United States District Court, S.D. Indiana, Indianapolis Division
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:
(Image
Omitted)
There
is no evidence that Miller visited a mental health care
provider of any kind until after Hartford terminated
...