Miller v. The Hartford Life and Accident Insurance Co.

          ORDER ON MOTIONS FOR SUMMARY JUDGMENT (ECF NOS. 50, 52)

          JAMES R. SWEENEY II, JUDGE UNITED STATES DISTRICT COURT

         Plaintiff Dee Ann Miller (“Miller”) brings this action under the applicable provisions of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., to challenge the termination of her long-term disability benefits under the Group Long Term Disability Plan for Employees of Springleaf Finance, Inc. (the “Plan”) by the Plan's administrator, Defendant The Hartford Life and Accident Insurance Co. (“Hartford”). The parties' cross-motions for summary judgment are fully briefed and ripe for decision. Having carefully reviewed the administrative record, as well as the parties' memoranda, responses, and replies, the Court concludes that Hartford's motion (ECF No. 52) should be granted and Miller's motion (ECF No. 50) should be denied for the following reasons.

         I. Background

         A. The Plan

         Miller worked as a senior collector for Springleaf Finance, Inc. beginning in 1997 and received long-term disability coverage under the Plan. (R. 22, ECF No. 49-1 at 23; R. 867, ECF No. 49-4 at 21).^[1] The Plan is funded by a group insurance policy issued by Hartford and grants Hartford discretionary authority to determine eligibility for benefits and interpret the Plan's terms. (R. 234, 248, ECF No. 49-1 at 235, 249.)

         The Plan defines “Disability or Disabled” as

You are prevented from performing one or more of the Essential Duties of:

1) Your Occupation during the Elimination Period;

2) Your Occupation, for the 24 months following the Elimination Period, and as a result, Your Current Monthly Earnings are less than 80% of Your indexed Predisability Earnings; and 3) after that, Any Occupation.

(R. 249, ECF No. 49-1 at 250.) The Plan defines “Your Occupation” 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 at a specific location.” (R. 252, ECF No. 49-1 at 253.) The Plan also provides that benefits are limited to 24 months for disability due to “Mental Illness that results from any cause” or “any condition that may result from Mental Illness.” (R. 239, ECF No. 49-1 at 241.)

         B. “Your Occupation”

         The parties do not appear to dispute the essential duties of Miller's occupation. Miller's job description as senior collector at Springleaf provided:

Job Functions / Responsibilities (list in order of importance):

% Function

1 70 Initiate contact with customers, and external third parties (e.g. collection agencies, appraisers, legal firms, brokers, etc.). as warranted, to arrange for repayment and/or settlement of delinquent accounts according to Ft)CPA and/or RESPA guidelines and applicable collection laws.

Respond to inquiries from internal personnel, customers and external third parties (e.g. courts, agencies, realtors, brokers, attorneys, etc.).

Maintain and notate all appropriate information and documentation regarding customer and account status on computer system and provide same to others involved in collection of account.

Analyze account status to determine appropriate collection strategy.

2 12 Create and respond to correspondence and documentation to and from a variety of sources (e.g. brokers, realtors, appraisers, customers, agencies, legal firms, bankruptcy courts, etc.) regarding delinquent accounts.

3 8 Obtain appropriate information to proceed in further collection activity including skip-tracing procedures.

4 5 Complete necessary reports on a daily basis.

5 1 Maintains Appropriate Position Documentation.

6 4 100% Performs all other duties as assigned by Management.

(R. 321-22, ECF No. 49-2 at 34-35.) According to an occupational analysis completed by Hartford's vocational rehabilitation clinical case manager, the essential duties of Miller's occupation as it is recognized in the general workplace “include contacting customers with high risk accounts, negotiating repayment, providing documentation to monitor results and productivity of collection efforts, responding to inquiries, analyzing account status and obtaining information needed.” These duties require the ability “to occasionally reach and handle, frequently finger, and constantly talk and hear.” (R. 179-80, ECF No. 49-1 at 180-81.) The Dictionary of Occupational Titles classifies the position as “sedentary, semiskilled work.” (R. 1124, ECF No. 49-4 at 278.)

         C. Hartford's approval of Miller's short-term disability benefits claim

         On March 5, 2014, Miller received a performance appraisal, which concluded that Miller's performance “Needs Improvement.” In that appraisal, Miller's supervisor commented: (1) that Miller “fails to use her time wisely when she is at work. She is known to be in Aux work frequently and also utilizes her time doing other things besides work related items”; (2) that Miller “has a tendency to be hesitant to accept when a new rule/policy has been put in place and typically refers to how things used to be with her previous boss[ ] when ultimately it is irrelevant and things just need to be accepted”; (3) that Miller “has little interest in her position”; and (4) that the supervisor “would like to see [Miller] use her time more wisely while on company time.” (R. 328, ECF No. 49-2 at 672.)

         Miller would not return to work thereafter. (R. 867, ECF No. 49-4 at 21.) Instead, five days later, Miller applied for short-term disability benefits, (R. 864, ECF No. 49-4 at 18), and visited her primary care physician, Dr. Judi Brezausek, complaining of depression. (R. 888, ECF No. 49-4 at 42.) In connection with Miller's application for short-term disability benefits, Dr. Brezausek submitted an “Attending Physician's Statement of Functionality” indicating that Miller's primary diagnosis was depression and her secondary diagnosis was fibromyalgia.^[2] (R. 911, ECF No. 49-4 at 65.) Dr. Brezausek reported that Miller could sit for two hours at a time-though did not indicate how many hours per day total-and that Miller could lift or carry up to ten pounds without restriction and could occasionally reach, finger, and handle with both hands. (Id.) Dr. Brezausek further noted that Miller was “depressed, fatigued, cannot sleep well, ” and that her symptoms were “increasing due to her fibromyalgia pain” as well as work- and family-related stress. (Id.) Dr. Brezausek started Miller on Pristiq (50 mg) for depression and set her expected return to work date as April 7, 2014. (R. 890, 912, ECF No. 49-4 at 44, 66.) Hartford approved Miller's claim for short-term disability benefits on March 13, 2014, effective March 17 through April 6, 2014. (R. 880, ECF No. 49-4 at 34.)

         Hartford would extend Miller's short-term disability benefits multiple times over the following six months, ultimately exhausting Miller's short-term disability coverage on September 7, 2014. (R. 869, ECF No. 49-4 at 23.) Over this period, Miller visited Dr. Brezausek on several occasions, and Dr. Brezausek submitted several statements to Hartford in support of Miller's continuing disability. On March 27, 2014, Miller visited Dr. Brezausek complaining of depression and reported that Pristiq had “helped the depression, but her pain is worse this week. No. energy. Could hardly walk in here.” (R. 892, ECF No. 49-4 at 46.) The next day, Dr. Brezausek submitted an “Attending Physician's Statement of Continued Disability (For Mental Health Claims), ” again indicating that Miller suffered from depression and fibrom-yalgia and reporting Miller's symptoms as “fatigue, emotional lability, [and] difficulty concentrating.” (R. 2289, ECF No. 49-9 at 76.) Dr. Brezausek's “Current Mental Status Examination” of Miller indicated that Miller was well-groomed and cooperative; that Miller's speech was normal, her thought process was “Logical/Coherent, ” her insight into her illness was good, her psychomotor activity was within normal limits but with “(some) agitation, ” and her attention, concentration, and memory were intact. (Id.) Nevertheless, Dr. Brezausek reported that Miller could “barely perform [activities of daily living]” and could work zero hours per day, setting her target date for return to work as May 5, 2014. (R. 2290, ECF No. 49-9 at 77.) Hartford extended Miller's short-term disability benefits through May 5, 2014. (R. 879, ECF No. 49-4 at 33.)

         Miller visited Dr. Brezausek again the following month for follow-up on her fibromyalgia. (R. 894, ECF No. 49-4 at 48.) Miller complained of pain in her knees, legs, shoulders, and back. Miller further complained that she felt “cloudy-headed, ” that she had to leave herself “a lot of notes, ” and that she felt “like she isn't safe driving” because she “puts the car in drive instead of reverse, ” (id.), though it does not appear that Dr. Brezausek ever restricted Miller from driving. Two days later, Dr. Brezausek sent a message to a colleague stating, “Darn it. [Miller] is positive for Chronic Fatigue Immunodeficiency Syndrome (CFIDS), ” and asking the colleague to “[l]et [Miller] know that I will fill out her Hartford paperwork, but that we have heard through the grapevine that she may have her job in jeopardy.” (R. 897, ECF No. 49-4 at 51.)

         That same day, Dr. Brezausek submitted another “Attending Physician's Statement of Continued Disability (For Mental Health Claims), ” indicating that Miller suffered from depression, fibromyalgia, and chronic fatigue, with symptoms including “fatigue, emotional lability, [and] difficulty concentrating.” (R. 2291-92, ECF No. 49-9 at 78-79.) Dr. Brezausek's “Current Mental Status Examination” again indicated that Miller was well-groomed and cooperative and that Miller's speech was normal, her thought process was “Logical/Coherent, ” her insight into her illness was good, and her attention and memory were intact. (R. 2291, ECF No. 49-9 at 78.) However, Dr. Brezausek checked a box describing Miller's psychomotor activity as “Retardation, ” with a handwritten notation “slow to answer, ” and indicated Miller's concentration was “impaired: mild.” (Id.) Dr. Brezausek again reported that Miller could “barely perform [activities of daily living]” and could work zero hours per day, setting her target date for return to work as June 2, 2014. (R. 2292, ECF No. 49-9 at 79.) On May 22, 2014, Hartford extended Miller's short-term disability benefits through July 13, 2014. (R. 875, ECF No. 49-4 at 29.)

         On May 28, 2014, Miller again visited Dr. Brezausek for a follow-up on her depression. (R. 835, ECF No. 49-3 at 261.) Miller complained of pain in her left leg, which would subside only when she lay back, and reported that she thought “pain is causing more of her depression.” (Id.) Dr. Brezausek found that Miller was “alert, cooperative, ” and in “no distress, ” with “extremities normal, atraumatic, no cyanosis or edema, ” and a “[g]rossly normal” neurologic exam except for “[d]ampened reflex on left” and “weakness at left great toe.” (Id.) On August 14, 2014, Hartford extended Miller's short-term disability benefits through September 7, 2014, exhausting those benefits. (R. 869, ECF No. 49-4 at 23.)

         D. Hartford's initial approval of Miller's long-term disability benefits claim

         On July 9, 2014, Hartford notified Miller that it would begin investigating her eligibility for long-term disability benefits and interviewed Miller by telephone. (R. 152, ECF No. 49-1 at 153; R. 870, ECF No. 49-4 at 24.) Miller reported symptoms of pain, lack of energy, and confusion, as well as limitations including difficulty walking, inability to sit for 20 minutes, and inability to clean, leave the house, or even watch television. (R. 153, ECF No. 49-1 at 154.) Miller further reported that she thought her illness was “because of stress from work-a new company took over so jobs were changed.” (Id.)

         The next day, Dr. Brezausek submitted three forms in support of Miller's long-term disability claims based on Miller's June 30, 2014, office visit. In her notes for that visit, Dr. Brezausek reported that Miller complained of fatigue, leg pain, and numbness in her toes. (R. 837, ECF No. 49-3 at 263.) Dr. Brezausek found that Miller was “alert, cooperative, no distress, ” and had normal range of motion in her back but reported no examination of Miller's extremities. (Id.)

         Dr. Brezausek completed a “Physical Capacities Evaluation Form” indicating that Miller could occasionally handle, finger, and feel with both hands, but could sit for no more than two hours per day, could stand and walk for less than one hour per day, and “becomes easily exhausted [and] experiences leg pain[, ] so harsh physical activity cannot be done.” (R. 2293-94, ECF No. 49-9 at 80-81.) That same day, Dr. Brezausek submitted another “Attending Physician's Statement of Continued Disability (For Mental Health Claims), ” indicating that Miller suffered from depression, fibromyalgia, and chronic fatigue, could work for zero hours per day, and could “barely perform [activities of daily living].” (R. 818-19, ECF No. 49-3 at 244-45.) Similarly, Dr. Brezausek completed a “Behavioral Functional Evaluation Form” indicating that Miller had “Minimal Ability” to perform a broad range of activities and had “no ability” to “[p]erform[ ] a variety of duties” or be “[r]eliab[le] / consisten[t].” (R. 2297, ECF No. 49-9 at 84.) Dr. Brezausek noted that “stress involves [Miller's] depression, suicidal ideations, ability to make decisions / finding directions, ” and cited family-related stress. (Id.)

         But these extreme restrictions and limitations had no support in Dr. Brezausek's objective findings. Dr. Brezausek's “Current Mental Status Examination, ” based on her June 30, 2014, examination of Miller, again indicated that Miller was well-groomed and cooperative and that Miller's speech was normal, her thought process was “Logical/Coherent, ” her insight into her illness was good, and her attention and memory were intact. (R. 2295, ECF No. 49-9 at 82.) Consistent with her statement the month prior, Dr. Brezausek described Miller's psychomotor activity as "Retardation," with a handwritten notation "slow to answer," and indicated Miller's concentration was "impaired: mild." (Id.)

         On August 6, 2014, Hartford propounded specific questions to Dr. Brezausek relating to these inconsistencies. (R. 338-39, ECF No. 49-2 at 51-52.) Dr. Brezausek responded as follows:

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         There is no evidence that Miller visited a mental health care provider of any kind until after Hartford terminated ...