Broderick v. Hartford Life and Accident Insurance Company
MEMORANDUM OPINION AND ORDER granting in part 16 Plaintiff's Motion for Summary Judgment; denying 20 Defendant's Motion for Summary Judgment (Written Opinion). The parties shall schedule a status conference with Magistrate Judge Frankl in L. Noel to discuss whether the case should: 1) be remanded to Hartford, 2) remain with the Court for further briefing on the appropriate remedy, or 3) whether the parties can reach a settlement. Signed by Judge Ann D. Montgomery on 02/16/2017. (TLU)
UNITED STATES DISTRICT COURT
DISTRICT OF MINNESOTA
Civil No. 15-4315 ADM/FLN
Hartford Life and Accident Insurance Company,
Sarah J. Demers, Esq., and Katherine L. MacKinnon, Esq., Law Office of Katherine L.
MacKinnon PLLC, St. Paul, MN, on behalf of Plaintiff.
Scott A. Moriarity, Esq., Lockridge Grindal Nauen PLLP, Minneapolis, MN, on behalf of
On November 17, 2016, the undersigned United States District Judge heard oral
argument on Plaintiff Michael Broderick’s (“Broderick”) Motion for Summary Judgment
[Docket No. 16] and Defendant Hartford Life and Accident Insurance Company’s (“Hartford”)
Motion for Summary Judgment [Docket No. 20]. For the reasons stated below, Broderick’s
motion is granted in part and Hartford’s motion is denied.
A. Work and Medical History
Broderick began working for Xcel Energy, Inc. (“Xcel”) in 2006. Moriarity Aff. [Docket
No. 26] Ex. 1 (Administrative Record, hereinafter “AR”) at HART304. He last worked at Xcel
as a phone service representative in the Credit and Collections department. Id.
As a result of his injuries in a December 2010 car accident, there were several periods
starting in July 2012, when Broderick was unable to work or able to work only part time. Id. at
HART519–20, 537, 543, 551, 559, 592, 618–19. His medical complications included neck pain,
headaches, and tingling and numbness in his arms. Id. at HART557, 559, 592, 618–19.
Broderick began receiving short term disability (“STD”) benefits in July 2012 under Xcel’s STD
policy insured by Hartford. Id. at HART572.
By January 13, 2013, Broderick had exhausted his STD benefits and was transitioned to
long term disability (“LTD”) benefits under Xcel’s group LTD policy insured through Hartford.
Id. at HART561. The LTD policy defines “Disability or Disabled” in relevant part as:
You are prevented from performing one or more of the Essential
Your Occupation during the Elimination Period;
Your Occupation, for the 24 month(s) following the
Elimination Period . . . ; and
after that, Any Occupation.
Id. at HART18. “Essential Duty” is defined to include “”Your ability to work the number of
hours in Your regularly scheduled work week.” Id.
Broderick was on LTD from January 14, 2013 to May 27, 2014 due to his inability to
work full time. Id. at HART172, 175. During this time period, Broderick had three surgeries:
for neck pain in February 2013, for hip pain in June 2013, and for nerve decompression in his
right elbow and a carpal tunnel release in February 2014. Id. at HART398, 411, 461, 476. On
June 16, 2014, Broderick returned to a full-time work schedule. Id. at HART389.
B. Radiofrequency Ablation Procedure and Subsequent Work Restrictions
In September 2014, Broderick stopped working due to neck pain and headaches. Id. at
HART363–64. His orthopedist, Dr. Sherif Roushdy (“Dr. Roushdy”), wrote to Hartford on
October 8, 2014, that he had seen Broderick “and kept him off work because of the increasing
headache and inability to concentrate and process information.” Id. at HART374. He also
explained that Broderick would be undergoing a radiofrequency ablative (“RFA”) procedure,
and that Dr. Roushdy would “reevaluate his condition and likely send him back to work
On December 3, 2014, Dr. Roushdy performed the RFA on Broderick without
complications. Id. at HART272–74. At a follow-up exam with Dr. Roushdy on December 15,
2014, Broderick reported that he had a 70–80% improvement in his pain, was taking pain
medications only “as needed, but very rarely,” and wanted to discuss going back to work.
HART270. Broderick reported his pain level as 2 on a 10-point scale. Id. Dr. Roushdy’s notes
from this exam state: “We will have him go back to work with some restrictions.” Id. at
HART271. Consistent with this statement, Dr. Roushdy completed a Report of Workability
form specifying that Broderick could return to work on December 16, 2014 with restrictions. Id.
at HART278. Specifically, Broderick was restricted to working four hours per day, 20 hours per
week for four weeks, and was restricted from lifting, carrying, pushing or pulling anything over
20 pounds. Id. The Report of Workability form included a section titled “Permanent
Disability,” which gives the physician the option of answering “Yes,” “No,” or “Undetermined.”
Id. Dr. Roushdy left this portion of the form blank. Id.
Due to the holidays, Xcel did not schedule Broderick to return to work until January 19,
2015. Id. at HART283. On January 8, 2015, Dr. Roushdy completed another Report of
Workability form for Broderick, stating that he could return to work with restrictions on January
19, 2015. Id. at HART279. Dr. Roushdy again restricted Broderick to working four hours per
day, 20 hours per week for four weeks; restricted him from lifting, carrying, pushing or pulling
anything over 20 pounds; and left the“Permanent Disability” portion of the form blank. Id.
On January 12, 2015, before he had resumed work at Xcel, Broderick had a follow-up
appointment with Dr. Roushdy. Id. at HART268. At that appointment, Broderick complained of
neck pain and stated there was a “new feeling of numbness and tingling” in his arms. Id. He
described his pain level as 6 on a 10-point scale. Id. Dr. Roushdy recommended that Broderick
continue taking the opioid pain medication that had already been prescribed to him at the time of
the RFA procedure, and to also take 600 mg of Advil three times per day for 14 days. Id. at
On February 5, 2015, Dr. Roushdy approved an early refill of Broderick’s pain
medication due to his increased pain. Id. at HART267. The next day, Dr. Roushdy completed a
Report of Workability form ordering Broderick to be completely off work from February 4 to
February 16, 2015. Id. at HART280. No other restrictions were imposed. Id. In the
“Permanent Disability” section of the form, Dr. Roushdy checked the answer for
On February 16, 2015, Broderick reported “unbearable” neck pain at a follow-up exam
with Dr. Roushdy. HART265. Broderick told Dr. Roushdy that he had been doing well and
returned to work, but that about 10 days ago he began experiencing pain. He described his pain
level as 7 out of 10. Id. After examining Broderick, Dr. Roushdy completed a Report of
Workability form ordering him to be off work for six weeks beginning February 16, 2015.
HART281. No weight restrictions were imposed, and the “Permanent Disability” portion of the
form was left blank. Id. Dr. Roushdy also ordered Broderick to undergo a work hardening
program. Id. at HART266, HART281.
On March 27, 2015, Broderick returned to Dr. Roushdy to discuss work forms given his
cervical pain. Id. at HART262. Broderick reported his pain level at this appointment at 7 out of
10. Id. He informed Dr. Roushdy that he had been doing physical therapy and would be starting
the work hardening program that day. Id. Dr. Roushdy stated that he would “adjust
[Broderick’s] workability according to what the PT schedule[d].” On April 14, 2015, Dr.
Roushdy refilled Broderick’s opioid pain medication. Id. at HART261.
On May 7, 2015, Broderick came to Dr. Roushdy’s office “without any appointment
demanding to discuss his care.” Id. at HART282. Broderick informed Dr. Roushdy’s staff that
he “needed a workability to return to work without restrictions for four hours per day due to
training at work, that was required for him to be at.” Id. Dr. Roushdy noted:
Mr. Broderick had the radiofrequency ablative procedure followed by
a slow return to work with limitations as far as hours. He was unable
to tolerate that. A work hardening program was ordered but he was
unable to do it due to the extreme physical demands. As a result I
took him off work a few months ago. . . . He initially wanted to have
a renewal of his hydrocodone/acetaminophen which was done. He
later on said that he does not need this prescription renewed once
more. Patient kept arguing the issue of workability. . . . Mr.
Broderick kept on asking for a dictated letter as to what was done
before. . . .
I advised him that I did take him off work because of the possibility
for soft tissue injury however he would certainly need to go back to
some kind of rebuilding of his muscle function through physical
therapy even though it might be spaced out enough to allow
rebuilding of the muscles of his neck as a result of the injury that he
suffered previously. I advised patient that this is the extent of what
I can do for him and also that I am willing to provide any further
information once needed by his insurance company to optimize his
C. Long Term Disability Claim Denial
After Broderick’s RFA procedure in early December 2014, Hartford sent Dr. Roushdy a
form that it had created to elicit Dr. Roushdy’s opinion about Broderick’s “ability to return to
work (either at his present occupation or any other occupation) based on the results of this recent
procedure.” Id. at HART251. The form stated in relevant part:
Based on your most recent physical exam, please address the following:
Please advise if in your opinion Mr. Broderick has the functionality
needed for Sedentary Work as defined below on a full-time basis (8
hours a day, 5 days a week) . . .
_____ I agree that Mr. Broderick is currently able to perform
Sedentary Work on a full-time basis.
_____ I disagree that Mr. Broderick is currently able to perform
Sedentary Work on a full-time basis.
Please advise if in your opinion Mr. Broderick has the functionality
needed to for Sedentary Work as defined below on a part-time basis
(4 hours a day, 5 days a week).
_____ I agree that Mr. Broderick is currently able to perform
Sedentary Work on a part-time basis.
_____ I disagree that Mr. Broderick is currently able to perform
Sedentary Work on a part-time basis.
Id. at HART251–52. In a reply signed on December 29, 2014 but not faxed until January 13,
2015, Dr. Roushdy indicated through check marks on the form that Broderick was currently able
to perform both full-time and part-time sedentary work. Id. at HART250–53. Dr. Roushdy
made no mention of the Report of Workability forms he had completed on December 15, 2014
and January 8, 2015 that restricted Broderick to working four hours per day, 20 hours per week
for four weeks. See id. Thus, at the time Hartford received the form from Dr. Roushdy on
January 13, 2015, it was not aware of the restrictions he had imposed on Broderick’s return to
By letter dated January 14, 2015, Hartford terminated Broderick’s LTD benefits as of
December 29, 2014. Id. at HART153–60. Relying on the form Dr. Roushdy had signed on
December 29, Hartford determined that Broderick could resume full-time sedentary work. Id. at
D. Appeal of Claim Denial
Broderick appealed from the termination of his LTD benefits by letter dated May 19,
2015. Id. at HART297. In the letter, Broderick explained that Dr. Roushdy had restricted him to
returning to work part time on December 16, 2014, that he returned to work January 19, 2015
pursuant to his employment arrangement with Xcel, and that his pain increased and he again
stopped working. Id. Broderick further stated that he attended four sessions of a work hardening
program provided by the Courage Kenny Allina clinics that resulted in increased pain, and the
program therapist, Chris Hallenberg, advised him that he was “unable to work any occupation
for an extended amount of time.” Id. Broderick also stated that he “followed up with Dr.
Roushdy at Advanced Spine Clinic and he took me out of work permanently following the
advice of the therapist. I would have documentation available as requested.” Id. Upon
receiving the appeal, Hartford sent Broderick a May 27, 2015 letter requesting him to complete
authorization forms so that Hartford could obtain the information necessary to evaluate his
appeal. Id. at HART151.
On June 3, 2015, during Hartford’s investigation of Broderick’s appeal, Xcel sent
Hartford an email summarizing Broderick’s return to work afer his RFA procedure. Id. at
HART283. The email explained that “[o]n 12/16/14 we received a release for [Broderick] to
return to work at 4 hours per day, 5 days per week. Due to the holidays, we were not able to
bring him back to work until 1/19/15. It was anticipated that after one month of working part
time he would be able to work full-time hours. However, on 2/4/15 we received a note from his
doctor taking him off of work completely. He has not been at work since 2/3/15.” Id. Attached
to the email were Broderick’s medical records from Dr. Roushdy’s office in 2015, including the
Report of Workability forms showing that Dr. Roushdy had ordered Broderick to return to parttime work in January, had taken him off work completely in February, and had also ordered a
work hardening program for him in February. Id. at HART287–96.
Upon receiving this information, the Appeal Specialist at Hartford noted the discrepancy
between these medical records and the form signed by Dr. Roushdy on December 29, 2014
stating that Broderick could perform part-time and full-time sedentary work. Id. at HART41.
On June 10, 2015, the Appeal Specialist faxed a form to Dr. Roushdy that stated in relevant part:
We are reviewing a Long Term Disability claim for Mr. Michael
Broderick. We have attached a copy of correspondence that you
completed on December 29, 2014. Have there been any changes to
the information you provided on December 29, 2014?
If yes, please provide our office with a list of these changes:
The date the changes became applicable ___________
Please provide any medical records that will support your clinical
rationale for any applicable changes.
Id. at HART248. Dr. Roushdy circled the word “No,” and wrote “last visit 3/27/15" next to the
circled answer. Id. In the space below the sentence requesting medical records, Dr. Roushdy
wrote, “He was last seen in our office 3/27/15.” Id. He signed the form, dated it June 19, 2015,
and returned it by fax on June 23, 2015. Id.
Hartford also received from Dr. Roushdy’s office Broderick’s medical records from
October 2014 to present. Id. at HART255–82. The medical records included Dr. Roushdy’s
exam notes from Broderick’s office visits, records of Broderick’s prescription refills, and the
Report of Workability forms completed by Dr. Roushdy in December 2014, January 2015, and
February 2015. Id.
On June 29, 2015, Hartford’s Appeal Specialist sent Broderick a letter informing him that
Hartford was upholding the decision to terminate Broderick’s LTD benefits. Id. at
HART142–46. The letter summarized the office visit notes and Report of Workability forms
that Hartford had received from Dr. Roushdy. Id. at HART143–44. The letter also referenced
the form Dr. Roushdy signed on December 29, 2014 stating that Broderick was capable of
performing both full time and part time sedentary work, and the form Dr. Roushdy signed on
June 19, 2015. Hartford interpreted the June 19 form as confirming “that there had been no
changes to his assessment of [Broderick’s] functionality on December 29, 2014.” Id. at
HART144. The letter stated that Hartford was denying Broderick’s appeal because:
The weight of the medical evidence indicates that you were capable
of performing full time sedentary work effective December 29, 2014.
. . . Although we understand that you have ongoing symptoms that
you believe precludes [sic] you from working, the medical evidence
does not support that these symptoms are of such severity that you
would be precluded you [sic] from performing Your Occupation
effective December 29, 2014 and Any Occupation effective January
Following a complete review of the information in your claim file,
including your physician’s opinions and your subjective complaints,
the Hartford’s Appeal Unit finds that you do not meet the Policy
definition of Disability beyond December 2014 since you are longer
[sic] precluded from performing the Essential Duties of Your
Id. at HART145.
Although the letter referenced the Report of Workability forms, it did not explain why the
forms were discredited. Nor did the letter include an analysis of the medical evidence or the
reason for concluding that the weight of such evidence supported the conclusion that Broderick
was no longer disabled as of December 29, 2014.
E. Present Action
On December 8, 2015, Broderick filed this action under the Federal Employee
Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”), seeking to
overturn Hartford’s decision to terminate his LTD benefits. The parties have filed cross motions
for summary judgment.
A. Summary Judgment Standard
Rule 56(c) of the Federal Rules of Civil Procedure provides that summary judgment shall
be rendered if there exists no genuine issue as to any material fact and the moving party is
entitled to judgment as a matter of law. On a motion for summary judgment, the court views the
evidence in the light most favorable to the nonmoving party. Ludwig v. Anderson, 54 F.3d 465,
470 (8th Cir. 1995). However, the nonmoving party may not “rest on mere allegations or denials
but must demonstrate on the record the existence of specific facts which create a genuine issue
for trial.” Krenik v. Cty. of Le Sueur, 47 F.3d 953, 957 (8th Cir. 1995).
If evidence sufficient to permit a reasonable jury to return a verdict in favor of the
nonmoving party has been presented, summary judgment is inappropriate. Id. However, “the
mere existence of some alleged factual dispute between the parties is not sufficient by itself to
deny summary judgment. . . . Instead, ‘the dispute must be outcome determinative under
prevailing law.’” Get Away Club, Inc. v. Coleman, 969 F.2d 664, 666 (8th Cir. 1992) (citation
omitted). “[S]ummary judgment need not be denied merely to satisfy a litigant’s speculative
hope of finding some evidence that might tend to support a complaint.” Krenik, 47 F.3d at 959.
B. Abuse of Discretion Standard
Under ERISA, a plan participant or beneficiary may seek judicial review of a denial of
benefits by the plan administrator. 29 U.S.C. § 1132(a)(1)(B). When benefits have been denied
to a plan participant, the plan administrator must “set forth the specific reasons for such denial,
written in a manner calculated to be understood by the participant,” and must afford the plan
participant a “full and fair review by the appropriate named fiduciary of the decision denying the
claim.” 29 U.S.C. § 1133.
The Supreme Court has held that when a plan gives an administrator discretionary
authority to determine eligibility for benefits or to construe the terms of the plan, an
administrator’s decision is to be reviewed under the abuse of discretion standard. Firestone Tire
& Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989); King v. Hartford Life & Acc. Ins. Co., 414
F.3d 994, 998–99 (8th Cir. 2005) (en banc). Hartford’s LTD plan includes the following
language: “We have full discretion and authority to determine eligibility for benefits and to
construe and interpret all terms and provisions of The Policy.” AR at HART17. The parties
agree that this language confers discretion upon Hartford and that the abuse of discretion
standard of review applies.
Under the abuse-of-discretion standard, a court examines whether the plan
administrator’s decision was reasonable. Willcox v. Liberty Life Assur. Co. of Boston, 552 F.3d
693, 700 (8th Cir. 2009). A plan administrator’s decision must be affirmed if a “reasonable
person could have reached a similar decision, given the evidence before him, not that a
reasonable person would have reached that decision.” Prezioso v. Prudential Ins. Co. of Am.,
748 F.3d 797, 805 (8th Cir. 2014) (quoting Ferrari v. Teachers Ins. & Annuity Ass’n, 278 F.3d
801, 807 (8th Cir. 2002) (emphases in original)).
Although the abuse of discretion standard is deferential, it is “not tantamount to rubberstamping the result.” Torres v. UNUM Life Ins. Co. of Am., 405 F.3d 670, 680 (8th Cir. 2005).
A reasonable decision must be supported by substantial evidence. Id.; Wise v. Kind & Knox
Gelatin, Inc., 429 F.3d 1188, 1190 (8th Cir. 2005). “Substantial evidence is more than a mere
scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to
support a conclusion. Both the quantity and quality of evidence may be considered.” Norris v.
Citibank, N.A. Disability Plan (501), 308 F.3d 880, 884 (8th Cir. 2002). Additionally, “an
administrator cannot simply ignore relevant evidence or ‘arbitrarily refuse to credit a claimant’s
reliable evidence.’” Waldoch v. Medtronic, Inc., 757 F.3d 822, 833 (8th Cir. 2014) (quoting
Willcox, 552 F.3d at 701) (quoting in turn Black & Decker Disability Plan v. Nord, 538 U.S.
822, 834 (2003)).
1. Lack of Substantial Evidence
Broderick argues that Hartford’s decision to uphold the denial of his LTD benefits is an
abuse of discretion because it is based solely on two confusing and ambiguous pieces of
evidence: 1) the form signed by Dr. Roushdy on December 29, 2014 that contradicted
Broderick’s medical records and the work restrictions imposed by Dr. Roushdy, and 2) the form
signed by Dr. Roushdy on June 19, 2015 that failed to clarify his December 29, 2014 opinion.
Broderick contends the quantity and quality of these two documents are insufficient to constitute
substantial evidence that Hartford’s decision was reasonable. The Court agrees.
With respect to quality, the December 29, 2014 form plainly contradicts Dr. Roushdy’s
own work restrictions that were in place for Broderick at that time. Two weeks before signing
the December 29 form, Dr. Roushdy restricted Broderick to part-time work for the next four
weeks. Hartford argues that Dr. Roushdy’s opinion on December 29 that Broderick could work
full time is attributable to the marked improvement Broderick reported during his December 15,
2014 exam. However, Dr. Roushdy was aware of this improvement at the time he imposed the
four-week work restriction. Nothing transpired in the two weeks after the December 15
appointment that would have caused Dr. Roushdy on December 29 to alter his earlier opinion
that Broderick was not capable of returning to full-time work for four weeks. Had Dr. Roushdy
thought on December 15 that Broderick’s improvement warranted only a two-week work
restriction he could have imposed this shorter restriction, but he did not. Further diminishing the
quality of the December 29 form—which was a Hartford form completed by Dr. Roushdy—is
that Dr. Roushdy indicated that Broderick could perform both full-time and part-time work. This
answer, particularly when viewed together with Dr. Roushdy’s December 15 work restrictions,
required further explanation from Dr. Roushdy about the meaning of this confusing response.
Yet Dr. Roushdy provided no explanation, analysis, or reasoning in the December 29, 2014 form
for why he indicated that Broderick was, on that day, capable of performing sedentary work on a
full-time and part-time basis. Therefore, the December 29, 2014 form is not “such relevant
evidence as a reasonable mind might accept as adequate to support a conclusion” that Broderick
was no longer disabled as of that date. Norris, 308 F.3d at 884.
The quality of the June 19, 2015 form from Dr. Roushdy fares no better. That form was
elicited from Hartford based on its review of some of Broderick’s medical records and the
realization that Dr. Roushdy’s December 29 form stating Broderick was capable of full-time
work was at odds with the work restrictions he had imposed on January 8, 2015, February 6,
2015, and February 16, 2015. See AR at HART41. Hartford concedes that the December 29
form “required further investigation.” Def.’s Reply Mem. Supp. Summ. J. [Docket No. 29] at 4.
The June 19 form asked Dr. Roushdy to indicate “No” or “Yes” to whether there had “been any
changes to the information [he] provided on December 29 2014, ” and “[i]f yes, please provide
our office with a list of these changes.”1 AR at HART248. Dr. Roushdy’s “No” answer, without
further explanation, fails to shed light on the confusion that Hartford was attempting to clarify.
If nothing had changed since Dr. Roushdy’s December 29, 2014 form stating Broderick was
It is not certain if Dr. Roushdy interpreted this question to mean (1) whether Dr.
Roushdy had changed his opinion on whether Broderick was able to perform sedentary work on
a full-time basis in December 2014, or (2) whether Broderick’s ability to perform full-time work
had changed since December 2014.
capable of full-time sedentary work, why had Dr. Roushdy limited him to part-time work in
January 2015 and taken him off work completely in February 2015? Why had he indicated on
February 6, 2015 that it was “undetermined” whether Broderick had a permanent disability and
ordered a work hardening program on February 16, 2015? Why did he continue to refill, and at
times increase, Broderick’s opioid pain medication? Why was he willing in March 2015 to
adjust Broderick’s workability to what the physical therapist scheduled? Why had he noted in
May 2015 that Broderick’s RFA procedure was followed by a slow return to work with
limitations as to the number of hours worked and that Broderick was unable to tolerate that?
Because the June 19, 2015 form fails to answer any of these questions, it also is not “such
relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”
Norris, 308 F.3d at 884; see also Torres, 405 F.3d at 681–82 (holding that a plan administrator’s
failure to probe issues that were directly relevant to plaintiff’s disability determination
constituted abuse of discretion).
The quantity of the evidence relied on by Hartford to conclude that Broderick was
capable of full-time sedentary work—namely, the two fill-in-the-blank forms created by
Hartford and signed by Dr. Roushdy in December 2014 and June 2015—is nowhere near the
amount of evidence showing Broderick was restricted from full-time sedentary work on
December 29, 2014, and in the months that followed. Dr. Roushdy’s exam notes and Report of
Workability forms consistently show that he had restricted Broderick from returning to full-time
sedentary work from December 15, 2014 until at least the end of March, and had ordered a work
hardening program for Broderick following a failed attempt to return to work. Rather than
probing this relevant, considerable evidence and attempting to reconcile it with Dr. Roushdy’s
conflicting forms, Hartford seized on Dr. Roushdy’s circling the word “no” on a form in June
2015 indicating that nothing had changed since December 2014, and accepted the answer
without explanation. “[W]here the evidence in support of the decision does not ring true and is
so overwhelmed by contrary evidence, the administrative decision is unreasonable and will not
stand.” Donaho v. FMC Corp., 74 F.3d 894, 901 (8th Cir. 1996). Given the amount of evidence
to the contrary, a reasonable mind would not have accepted Dr. Roushdy’s unexplained
responses on Hartford’s two forms as adequate to conclude that Broderick was capable of fulltime sedentary work on December 29, 2014.
Hartford contends that in addition to Dr. Roushdy’s responses on the forms, the decision
to terminate benefits was supported by medical records showing that Broderick’s subjective
complaints of pain were not corroborated by objective evidence. For example, Dr. Roushdy’s
exam notes consistently found no acute distress, observed no physical indicia of pain, swelling or
tenderness, and characterized Broderick’s prognosis as “much resolved.” See, e.g.,
HART262–63, 265–66. However, Hartford’s June 29 appeal letter did not specifically articulate
this as a reason for denying his appeal.2 Nor do the Hartford Appeal Specialist’s file notes make
any mention of uncorroborated complaints of pain or a lack of objective evidence. A plan
administrator is required to set forth the specific reason for the denial of plan benefits, and a
The appeal letter states that “[a]lthough we understand that you have ongoing symptoms
that you believe precludes [sic] you from working, the medical evidence does not support that
these symptoms are of such severity that you would be precluded from performing Your
Occupation effective December 29, 2014 and Any Occupation effective January 14, 2015.”
HART145. Aside from simply reciting Broderick’s medical records, the letter provides no
analysis of the medical evidence and no explanation for why Broderick’s symptoms were not
sufficiently severe to preclude him from performing full-time sedentary work.
reviewing court must not consider “post hoc rationales.” King, 414 F. 3d at 999; Marolt v.
Alliant Techsys., Inc., 146 F.3d 617, 620 (8th Cir. 1998) (“We will not permit ERISA claimants
denied the timely and specific explanation to which the law entitles them to be sandbagged by
after-the-fact plan interpretations devised for purposes of litigation.”).3
For these reasons, Hartford’s decision denying Broderick’s benefits was not supported by
2. Ignoring Relevant Evidence
In addition to lacking the substantial evidence required to support its decision to deny
benefits, Hartford also ignored the many medical records that contradict its conclusion that
Broderick was capable of performing full-time work on December 29, 2014. “A plan
administrator abuses its discretion when it ignores relevant evidence.” Willcox, 552 F.3d at 701.
A plan administrator may not “focus on slivers of information that could be read to support a
denial of coverage and ignore—without explanation—a wealth of evidence that directly
contradict[s] [the] basis for denying coverage.” Id. at 702 (quoting Metropolitan Life Ins. Co. v.
Conger, 474 F.3d 258, 265 (6th Cir 2007) (emphases in original)).
Hartford argues that its June 29 letter denying Broderick’s appeal cited all of the medical
records it had received from Dr. Roushdy, which shows that Hartford considered and did not
ignore this evidence. While Hartford did recite Dr. Roushdy’s exam notes and Report of
Workability forms in the letter denying Broderick’s appeal, the letter fails to analyze this
Hartford also argues that it had reason to conclude that Broderick was exaggerating his
impairments and that he had misrepresented his work restrictions to Hartford, which reasonably
supports the conclusion that he was capable of resuming full-time work. These reasons were not
in any way articulated in the appeal letter or file notes, and the Court will not consider them here.
contradictory evidence or to provide any reason for why it was rejected.
Hartford also contends that it had no obligation to interpret the evidence in Broderick’s
favor, and that it was within Hartford’s discretion to resolve any factual discrepancies relating to
Broderick’s functional capacity. Again, however, the appeal letter lacks any explanation for how
the factual inconsistencies were resolved and why Dr. Roushdy’s confusing and unexplained
answers on the December 29, 2014 and June 19, 2015 forms were credited over his Report of
Workability forms and exam notes showing that Broderick was not capable of performing fulltime sedentary work.
Hartford relies on Wakkinen v. UNUM Life Ins. Co., 531 F.3d 575, 583 (8th Cir. 2008)
to argue that where a treating physician finds a claimant is not disabled but then issues a
contradictory opinion, the plan administrator has discretion to resolve the conflict against a
conclusion of disability. In Wakkinen, the claimant’s treatment records showed that his treating
physician had urged him to return to work just days before determining him to be disabled. Id.
Because the treating physician’s conclusion regarding disability was contradicted by his own
treatment records, the Eighth Circuit found that it was not unreasonable for the plan
administrator to reject the treating physician’s conclusion. Id. Here, as in Wakkinen, Dr.
Roushdy’s December 29, 2014 and June 19, 2015 conclusions regarding Broderick’s disability
as of December 29, 2014 are contradicted by his own treatment records showing that he had
restricted Broderick from full-time work at that time and beyond. Yet instead of rejecting Dr.
Roushdy’s conclusions for being at odds with his treatment records, as was done in Wakkinen,
Hartford chose to rely on those conclusions. Thus, Wakkinen undermines Hartford’s position
because it holds that a treating physician’s conclusion regarding disability may be rejected as
unreliable if the conclusion is contradicted by the physician’s own treatment records.
In sum, Hartford failed to provide Broderick a full and fair review of the decision
denying his LTD benefits. 29 U.S.C. § 1133. Its decision to uphold the denial of Broderick’s
LTD benefits is unsupported by substantial evidence and ignores relevant evidence that directly
contradicts Hartford’s basis for denying coverage. Thus, Hartford’s decision to terminate
Broderick’s LTD claim effective December 29, 2014 is an abuse of discretion and must be
In addition to asking this Court to overturn the termination of his LTD benefits,
Broderick seeks an order requiring Hartford to pay all LTD benefits owed to him at this time and
to begin paying him monthly LTD benefits as allowed by the policy. The parties have not
briefed the issue of whether this remedy is appropriate. Where an insurer has violated 29 U.S.C.
§ 1133(2)’s requirement to provide a full and fair review, the appropriate remedy is normally a
remand for reconsideration. Jalowiec v. Aetna Life Ins. Co., 155 F. Supp. 3d 915, 948–49 (D.
Minn. 2015) (citing Brown v. J.B. Hunt Transp. Servs., Inc., 586 F.3d 1079, 1087 (8th Cir.
2009)). Although Hartford clearly abused its discretion in denying Broderick’s claim, the Court
is not presently able to determine whether the remedy should be a remand or the award of
benefits (and if so, what amount is appropriate). The parties shall schedule a status conference
with Magistrate Judge Franklin L. Noel to discuss whether the case should: 1) be remanded to
Hartford, 2) remain with the Court for further briefing on the appropriate remedy, or 3) whether
the parties can reach a settlement.
Broderick also requests an award of attorney’s fees and costs pursuant to 29 U.S.C. §
1132(g)(1), which provides that “the court in its discretion may allow a reasonable attorney’s fee
and costs of action to either party.” The Eighth Circuit has held that there is no presumption in
favor of a fee award for prevailing plaintiffs in ERISA cases. Martin v. Ark. Blue Cross & Blue
Shield, 299 F.3d 966, 969–72 (8th Cir. 2002). The issue of attorney’s fees shall be among the
items discussed during the status conference.
Based on the foregoing, and all the files, records and proceedings herein, IT IS
HEREBY ORDERED that:
Plaintiff Michael Broderick’s Motion for Summary Judgment [Docket No. 16] is
GRANTED IN PART as follows:
Plaintiff’s request for an order requiring Hartford to pay past, current and
future LTD benefits under the policy is RESERVED. The parties shall
schedule and participate in a status conference with the magistrate judge
to discuss the proper remedy.
Defendant Hartford Life and Accident Insurance Company’s denial of
Plaintiff’s claim for LTD benefits is REVERSED because it was not
supported by substantial evidence and was an abuse of discretion.
Plaintiff’s request for an award of attorney’s fees and costs is
RESERVED. The parties shall discuss the issue of attorney’s fees and
costs during the status conference.
Defendant Hartford Life and Accident Insurance Company’s Motion for
Summary Judgment [Docket No. 20] is DENIED.
BY THE COURT:
s/Ann D. Montgomery
ANN D. MONTGOMERY
U.S. DISTRICT JUDGE
Dated: February 16, 2017.
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?