MILLER v. THE HARTFORD LIFE AND ACCIDENT INSURANCE CO. et al

Filing 34

CLOSED DISMISSED - ENTRY ON MOTION FOR ADMINISTRATIVE REMAND AND MOTION TO STRIKE. For the reasons stated above, the Court GRANTS Defendants' Motion for Administrative Remand and to Stay Proceedings (Filing No. 25), and the Court DENIES Mi ller's Motion to Strike (Filing No. 30). The matter is remanded to Hartford for additional administrative review. This matter is administratively closed, upon motion of either party to re-open the case. (See Entry.) Signed by Judge Tanya Walton Pratt on 5/19/2017.(JLS)

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
INDIANAPOLIS DIVISION
DEE ANN MILLER,
Plaintiff,
v.
THE HARTFORD LIFE AND ACCIDENT
INSURANCE CO., and SPRINGLEAF
FINANCE, INC. DISABILITY PLAN,
Defendants.

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Case No. 1:16-cv-00166-TWP-DML

ENTRY ON MOTION FOR ADMINISTRATIVE REMAND AND MOTION TO STRIKE
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.

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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

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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 Fleet v. Indep. Fed. Credit
Union Employee Ben. Plan, No. 1:04CV0507DFHTAB, 2005 WL 1183177, at *2 (S.D. Ind. May
18, 2005).
Defendants note, in her response in opposition to Defendants’ request for remand, Miller
argued Defendants’ evaluation of her disability claim was arbitrary and capricious, among other
things. Defendants argue that its Reply appropriately rebutted those arguments raised by Miller.
See Trinity Indus. Leasing Co. v. Midwest Gas Storage, Inc., No. 1:11-CV-01579-JMS, 2013 WL

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212929, at *6 (S.D. Ind. Jan. 18, 2013) (“[w]hile it is true that new arguments cannot be raised in
a reply brief, a party can counter ... arguments raised in [a] response brief”) (citations and quotation
marks omitted); Woods v. Wells Fargo Fin. Bank, 753 F. Supp. 2d 784, 788 (S.D. Ind. 2010) (“the
purpose for having a motion, response and reply is to give the movant the final opportunity to be
heard and to rebut the non-movant’s response…”) (citations and quotation marks omitted).
After reviewing the record, the Court agrees with Defendants and finds that Exhibits B
through E and pages six through eight of Defendants’ Reply merely counters the arguments made
by Miller in her response in opposition to Defendants’ request for remand. See Trinity, 2013 WL
212929, at *6; Woods, 753 F. Supp. 2d at 788. Accordingly, Miller’s Motion to Strike is denied.
B.

Motion to Remand
Regarding the merits of this case, Miller moves the Court for an administrative remand in

order to evaluate the Physician’s Statement and to provide Miller with a “full and fair” review.
Miller, however, argues that the Court should not remand the case because Hartford negligently
failed to notice the missing pages from the Physician’s Statement and Hartford also misrepresented
certain statements made by Miller’s rheumatologist 1 during the administrative process.
The Court first notes that Miller’s contentions are immaterial to the issue before the Court.
The only issue before the Court is whether Defendants failed to afford Miller a “full and fair
review” when denying Miller’s benefits prior to evaluating the first two pages of the three-page
Physician’s Statement. There is no dispute that the first two pages of the Physician’s Statement
were not included in the administrative record due to the mistake of Xerox. Miller also concedes
that the two missing pages contain critical information regarding Miller’s medical condition and
capacity to work. The Court concludes, and Defendants acknowledge, that the defect in the

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Miller asserts that Hartford violated its fiduciary duty when misrepresenting to Miller that Miller’s rheumatologist
reported she could perform light duty work. (Filing No. 27 at 12-13.)

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administrative record did not afford Miller a “full and fair review.” Arbitrary and capricious
review turns on “whether the plan administrator afforded the claimant an opportunity for full and
fair review,” and whether the plan administrator failed to “address any reliable, contrary evidence
submitted by the claimant.” See Majeski, 590 F.3d at 484; Love, 574 F.3d at 397; Leger, 557 F.3d
at 832-33.

Accordingly, because it is not abundantly clear from the record that the only

determination Hartford could reasonably make is that Miller is disabled, the Court grants
Defendants’ Motion for Administrative Remand. See Majeski, 590 F.3d at 484; Love, 574 F.3d at
398.
IV. CONCLUSION
For the reasons stated above, the Court GRANTS Defendants’ Motion for Administrative
Remand and to Stay Proceedings (Filing No. 25), and the Court DENIES Miller’s Motion to Strike
(Filing No. 30). The matter is remanded to Hartford for additional administrative review. This
matter is administratively closed, upon motion of either party to re-open the case.

SO ORDERED.

Date: 5/19/2017

DISTRIBUTION:
Bridget L. O’Ryan
O'RYAN LAW FIRM
[e-mail]
Warren von Schleicher
SMITH von SCHLEICHER & ASSOCIATES
[e-mail]

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