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Miller v. Hartford Life And Accident Insurance Co.

United States District Court, S.D. Indiana, Indianapolis Division

May 19, 2017

DEE ANN MILLER, Plaintiff,
v.
THE HARTFORD LIFE AND ACCIDENT INSURANCE CO., and SPRINGLEAF FINANCE, INC. DISABILITY PLAN, Defendants.

          ENTRY ON MOTION FOR ADMINISTRATIVE REMAND AND MOTION TO STRIKE

          TANYA WALTON PRATT, JUDGE

         Before the Court is a Motion for Administrative Remand and to Stay Proceedings filed by Defendants Hartford Life and Accident Insurance Co. (“Hartford”) and Springleaf Finance, Inc. Disability Plan (“the Plan”) (collectively, “Defendants”) (Filing No. 25), as well as a Motion to Strike filed by Plaintiff Dee Ann Miller (“Miller”) (Filing No. 30). On January 1, 2016, after exhausting all remedies through the administrative process, Miller filed a wrongful denial of employee benefits claim against Defendants pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., (Filing No. 1). Defendants seek an administrative remand, arguing Miller did not receive a “full and fair review” because “critical” evidence that benefits Miller was not included in the administrative record. For the following reasons, Defendants' Motion for Administrative Remand and to Stay Proceedings is GRANTED and Miller's Motion to Strike is DENIED.

         I. BACKGROUND

         Miller worked for Springleaf Finance, Inc. (“Springleaf”) from December 1999 until March 5, 2014. After nearly fifteen years, Miller stopped working at Springleaf due to symptoms of severe fibromyalgia, psoriatic arthritis, osteoarthritis, and chronic pain. Miller then applied for short term disability (“STD”) benefits provided through her employee benefit plan and administered by Hartford. Hartford approved Miller's application for STD benefits. After Miller received the maximum duration of STD benefits, she applied for long term disability (“LTD”) benefits under the terms of her disability policy. On September 8, 2014, Hartford approved Miller's LTD benefits claim. (Filing No. 27-1 at 2.)

         Thereafter, Hartford received notice that Miller applied for Social Security disability benefits, however, the Social Security Administration denied Miller's claim on November 21, 2014, and denied her request for reconsideration on February 10, 2015. (Filing No. 29-4.) In April 2015, Hartford consulted Ibraham Alghafeer, M.D., a rheumatology specialist, and Marcus Goldman, M.D., a psychiatrist, both of whom opined that Miller maintained the capacity to continue working. (Filing No. 29-5 at 2-7.) The following month, on May 7, 2015, Hartford sent a letter to Miller terminating Miller's benefits as of April 30, 2015, explaining that Miller failed to satisfy the Plan's definition of “disability.” (See Filing No. 29-1 at 34, defining disability).

         Miller appealed the denial of benefits on October 28, 2015, and submitted a 258-page appeal packet, including an appeal letter and a three-page statement (“Physician's Statement”) drafted by Miller's treating physician, Dr. Judi Brezausek. (Filing No. 27-1.) Miller's appeal letter referenced specific contents of the Physician's Statement; however, due to a scanning error by outside vendor Xerox Services Healthcare (“Xerox”), the first two pages of the Physician's Statement were not contained in the administrative record. (Filing No. 27-2.) On December 17, 2015, Defendants denied Miller's appeal without knowledge of the missing pages of the Physician's Statement.

         Thereafter, on January 20, 2016, Miller sought relief in this Court. Miller filed a Complaint against Defendants asserting wrongful denial of employee benefits. (Filing No. 1.) On July 26, 2016, during mediation and well after the denial of Miller's appeal, Miller's counsel informed Defendants that the first two pages of the Physician's Statement were missing from the administrative record. Miller represented that the two pages of the Physician's Statement contain critical information regarding Miller's medical condition and capacity to work. On October 14, 2016, Defendants filed a Motion for Administrative Remand and to Stay Proceedings in order to evaluate the Physician's Statement and to provide Miller with a “full and fair” review. (Filing No. 25.)

         II. LEGAL ANALYSIS

         Where, as in this case, a plan grants discretionary authority to the plan administrator, a court reviews the denial of benefits under the arbitrary and capricious standard. Hackett v. Xerox Corp. Long-Term Disability Income Plan, 315 F.3d 771, 773 (7th Cir. 2003) (citing Hess v. Hartford Life & Accident Ins. Co., 274 F.3d 456, 461 (7th Cir.2001)). If a court determines that a plan administrator acted arbitrary and capricious, the court must next determine the appropriate remedy. Hackett, 315 F.3d at 775.

         ERISA requires every employee benefit plan to “afford…a full and fair review” of claim denials. 29 U.S.C.A. § 1133. Generally, in ERISA cases, if an administrator “fails to make adequate findings” or “fails to provide… adequate reasoning” for denial of benefits, the proper remedy is to remand. Love v. Nat'l City Corp. Welfare Benefits Plan, 574 F.3d 392, 398 (7th Cir. 2009); Majeski v. Metro. Life Ins. Co., 590 F.3d 478, 484 (7th Cir. 2009); Leger v. Tribune Co. Long Term Disability Ben. Plan, 557 F.3d 823, 835 (7th Cir. 2009). However, in rare cases, a court may retroactively reinstate a claimant's benefits where it is clear from the record that “the only determination the plan administrator could reasonably make is that the claimant is disabled.” Majeski, 590 F.3d at 484; Love, 574 F.3d at 398.

         III. DISCUSSION

         A. Motion to Strike

         As an initial matter, Miller asks the Court to strike certain exhibits filed by Defendants in their Reply brief. Federal Rule of Civil Procedure 12(f) allows the court to “strike from a pleading an insufficient defense or redundant, immaterial, impertinent, or scandalous matter.” Fed.R.Civ.P. 12(f). The court may, (1) act on its own, or (2) on a motion made by a party either before responding to the pleading or, if a response is not allowed, within 21 days after being served with the pleading. Id. Motions to strike are generally disfavored; however, “where . . . motions to strike remove unnecessary clutter from the case, they serve to expedite, not delay.” Heller Fin., Inc. v. Midwhey Powder Co., Inc., 883 F.2d 1286, 1294 (7th Cir. 1989).

         On November 22, 2016, in reply to Miller's Response in Opposition to Defendants' request for remand, Defendants designated six exhibits-Exhibits A through F. (See Filing No. 29.) Without any substantive detail, Miller moves the Court to strike pages six through eight of Defendants' Reply brief, as well as corresponding Exhibits B through E, arguing Defendants failed to raise the issues contained in those exhibits in their initial brief. See ...


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