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McKinnis v. Hartford Life

May 22, 2009

MICHAEL MCKINNIS, PLAINTIFF,
v.
HARTFORD LIFE, DEFENDANT.



The opinion of the court was delivered by: Slomsky, J.

MEMORANDUM AND ORDER

I. INTRODUCTION

This civil action was removed to this court from the Philadelphia Court of Common Pleas on May 31, 2002. In his First Amended Complaint, filed April 12, 2004, Plaintiff alleges a cause of action under the Employment Retirement Income Security Act of 1974 ("ERISA"), based upon Defendant Hartford Life's ("Hartford") failure to pay Plaintiff disability benefits under his employer's Short-Term Disability Group Insurance Policy (the "Hartford Policy"). On December 23, 2004, Defendant moved for summary judgment on Plaintiff's claim that he was entitled to short-term disability benefits (Doc. No. 21). Plaintiff filed his answer in opposition to Defendant's Motion for Summary Judgment (Doc. No. 22) on January 24, 2005. The Motion for Summary Judgment is ripe for disposition and will be granted.*fn1

II. FACTUAL BACKGROUND

A. Plaintiff's Claim for Benefits

Plaintiff commenced his employment at Worldcom, Inc. ("Worldcom" or "Employer") on January 24, 2000. (Administrative Record at H62, Appendix to Defendant's Motion for Summary Judgment [hereinafter "Admin. Record"].) While Plaintiff was employed by Worldcom, Plaintiff was covered by a short-term disability insurance policy offered by Worldcom and underwritten by Defendant Hartford. (Pl. Compl. ¶4; Hartford Life and Accident Insurance Company Policy at H1-H48, Appendix to Defendant's Motion for Summary Judgment [hereinafter "Hartford Policy"].) Plaintiff's last day of work at Worldcom was on April 20, 2001. (Admin. Record at H62.) On April 23, 2001, Plaintiff made a claim for short-term disability benefits under the Hartford Policy. (Id. at H110.) Worldcom paid Plaintiff for one week of sick time through April 27, 2001, but noted that Plaintiff's employment ended on April 20, 2001. (Id. at H66.)

On the same day that Plaintiff made his claim under the Policy, Hartford sent a letter to Plaintiff requesting information from his physician about his alleged disability. (Id. at H57.) On May 2, 2001, Hartford spoke with Plaintiff's psychotherapist, William Silver, who informed Hartford that he had never advised Plaintiff to stop working. (Id. At 110.) Hartford, in turn, advised Plaintiff that he needed to have an attending physician call Hartford to confirm that a physician told Plaintiff to stay out of work, or Plaintiff would be denied benefits. (Id. at H109.) Hartford heard nothing from Plaintiff or his physician for more than two weeks. Hartford then sent Plaintiff another letter requesting information about his medical providers and evidence of his disability. (Id. at H55-H56.)

On May 18, 2001, Plaintiff visited Dr. Louis R. Petrone, M.D., for the first time. (Id. at H105; Letter from Dr. Petrone to Hartford Life, June 15, 2001 [hereinafter "Petrone Letter"].) On that same day, someone from Dr. Petrone's office called Hartford and informed Hartford that Plaintiff had been diagnosed with depression, alcohol abuse and hypertension, and that Dr. Petrone recommended admitting Plaintiff to an inpatient treatment facility. (Admin. Record at H109.) On June 6, 2001, Hartford personnel in its claims department contacted Dr. Petrone's office for additional information about Plaintiff's alleged disability. "Joy", an employee of Dr. Petrone, told Hartford that Dr. Petrone saw Plaintiff for the first time on May 18, 2001, and that Dr. Petrone would not certify that Plaintiff was disabled prior to that date. (Id. at H52.) In the letter sent by Dr. Petrone to Hartford on June 15, 2001, Dr. Petrone again confirms that Plaintiff first saw Dr. Petrone on May 18, 2001, and notes that Plaintiff should be on disability coverage until Plaintiff can complete an alcohol rehabilitation program. (Petrone Letter.)

In an undated letter Psychotherapist Silver again communicated with Hartford, noting that he had seen Plaintiff on April 26, 2001 and May 2, 2001 and recommended Plaintiff undergo an alcohol rehabilitation program. (Admin. Record at H68.) This letter did not confirm that Plaintiff was disabled, or that Mr. Silver had told Plaintiff to stay out of work. (Id.)

In a letter from Plaintiff's counsel to Hartford, which appears to have been faxed to Defendant on June 20, 2001, Plaintiff's counsel states that "my client is making a claim for short term disability starting May 18, 2001." (Letter from Adrian R. Reid to Tina M. Palmer, Admin. Record at H75.) This letter recognizes that no doctor had declared Plaintiff disabled prior to May 18, 2001.

From the date that Hartford was notified of Plaintiff's claim, April 23, 2001, until a final decision was made to deny Plaintiff's claim on June 7, 2001, Hartford worked diligently to ascertain whether Plaintiff was disabled as of Plaintiff's last day of work at Worldcom, April 20, 2001. Based upon the information gathered, Hartford made a determination that Plaintiff was not disabled as of his last day of work at Worldcom, and accordingly Plaintiff was not entitled to short-term disability benefits under the Hartford Policy. (Id. at H52.)

B. Worldcom's Hartford Life and Accident Insurance Company Policy

The Hartford Policy, which covers the short-term disability benefit plan for Worldcom, states that an employee's coverage under the Policy terminates on the date on which the employee ceases to be an active full time employee. (Hartford Policy at H13.) The Policy defines an "active full time employee" as: "An employee who works for the Employer on a regular basis in the usual course of the Employer's business. Such employee must work the number of hours in the Employer's normal work week." (Id. at H6.) The policy also defines "actively at work" as follows: "You will be considered to be actively at work with the Employer on a day which is one of the Employer's scheduled work days if you are performing, in the usual way, all of the regular duties of your job on a full time basis on that day." (Id.)

The Hartford Policy further grants full discretion to Hartford to make eligibility decisions under the ...


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