Hartford is the Claims Administrator for the LTD plan. Motion for Summary Judgment at 3. In this capacity, Hartford is responsible for determining what benefits are payable according to the terms and conditions of the plan and to review appeals of claims. Id. Hartford has "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions" of the LTD plan. Id. (quoting Administrative Record at H00016).
On September 24, 1990, McSperitt began working at Symbol as a Senior Systems Analyst.1 Id. at 2, 3. During his employment at Symbol, McSperitt became insured for LTD benefits under Hartford's Group Long Term Policy on November 1, 1990. Id. at 3; Administrative Record at H00001-33; McSperitt's Response ¶ 2.
McSperitt was injured in a car accident four years after he began working at Symbol. Motion for Summary Judgment at 3. Although McSperitt did not report any injuries at the time of accident, the following day he visited Physical Therapy, Inc. complaining of pain and stiffness in his lower back and between his shoulder blades. Id.; Administrative Record at H00943. After a doctor at the clinic diagnosed McSperitt with cervical and lumbar strain and post-traumatic cervical and lumbar syndrome, he filed a short-term disability claim and was off work for ten days. Motion for Summary Judgment at 3-4. McSperitt returned to his job for approximately two months, but he stopped working completely on August 11, 1994. Motion for Summary Judgment at 4. McSperitt did not, however, file a claim for LTD benefits with Hartford until October 23, 1994. Id.
McSperitt continued to receive treatment for several months after he stopped working. Id.; see also Administrative Record at H00938-41. On December 2, 1994, McSperitt was certified as totally disabled in a Physician's Statement describing his diagnosis as post-traumatic cervical radicular syndrome and lumbar radicular syndrome. Motion for Summary Judgment at 4; Administrative Record at H01020-21. McSperitt's physician, Dr. Jonathon Walker, listed him as totally disabled to perform his own job. Motion for Summary Judgment at 5; Administrative Record at H00831-32. Based on this assessment, Hartford awarded McSperitt benefits dating back to November 11, 1994. Motion for Summary Judgment at 4 n. 14; Administrative Record at H00879.
In August 1995, Hartford referred McSperitt's claim to Case Management Services to evaluate his potential for returning to work and for rehabilitation. Motion for Summary Judgment at 5. At this time, the reviewing nurse telephoned McSperitt and they discussed his current treatment, his condition, and his interest in returning to work. Id. According to McSperitt, his doctors had restricted him from all lifting, bending, or stooping and he was unable to return to his previous job because it required him to travel "70-80% of the time," carry a computer and baggage, and use a keyboard.2 Id. at 5-6; Administrative Record at H00854. One year later in February 1996, McSperitt informed the reviewing nurse that his pain had increased over the last six months and that he was now taking Percodan in addition to his other prescriptions. Motion for Summary Judgment at 6; Administrative Record at H00791.
In June 1996, a Hartford Vocational Rehabilitation Counselor attempted to contact McSperitt by phone to discuss rehabilitation. Motion for Summary Judgment at 6; McSperitt's Response ¶ 73; Administrative Record at H00787-96. When she could not reach McSperitt, she wrote him a letter suggesting that he would be a good candidate for rehabilitation. Motion for Summary Judgment at 6. Following this correspondence, McSperitt responded and stated that he did not want to explore rehabilitation at that time because his doctor had suggested he undergo surgery.3 Id.
In February 1997, Dr. Walker reported to Hartford that McSperitt was still unable to perform any kind of work because of chronic severe neck pain, back pain, and numbness. Id. at 7. Although McSperitt reported that his condition continued to worsen in August 1997, Dr. Walker changed his evaluation. Id. On September 5, 1997, Dr. Walker indicated that McSperitt was capable of performing sedentary work with some limitations.4 Id.; Administrative Record at H00330-31. Moreover, since McSperitt refused to undergo surgery Dr. Walker stated that he had reached his point of maximum medical improvement. Motion for Summary Judgment at 8; Administrative Record at H00329.
On March 25, 1999, Hartford notified McSperitt that it was investigating his continued eligibility for disability benefits because the 60-month "own occupation" period would end on September 12, 1999. Motion for Summary Judgment at 8. After that date, McSperitt would have to meet the plan's "any occupation" definition of disability to be entitled to benefits. Id.; Administrative Record at H00676-77. Dr. Walker reported a new diagnosis of McSperitt's condition to Hartford. Motion for Summary Judgment at 8. Given this new assessment, Hartford referred McSperitt's file to its Investigative Unit. Id. That unit then conducted a video surveillance of McSperitt over a period of three months.5 Id.; Administrative Record at H00213; McSperitt's Response ¶ 77. Hartford forwarded the video surveillance to Dr. Walker for his review and assessment. Motion for Summary Judgment at 9. After viewing the tapes, Dr. Walker admitted that McSperitt could "sit very comfortably for a prolonged period of time." Id.; Administrative Record at H00258. However, Dr. Walker clearly indicated that this was only possible when McSperitt was taking Percodan for his pain. Motion for Summary Judgment at 9; Administrative Record at H00258.
On January 10, 2001, Dr. George Kazda, Associate Medical Director of Medical Advisory Group LLC, reviewed McSperitt's claim to determine whether he qualified as totally disabled for any occupation. Motion for Summary Judgment at 9; McSperitt's Response ¶ 80. Dr. Kazda ultimately concluded that McSperitt had the physical capacity to perform sedentary work. Motion for Summary Judgment at 9. As a result, Hartford terminated McSperitt's long-term disability benefits on February 5, 2001 because he failed to meet the definition of totally disabled as defined in the plan. Id.; Administrative Record at H00620-22, H00204-10; McSperitt's Response ¶ 5. On May 3, 2001, McSperitt appealed Hartford's decision to terminate his long-term disability benefits. Motion for Summary Judgment at 9; Administrative Record at H00599. After a review of his claim, Hartford determined that McSperitt was physically capable of performing sedentary work and, therefore, was not physically disabled. Motion for Summary Judgment at 9-10; Administrative Record at H00401-03. Nevertheless, based on new information submitted during Hartford's review, Hartford investigated McSperitt's possible claim to long-term disability benefits under the mental illness provision of the LTD plan. Motion for Summary Judgment at 10; Administrative Record at H00401-03.
During this investigation, Hartford reviewed a neuropsychological evaluation prepared by McSperitt's psychologist, Dr. Nancy Didriksen. Motion for Summary Judgment at 10; Administrative Record at H00595; McSperitt's Response ¶ 81. Dr. Didriksen examined McSperitt on four separate occasions and concluded that he had a severe degree of neurocognitive dysfunction.6 Motion for Summary Judgment at 10; Administrative...
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