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Claudia Whittaker v. Hartford Life Insurance Company

November 25, 2012

CLAUDIA WHITTAKER, PLAINTIFF,
v.
HARTFORD LIFE INSURANCE COMPANY,
DEFENDANT.



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

MEMORANDUM

Claudia Whittaker sued Hartford Life Insurance Company ("Hartford") under the Employee Retirement Income Security Act of 1974 ("ERISA"). She alleges that Hartford wrongfully terminated the long term disability ("LTD") benefits that she had been receiving under a group benefit plan ("Plan") administered by Hartford. Whittaker seeks a declaration that she was disabled within the meaning of the Plan at the time Hartford terminated her benefits and an award of the benefits she alleges she is owed under the Plan. Presently before the Court are Hartford's and Whittaker's cross-motions for summary judgment. For the reasons that follow, the Court grants Hartford's motion for summary judgment and denies Whittaker's.

I. BACKGROUND

A. LTD Benefits Policy

Whittaker was employed as an Associate Director of Case Management at Lenape Valley Foundation ("Lenape"). (Pl.'s Statement of Undisputed Facts and Mem. of Law in Supp. of Mot. for Summ. J. [Whittaker SOF] ¶ 1.) Hartford provided LTD coverage for Lenape employees, and Whittaker was a participant in the Plan. (Id. ¶ 2.) The policy states:

Disability or Disabled means:

1. during the Elimination Period, you are prevented from performing one or more of the Essential Duties of your Occupation;

2. for the 24 months following the Elimination Period, you are prevented from performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly earnings are less than 80% of your Indexed Pre-disability Earnings;

3. after that, you are prevented from performing one or more of the Essential Duties of Any Occupation. (J.A. at LTD HLI 192.) The policy then defines "Elimination Period" as "the period of time you must be Disabled before benefits become payable." (Id. at LTD HLI 133, 518.) "Your Occupation" is defined as "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 LTD HLI 195.) "Essential Duty" under the policy means one that "1. is substantial, not incidental;

2. is fundamental or inherent to the occupation; and 3. can not be reasonably omitted or changed." (Id. at LTD HLI 192.)

Whittaker's elimination period was ninety days, beginning from the date of her disability; her elimination period thus ended on August 23, 2006. (Id. at LTD HLI 518.) Whittaker's benefits were terminated on August 7, 2008, during the twenty-four months following the elimination period. Therefore, Whittaker was considered disabled under the Plan at that time if she was unable to perform an essential duty of her occupation and experienced a resultant drop in income of at least twenty percent. (See id. at LTD HLI 192.) The parties do not dispute that this is the provision of the Hartford policy relevant to Whittaker's case, and Hartford does not challenge Whittaker's fulfillment of the decreased-income component of the Plan's disability definition.

The Plan gives Hartford "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy." (Id. at LTD HLI 212.)

B. Whittaker's Medical History and Application for LTD Benefits

On February 1, 2006, Whittaker saw Dr. Charles B. Burrows, an orthopaedist, for right shoulder and low-back pain. An MRI of Whittaker's right shoulder revealed "moderate degenerative changes of the acromioclavicular joint with impingement of the subacromial space and tendinosis of the supraspinatus tendon with a partial-thickness tear." (Id. at LTD HLI 498.) The MRI also indicated "multilevel degenerative changes" and "moderate to severe central canal narrowing" in the lumbosacral spine. (Id.) Dr. Burrows gave Whittaker Kenalog and lidocaine injectionsand suggested she visit a spine specialist. (Id.) Whittaker was uncertain about visiting the specialist, so Dr. Burrows also recommended epidural steroid injections.(Id.) Whittaker returned to Dr. Burrows on April 7, 2006 and reported "significant relief" from the epidural steroid injections. (Id. at LTD HLI 500.)

On April 14, 2006, Dr. Burrows's physician's assistant examined Whittaker for left degenerative Achilles tendonitis. (Id. at LTD HLI 501.) On May 24, 2006, Whittaker stopped work due to the pain in her left ankle and in preparation for upcoming surgery to repair her Achilles tendon on June 6, 2006. (Pl.'s Resp. to Def.'s Mot. for Summ. J. ¶¶ 8-9.)

In August 2006, Whittaker visited Dr. Burrows and told him that her low-back pain had increased and that the epidural injections were no longer providing relief. (Statement of Material Facts in Supp. of Def.'s Mot. for Summ. J. [Hartford SOF] ¶ 10.) An MRI showed no "significant changes" from the prior exam, except for a compression fracture in the spine. (J.A. at LTD HLI 497.)

On September 7, 2006, Whittaker applied for LTD benefits from Hartford due to her Achilles tendonitis, which caused "tingling in her left foot" and "pain in her left leg," making it difficult for her to walk to meetings, drive, and concentrate. (Id. at LTD HLI 529-37.) Whittaker also submitted an Attending Physician's Statement of Disability signed by Dr. Burrows, which stated that Whittaker's primary diagnosis was osteoarthritis in her knees, with secondary diagnoses of a rotator cuff tear, spinal stenosis, and lumbar radiculitis. (Id. at LTD HLI 540.) As a result, Dr. Burrows wrote, Whittaker would be unable to stand, walk, sit, lift, carry, push, pull, or drive "on a long-term basis." (Id. at LTD HLI 541.)

In a letter dated October 30, 2006, Hartford approved Whittaker's claim for LTD benefits, effective August 23, 2006. (Id. at LTD HLI 515-18.) Hartford's letter additionally informed Whittaker that benefit payments would continue "while you meet the policy definition of Disability." (Id. at LTD HLI 515.) Whittaker was notified by a letter dated December 10, 2006 that she had also been awarded Social Security disability benefits, effective November 2006. (Id. at LTD HLI 509.)

C. Changes in Whittaker's Condition

Whittaker was treated by several doctors in 2007 and early 2008. (Hartford SOF ¶¶ 17, 19-21, 24-25.) During this period, Whittaker submitted two Claimant Questionnaires.On the first, dated March 4, 2007, Whittaker listed her medical conditions as arthritis in her knees, back, and shoulder, spinal stenosis, asthma, depression, and a tear in her right upper arm. (J.A. at LTD HLI 485.) She reported a change in her condition, citing increased pain and decreased ability to walk. She was, however, able to perform all daily activities without assistance, except that she used equipment to help her bathe. (Id.) Dr. Burrows additionally submitted an Attending Physician Statement dated September 14, 2007,in which he reported that Whittaker would be unable to lift, carry, bend, kneel, drive, or reach for things for the rest of her life. (Id. at LTD HLI 478.)

In the second Claimant Questionnaire, dated March 10, 2008, Whittaker indicated that she experienced "pain most of the time in spite of pain medication," spasms down both legs while sitting or walking, and numb feet when she walked distances, which caused difficulty balancing. (Id. at LTD HLI 468.) She reported an additional diagnosis of psoriatic arthritis and worsening of her spinal stenosis. Whittaker's daily routine involved reading and watching television in bed until noon. She then ate lunch and could do one activity per day, such as "attempt[ing] to do ...


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