MINUTELLO v. HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY et al
Filing
33
MEMORANDUM OPINION & ORDER OF COURT granting 18 Motion for Summary Judgment and denying 23 Motion for Summary Judgment Signed by Judge Terrence F. McVerry on 8/12/2013. (kly)
MINUTELLO v. HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY et al
Doc. 33
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
THERESA R. MINUTELLO,
Plaintiff,
v.
HARTFORD LIFE AND ACCIDENT
INSURANCE COMPANY,
Defendant.
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2:12-cv-01240
MEMORANDUM OPINION
The instant action involves a plan administrator’s termination of long-term disability
benefits previously paid to a plan participant over the course of ten years. Before the Court for
disposition are the Defendant’s MOTION FOR SUMMARY JUDGMENT (ECF No. 18), the
Defendant’s Brief in Support of Motion for Summary Judgment (ECF No. 19), the Defendant’s
Concise Statement of Material Facts (ECF No. 20), the Plaintiff’s MOTION FOR SUMMARY
JUDGMENT (ECF No. 23), the Plaintiff’s Brief in Support of Motion for Summary Judgment
(ECF No. 22), the Plaintiff’s Concise Statement of Material Facts (ECF No. 24), the Defendant’s
Response in Opposition to the Plaintiff’s Motion for Summary Judgment (ECF No. 27), the
Defendant’s Response to the Plaintiff’s Concise Statement of Material Facts (ECF No. 28), and
the Plaintiff’s Response to the Defendant’s Motion for Summary Judgment (ECF No. 32). For
the reasons that follow, the Defendant’s Motion for Summary Judgment will be granted, and the
Plaintiff’s Motion for Summary Judgment will be denied.
I.
Background
Plaintiff Theresa R. Minutello (“Minutello”) was born on February 13, 1960. ECF No.
17 at 1. In 1979, at the age of nineteen, she started to work as an Assistant Manager for the
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Holiday Inn. ECF Nos. 24 & 28 at ¶ 1. On December 22, 1986, Starwood Hotels & Resorts
Worldwide, Inc. (“Starwood”), hired Minutello to work as an Assistant Banquet Manager. ECF
Nos. 20 & 32 at ¶ 1.
Defendant Hartford Life and Accident Insurance Company (“Hartford”) administers a
Group Benefit Plan (“Plan”) available to Starwood employees. ECF No. 17-2. The Plan
provides long-term disability benefits to eligible employees pursuant to the terms of Group
Insurance Policy GLT-673050 (“Policy”). Id. at 5. The language of the Policy that define the
terms “disability” and “disabled” provides as follows:
Disability or Disabled means that during the Elimination Period and for the next
18 months you are prevented by:
1.
accidental bodily injury;
2.
sickness;
3.
Mental Illness;
4.
Substance Abuse; or
5.
pregnancy,
From performing one or more of the Essential Duties of Your Occupation, and as
a result your Current Monthly Earnings are no more than 80% of your Predisability Earnings.
After that, you must be so prevented from performing one or more of the
Essential Duties of Any Occupation.
Your failure to pass a physical examination required to maintain a license to
perform the duties of Your Occupation does not alone mean that you are
Disabled.
Id. at 25. The term “Your Occupation” is defined as a particular individual’s “occupation as it is
recognized in the general workplace,” and “does not mean the specific job [that he or she is]
performing for a specific employer or at a specific location.” Id. at 28. The Policy defines the
term “Any Occupation” as “an occupation for which [an individual is] qualified by education,
training or experience,” and that has an “earnings potential” exceeding an amount calculated in
2
accordance with specified terms. Id. at 24. Hartford has “full discretion and authority to
determine eligibility for benefits and to construe and interpret all terms and provisions of the
Group Insurance Policy.” Id. at 17. As an employee of Starwood, Minutello participated in the
Plan. ECF Nos. 20 & 32 at ¶ 2.
In June 2001, Minutello was examined by her family physician, Dr. Gurmit Singh, and
her rheumatologist, Dr. Angela M. Stupi. ECF Nos. 20 & 32 at ¶ 7. She complained of fatigue,
joint pain, myalgia, night sweats, exhaustion, and fevers. Id. Dr. Singh determined that
Minutello was suffering from Mixed Connective Tissue Disease, Systematic Lupus
Erythematosis (“SLE”), and Raynaud’s Disease. Id. Minutello applied for long-term disability
benefits on December 18, 2001, contending that she was “disabled” within the meaning of the
Policy. Id. at ¶ 9. Her application was supported by a statement provided by Dr. Singh. Id.
Hartford approved Minutello’s application for benefits. ECF Nos. 20 & 32 at ¶ 10.
Maryann Iannettone (“Iannettone”), an Examiner for Hartford, communicated the approval to
Minutello in a letter dated February 1, 2002. ECF No. 17-1 at 862-863. Although Minutello was
deemed to be disabled because of her inability to perform the essential duties of her own
occupation, Iannettone’s letter explained that the more demanding “Any Occupation” standard
would apply as of June 2, 2003. Id. at 863. Minutello was informed that, regardless of her
condition, no benefits would be payable beyond February 12, 2027. Id. The amount of her
monthly payment was set at $2,400.76. Id. at 864.
A participant seeking benefits under the Plan must apply for benefits under the Social
Security Act [42 U.S.C. §§ 401-433, 1381-1383f] when the duration of his or her disability
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“meets the minimum duration required to apply for such benefits.”1 ECF No. 17-2 at 16.
Minutello was instructed to apply for Social Security disability benefits if she had not already
done so. ECF No. 17-1 at 863. In a decision rendered on February 17, 2002, the Social Security
Administration (“SSA”) determined that Minutello had become statutorily “disabled” on June 1,
2001. Id. at 1093. She was advised that benefits under the Social Security Act would be
forthcoming. Id.
After investigating Minutello’s condition further, Hartford determined that she was
“disabled” under the “Any Occupation” standard. ECF Nos. 20 & 32 at ¶ 12. Consequently,
Minutello’s benefits under the Plan continued beyond June 2, 2003. ECF No. 17-1 at 1061. On
June 7, 2005, Minutello verified that nobody in her family had an alternative source of income or
an interest in a business. Id. at 42. Between 2007 and 2009, Dr. Singh submitted annual
statements to Hartford supporting Minutello’s continued eligibility for benefits. ECF Nos. 20 &
32 at ¶ 14. Minutello periodically detailed her abilities and limitations in response to inquiries
made by Hartford. Id. at ¶ 15.
At some point, Minutello complained of progressive memory problems. ECF Nos. 20 &
32 at ¶ 17. On October 21, 2009, Dr. Hassan Hassouri performed a neurological examination of
Minutello to determine whether she was suffering from a memory impairment. Id. at ¶ 16. He
recommended that neuropsychometric testing be conducted to ascertain any deficits that she may
have had in specific areas. Id. An outpatient neuropsychological assessment was performed by
Dr. Tad Gorske on March 2, 2010. Id. at ¶ 17. In most respects, the assessment yielded normal
results. Id. at ¶ 18. Although Minutello’s cognitive scores were consistent with those of patients
suffering from autoimmune disorders, Dr. Gorske suggested that such cognitive difficulties were
1
A claimant attempting to secure Social Security disability benefits must satisfy the Social Security Act’s twelvemonth durational requirement. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A); Barnhart v. Walton, 535 U.S. 212, 214222, 122 S.Ct. 1265, 152 L.Ed.2d 330 (2002).
4
attributable to anxiety and depression. Id. at ¶ 19. A magnetic resonance imaging (“MRI”) scan
was recommended to rule out intracranial pathology. Id. at ¶ 20. Dr. Gorske also advised
Minutello to “seek out a course of psychotherapy to work on stress management.” Id. Minutello
apparently declined to follow Dr. Gorske’s recommendations. Id.
A participant’s payments under the Plan must be decreased by any amounts received
under the Social Security Act. ECF No. 17-2 at 10, 26. Minutello contacted Hartford personnel
on March 17, 2010, to advise that her daughter, Jacqueline Minutello (“Jacqueline”), had reached
the age of eighteen and would soon graduate from high school. ECF No. 17-1 at 43; ECF Nos.
24 & 28 at ¶ 11. These developments evidently decreased the amount of Minutello’s payments
from the SSA, requiring Hartford to increase the amount of her long-term disability benefits
under the Plan. Id. On May 18, 2010, the SSA sent Hartford a fax confirming the change in
Minutello’s benefits under the Social Security Act. ECF No. 17-1 at 43.
Minutello’s file was referred to Hartford’s Special Investigations Unit (“SIU”) on May
27, 2010. ECF Nos. 24 & 28 at ¶ 13. Hartford’s documentary record of the referral reads as
follows:
Siu Referral: Clmt adv HIG on 6/7/2005 that her and her family do not have any
income or interest in any business. Internet research shows that clmt’s spouse
possibly owns Minutello’s Restaurant and Lounge. This is possibly the
restaurant/lounge that clmt worked at prior to her employment w policy holder.
All APS in file are exactly the same. When prior examier’s called to speak to
clmt . . . clmt is very hard to reach. mj
ECF No. 17-1 at 42. The notation was recorded by Maurice R. Jones (“Jones”), who worked as
an Examiner for Hartford. Id. Further internet research apparently led Hartford’s investigators
to believe that Minutello was a shareholder of Allou Services Corporation, which operated out of
the same location as the restaurant mentioned in Jones’ notation. ECF Nos. 20 & 32 at ¶ 22.
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Hartford’s suspicions were increased by the fact that Minutello was difficult to reach at home.
Id. at ¶ 23.
Minutello was placed under video surveillance during the summer of 2010. ECF Nos. 20
& 32 at ¶¶ 25-32. Videotaped footage taken on June 9, 2010, and July 20, 2010, depicted
Minutello walking without assistance, shopping on her own, and carrying bags of groceries. Id.
at ¶¶ 26, 29-31. Additional footage taken on July 19, 2010, depicted Minutello and her daughter
lifting a large desk from a van and carrying it into their garage. Id. at ¶ 28. Minutello was
shown engaging in these activities in a free and agile manner. Id. at ¶ 32.
James M. Fitzgerald (“Fitzgerald”), a Hartford representative, interviewed Minutello in
her home on November 29, 2010. ECF No. 17 at 47-67. Although Minutello confirmed that her
husband owned Minutello’s Restaurant and Lounge, she asserted that she did not work there. Id.
at 53. During the interview, Minutello stated that she suffered from substantial exhaustion, and
that she was typically forced to spend two or three days per week in bed. ECF Nos. 20 & 32 at ¶
35. Minutello also complained of cognitive impairments. Id. She told Fitzgerald that, on a good
day, she could engage in a wide range of activities for short periods of time. Id. at ¶ 36.
Minutello acknowledged that she could sometimes drive or shop for up to two hours. Id. at ¶ 37.
After listening to Minutello’s description of her daily activities, Fitzgerald informed her of the
surveillance videos and showed her the relevant recordings. Id. at ¶ 38. While watching the
surveillance videos, Minutello suggested that they accurately reflected her average level of
functionality. Id. The interview lasted for almost four hours. Id. at ¶ 39. Fitzgerald observed
that Minutello had completed the interview without displaying signs of physical discomfort, and
that she had articulated her answers to his questions without difficulty. Id. He summarized his
findings in a written report. ECF No. 17 at 47-67.
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Registered nurse Connie Behrle (“Behrle”), a Medical Case Manager for Hartford, sought
Dr. Singh’s updated assessment of Minutello’s abilities and limitations. ECF No. 17-1 at 132134. The request was communicated to Dr. Singh in a letter dated March 24, 2011. Id.
Enclosed with Behrle’s letter were duplicates of the surveillance videos and a copy of
Fitzgerald’s written report. Id. at 132. Dr. Singh was asked to review the additional evidence
provided by Hartford before rendering an opinion as to whether Minutello could perform the
duties of a full-time job. Id. at 132-134. Hartford never received a response from Dr. Singh.
ECF Nos. 20 & 32 at ¶ 41.
Under the terms of the Plan, a participant receiving benefits can be asked to submit to a
medical examination. ECF No. 17-2 at 7. A participant’s refusal to undergo such an
examination can result in the termination of his or her benefits. Id. at 9. Hartford asked
Minutello to undergo an independent medical examination for the purpose of determining
whether she could work. ECF No. 17-1 at 418. The examination was performed by Dr. Lloyd
K. Richless on May 31, 2011. ECF Nos. 20 & 32 at ¶ 42. Minutello told Dr. Richless that she
could do “anything” on a good day, but that she could not even get out of bed on a bad day. ECF
No. 17-1 at 411-412. The examination yielded no outward manifestations of physical
abnormalities. ECF Nos. 20 & 32 at ¶ 44. After completing the examination, Dr. Richless
opined that Minutello’s impairments would not prevent her from maintaining a full-time job.
ECF No. 17-1 at 415. In a written report describing his examination findings, Dr. Richless stated
that Minutello could “perform all functions of a 51-year-old female without accommodation.”
Id. He reported that if Minutello were to be employed on a full-time basis, her fatigue would
necessitate no more than one or two absences every two to three months. Id. Dr. Richless’
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assessment was based on the findings of his examination and the depictions of Minutello in the
surveillance videos. ECF Nos. 20 & 32 at ¶ 49.
Registered nurse Johanna Cobb (“Cobb”), the Medical Case Manager assigned to
Minutello’s case, forwarded the results of the independent medical examination to Dr. Singh on
June 9, 2011. ECF No. 17-1 at 126. Dr. Singh was asked to review Dr. Richless’ findings and
provide feedback. Id. Someone from Dr. Singh’s office contacted Hartford personnel on June
16, 2011, and expressed concerns about Dr. Richless’ “credentials” and “conclusion.” ECF No.
17 at 78. Although Dr. Singh was encouraged to articulate his concerns in a more detailed
manner, he never did so. ECF Nos. 20 & 32 at ¶ 51. Marvin Bryant (“Bryant”), a Vocational
Rehabilitation Counselor, assessed Minutello’s employment prospects in a written report dated
July 14, 2011. ECF No. 17-1 at 383-396. After reviewing evidence of Minutello’s medical and
vocational background, Bryant expressed the view that she could work as either a manager of a
liquor establishment or a reservations manager for a hotel or restaurant. Id. at 384.
Based on the results of Dr. Richless’ examination and Bryant’s vocational assessment,
Hartford decided to terminate Minutello’s long-term disability benefits. ECF Nos. 20 & 32 at ¶
54. Investigative analyst Jonathan Dennis (“Dennis”) communicated Hartford’s decision to
Minutello in a letter dated July 26, 2011. ECF No. 17-1 at 118-124. The letter advised that her
long-term disability benefits would not continue beyond July 25, 2011. Id. at 122. The
Employee Retirement Income Security Act of 1974 (“ERISA”) [29 U.S.C. § 1001 et seq.]
requires a letter denying a participant’s claim for benefits to “set[] forth the specific reasons for
such denial . . . in a manner calculated to be understood by the participant.” 29 U.S.C. §
1133(1). Dennis’ letter explained that the termination of Minutello’s benefits had been prompted
by the content of the surveillance videos, the results of Fitzgerald’s interview, the findings of Dr.
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Richless’ examination, and Bryant’s vocational assessment. ECF No. 17-1 at 118-124. It was
specifically noted that Dr. Singh had not responded to Hartford’s inquiries. Id. at 121-122. The
ERISA requires every covered employee benefit plan to provide “any participant whose claim
for benefits has been denied” with “a reasonable opportunity . . . for a full and fair review by the
appropriate named fiduciary of the decision denying the claim.” 29 U.S.C. § 1133(2). Minutello
was informed that she could appeal the decision terminating her benefits by writing a letter to
Hartford’s Claim Appeal Unit within 180 days. Id. at 123. Dennis notified Starwood of
Hartford’s decision to discontinue Minutello’s benefits. Id. at 125.
A regulation promulgated pursuant to the ERISA requires any letter denying a
participant’s request for benefits to include “[a] statement that the claimant is entitled to receive,
upon request and free of charge, reasonable access to, and copies of, all documents, records, and
other information relevant to the claimant’s claim for benefits.” 29 C.F.R. § 2560.503-1(j)(3).
Dennis’ letter to Minutello contained the required statement. ECF No. 17-1 at 123. On August
24, 2011, Minutello’s attorney sent the Claim Appeal Unit a written request for all pertinent
documents. ECF No. 17-1 at 376-377. Copies of the documents were apparently furnished to
Minutello. Through her counsel, Minutello appealed Hartford’s decision in a letter to the Claim
Appeal United dated October 19, 2011. Id. at 294-296. Enclosed with the letter was an updated
assessment form completed by Dr. Singh on September 30, 2011. Id. at 297-302. On the form,
Dr. Singh reported that Minutello could sit, stand or walk for only ten minutes at a time, equaling
less than two hours of an eight-hour workday. Id. at 299-300. He further opined that she could
never lift or carry objects weighing ten pounds or more, that she could rarely twist or stoop, and
that she needed to avoid all exposure to cold and hot temperatures, high humidity, sunlight, and
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ultraviolet light. Id. at 300-301. Dr. Singh predicted that Minutello would need to miss more
than four days of work per month if she were to be employed on a full-time basis. Id. at 301.
In order to resolve the appeal, Hartford asked Minutello to undergo a functional capacity
evaluation. ECF Nos. 20 & 32 at ¶ 66. The evaluation was performed by Mark A. Aaron
(“Aaron”), a physical therapist, on December 13, 2011. Id. at ¶ 67. After completing the
evaluation, Aaron opined that Minutello was physically capable of performing “light” work on a
full-time basis. Id. The Dictionary of Occupational Titles (“DOT”) places a job in the “light”
category if it requires one to frequently lift or carry objects weighing up to ten pounds and
occasionally lift or carry objects weighing up to twenty pounds. Id. The jobs identified in
Bryant’s report were classified as “light” positions. ECF No. 17-1 at 389, 394. Aaron reported
that Minutello had “self-limited” on 50% of the twenty tasks that she had been asked to perform.
Id. at 252. Under the scale used during the evaluation, Minutello’s level of self-limiting behavior
was significantly in excess of normal limits. Id.; ECF Nos. 20 & 32 at ¶ 69.
Hartford ultimately decided to uphold its earlier decision terminating Minutello’s longterm disability benefits. ECF Nos. 20 & 32 at ¶ 70. Genie M. Guthrie (“Guthrie”), an Appeal
Specialist for Hartford, informed Minutello’s counsel of the decision in a letter dated December
20, 2011. ECF No. 17-1 at 107-110. Guthrie’s letter advised that the “appeal decision” was
“final,” that Minutello’s claim file was being closed, and that “no further review” of the matter
would be conducted by Hartford. Id. at 110. Minutello was provided with notice of her right to
challenge the termination decision in a civil action brought under the ERISA. Id.
Minutello commenced this action against Hartford and Starwood on August 28, 2012,
alleging that they had violated the ERISA by terminating her long-term disability benefits. ECF
No. 1. One month later, the parties stipulated to Starwood’s dismissal from the case. ECF Nos.
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6 & 7. The caption was amended to reflect Hartford’s status as the only remaining defendant.
ECF No. 7 at 1. Hartford moved for summary judgment on February 21, 2013. ECF No. 18.
Minutello filed her motion for summary judgment the next day. ECF No. 23. The parties’ crossmotions for summary judgment are the subject of this memorandum opinion.
II.
Jurisdiction and Venue
The instant action arises under the ERISA. The Court has subject-matter jurisdiction in
this case pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e)(1), (f). Venue is proper under 28
U.S.C. § 1391(b) and 29 U.S.C. § 1132(e)(2).
III.
Discussion
Employee benefit plans are regulated by the ERISA’s “comprehensive and complex
scheme.” Estate of Kensinger v. URL Pharma, Inc., 674 F.3d 131, 135 (3d Cir. 2012). Since the
Plan at issue in this case provides participants with “benefits in the event of . . . disability,” it
qualifies as an “employee benefit plan” governed by the ERISA. 29 U.S.C. § 1002(1), (3).
Although the ERISA neither “requires employers to establish employee benefits plans” nor
specifies the benefits available under such plans, it does “seek to ensure that employees will not
be left emptyhanded once employers have guaranteed them certain benefits.” Lockheed Corp. v.
Spink, 517 U.S. 882, 887, 116 S.Ct. 1783, 135 L.Ed.2d 153 (1996). In enacting the ERISA,
Congress created “a scheme that is built around reliance on the face of written plan documents.”
Curtiss-Wright Corp. v. Schoonejongen, 514 U.S. 73, 83, 115 S.Ct. 1223, 131 L.Ed.2d 94
(1995). In order to protect the legitimate expectations of plan participants, the relevant statutory
language provides that “[e]very employee benefit plan shall be established and maintained
pursuant to a written instrument.” 29 U.S.C. § 1102(a)(1). A fiduciary charged with the duty of
administering a plan must act “in accordance with the documents and instruments governing the
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plan,” provided that such “documents and instruments” are consistent with the applicable
statutory requirements. 29 U.S.C. § 1104(a)(1)(D); Kennedy v. Plan Administrator for DuPont
Savings & Investment Plan, 555 U.S. 285, 288, 129 S.Ct. 865, 172 L.Ed.2d 662 (2009).
Section 502(a)(1)(B) of the ERISA, which is codified at 29 U.S.C. § 1132(a)(1)(B),
permits a “participant” like Minutello “to recover benefits due to h[er] under the terms of h[er]
plan, to enforce h[er] rights under the terms of the plan, or to clarify h[er] rights to future benefits
under the terms of the plan.” Since Minutello seeks “to recover benefits due to h[er]” under the
Plan, and to “enforce” and “clarify h[er] rights to future benefits” thereunder, her claim against
Hartford arises under § 1132(a)(1)(B). Eichorn v. AT&T Corp., 484 F.3d 644, 651-653 (3d Cir.
2007). The ERISA provides that “[a]n employee benefit plan may sue or be sued . . . as an
entity.” 29 U.S.C. § 1132(d)(1). Minutello has sued Hartford, which administers the Plan, rather
than the Plan itself. ECF No. 1 at ¶ 4. Her claim against Hartford is based solely on her alleged
entitlement to long-term disability benefits. Id. at ¶¶ 11-17. The complaint does not allege that
Hartford has breached a distinct fiduciary duty. Therefore, Minutello can proceed with her
ERISA claim against Hartford only in its official capacity as the Plan administrator.2 Graden v.
Conexant Systems, Inc., 496 F.3d 291, 301 (3d Cir. 2007). She cannot seek a “money judgment”
against Hartford in its “individual capacity.” 29 U.S.C. § 1132(d)(2). Instead, she can only
request an order directing Hartford to provide her with benefits from the Plan assets.
Hahnemann University Hospital v. All Shore, Inc., 514 F.3d 300, 308 (3d Cir. 2008).
A.
The Standard of Review
The ERISA contains no specific language establishing a standard of review for claims
arising under § 1132(a)(1)(B). Haisley v. Sedgwick Claims Management Services, Inc., 776
2
Hartford qualifies as the Plan “administrator” by virtue of its status as the “plan sponsor.” 29 U.S.C. §
1002(16)(A)(ii).
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F.Supp.2d 33, 42 (W.D.Pa. 2011). Invoking principles of trust law, the United States Supreme
Court explained in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103
L.Ed.2d 80 (1989), that “a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed
under a de novo standard unless the benefit plan gives the administrator or fiduciary
discretionary authority to determine eligibility for benefits or to construe the terms of the plan.”
Although the rule established in Firestone defaults to de novo review when the terms of the plan
are silent, it calls for “a deferential standard of review” when “a trustee exercises discretionary
powers.” Firestone, 489 U.S. at 111. Where such discretionary powers are exercised, “an
employer can rely on the expertise of the plan administrator rather than worry about unexpected
and inaccurate plan interpretations that might result from de novo judicial review.” Conkright v.
Frommert, 559 U.S. 506, ___, 130 S.Ct. 1640, 1649, 176 L.Ed.2d 469 (2010).
Hartford bears the burden of establishing the applicability of a deferential standard of
review. Viera v. Life Insurance Co. of North America, 642 F.3d 407, 413 (3d Cir. 2011). The
proper standard of review must be ascertained from the terms of the Plan. Luby v. Teamsters
Health, Welfare, & Pension Trust Funds, 944 F.2d 1176, 1180 (3d Cir. 1991). The applicable
policy language clearly provides Hartford with “full discretion and authority to determine
eligibility for benefits and to construe and interpret all terms and provisions of the Group
Insurance Policy.” ECF No. 17-2 at 17. This language must be construed in accordance with
“[o]rdinary principles of contract interpretation.” US Airways, Inc. v. McCutchen, 569 U.S. ___,
___, 133 S.Ct. 1537, 1548-1549, 185 L.Ed.2d 654 (2013). Since the policy language
unambiguously gives Hartford the “authority to determine [Minutello’s] eligibility for benefits,”
its factual findings pertaining to her medical condition must be accorded deference. Heasley v.
Belden & Blake Corp., 2 F.3d 1249, 1256 (3d Cir. 1993).
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“The ‘arbitrary and capricious’ standard is essentially the same as the ‘abuse of
discretion’ standard.” Abnathya v. Hoffman-La Roche, Inc., 2 F.3d 40, 45, n. 4 (3d Cir. 1993).
This standard controls the Court’s review of Hartford’s decision to terminate Minutello’s longterm disability benefits. Estate of Schwing v. Lilly Health Plan, 562 F.3d 522, 526, n. 2 (3d Cir.
2009). The dispositive question is whether that decision was “without reason, unsupported by
substantial evidence or erroneous as a matter of law.” Adamo v. Anchor Hocking Corp., 720
F.Supp. 491, 500 (W.D.Pa. 1989).
B.
Hartford’s Conflict of Interest
“[I]f a benefit plan gives discretion to an administrator or fiduciary who is operating
under a conflict of interest, that conflict must be weighed as a ‘facto[r] in determining whether
there is an abuse of discretion.’” Firestone, 489 U.S. at 115 (brackets in original), quoting the
RESTATEMENT (SECOND) OF TRUSTS § 187, Comment d (1959). In Metropolitan Life Insurance
Co. v. Glenn, 554 U.S. 105, 112, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008), the Supreme Court
recognized that a “conflict of interest” exists when “a plan administrator both evaluates claims
for benefits and pays benefits claims.” Although this factor (like any other factor) may “act as a
tiebreaker when the other factors are closely balanced,” it is of minimal importance when the
administrator has taken steps to reduce bias and promote accuracy “by walling off claims
administrators from those interested in firm finances, or by imposing management checks that
penalize inaccurate decisionmaking irrespective of whom the inaccuracy benefits.” Glenn, 554
U.S. at 117. For this reason, the degree to which a conflict of interest may be relied upon to
impugn a denial of benefits often depends on the precise nature of the funding arrangement in
question. Post v. Hartford Insurance Co., 501 F.3d 154, 162-164 (3d Cir. 2007).
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Hartford implicitly acknowledges that it operates under a conflict of interest of the kind
identified in Glenn. ECF No. 27 at 3-5. The particular funding arrangement utilized by Hartford
cannot be gleaned from the record. Where a deferential standard applies, a reviewing court may
ordinarily consider only the evidence that was before the plan administrator at the time of the
challenged decision. Sivalingam v. Unum Provident Corp., 735 F.Supp.2d 189, 194-195
(E.D.Pa. 2010). This general rule, however, does not preclude the parties from supplementing
the record with evidence relating to a particular plan’s “actual funding mechanism.” Kosiba v.
Merck & Co., 384 F.3d 58, 67, n. 5 (3d Cir. 2004). Although the parties were free to introduce
extrinsic evidence pertaining to the precise nature of Hartford’s conflict of interest, they did not
do so.
Denying that bias infected its decision to discontinue Minutello’s long-term disability
benefits, Hartford points out that other courts have found its funding arrangement and review
procedures to be fair and impartial. ECF No. 27 at 3-5. The problem with Hartford’s position is
that the organization of its funding arrangement presents a question of adjudicative fact rather
than a question of legislative fact. Federal Rule of Evidence 201, which governs a federal
court’s ability to take “judicial notice” of facts extrinsic to the record, applies only to
adjudicative facts. FED. R. EVID. 201(a). A court is free to look beyond the evidentiary record
developed in a particular case in order to uncover legislative facts. Daggett v. Commission on
Governmental Ethics & Election Practices, 172 F.3d 104, 112 (1st Cir. 1999)(remarking that “the
ordinary limits on judicial notice hav[e] no application to legislative facts”); O’Hanlon v.
Hartford Accident & Indemnity Co., 457 F.Supp. 961, 962 (D.Del. 1978)(observing that
legislative facts “are not normally developed through the presentation of evidence”). For
example, a statute or ordinance challenged on constitutional grounds can sometimes be upheld
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on the basis of evidence presented in cases involving challenges to similar statutes or ordinances.
Lorillard Tobacco Co. v. Reilly, 533 U.S. 525, 555, 121 S.Ct. 2404, 150 L.Ed.2d (2001); Florida
Bar v. Went For It, Inc., 515 U.S. 618, 628-629, 115 S.Ct. 2371, 132 L.Ed.2d 541 (1995); City of
Renton v. Playtime Theatres, Inc., 475 U.S. 41, 51-52, 106 S.Ct. 925, 89 L.Ed.2d 29 (1986).
Unlike legislative facts, which “relate to the content of the law itself,” adjudicative facts
“concern the particular parties before the Court.” Project Vote v. Kelly, 805 F.Supp.2d 152, 184
(W.D.Pa. 2011). The factual circumstances surrounding Hartford’s conflict of interest clearly
fall into the latter category. Hartford does not assert that its funding arrangement “is generally
known within [this Court’s] territorial jurisdiction,” or that it “can be accurately and readily
determined from sources whose accuracy cannot reasonably be questioned.”3 FED. R. EVID.
201(b)(1)-(2). Since the criteria applicable under Rule 201 are not satisfied, the precise nature of
Hartford’s conflict of interest cannot be determined by reference to the evidentiary records
established in other cases.
Minutello contacted Hartford on March 17, 2010, to advise that Jacqueline had reached
the age of eighteen. ECF No. 17-1 at 43. The resulting change in Minutello’s Social Security
disability benefits was confirmed by the SSA on May 18, 2010. Id. According to Minutello, this
change required Hartford to pay her an additional $872.00 per month. ECF No. 22 at 13-14. Her
claim file was referred to Hartford’s SIU on May 27, 2010. ECF No. 17-1 at 42. Minutello
argues that the temporal proximity between the change in her monthly entitlement and the
commencement of the investigation suggests that Hartford acted to terminate her long-term
disability benefits on the basis of its own financial interests. ECF No. 32 at 6-7. She urges the
3
Hartford strenuously objects to a request by Minutello that judicial notice be taken of the definition of “lupus”
found on a website maintained by the Lupus Foundation of America. ECF No. 27 at 7-8. The Court understands
Hartford’s position to be that Rule 201 should not be utilized in this case. Id. at 8.
16
Court to consider this “conflict of interest” in determining whether Hartford’s actions were
reasonable. Id.
The timing of the investigation gives rise to an inference that it was triggered by the
information provided to Hartford by Minutello and the SSA. Lichtenstein v. University of
Pittsburgh Medical Center, 691 F.3d 294, 307 (3d Cir. 2012). The relevant question, however, is
whether that information “affected the decision to deny benefits.” Howley v. Mellon Financial
Corp., 625 F.3d 788, 794 (3d Cir. 2010). Minutello cannot prevail in this action simply by
showing that Hartford acted arbitrarily or capriciously in taking some discrete action independent
of the termination decision itself. Judge v. Metropolitan Life Insurance Co., 710 F.3d 651, 660
(6th Cir. 2013). While the Court must account for any “structural conflict of interest”
demonstrated by the record, the ultimate disposition of the case still turns on “whether a
reasonable basis existed for the administrator’s benefits decision.” Blankenship v. Metropolitan
Life Insurance Co., 644 F.3d 1350, 1355 (11th Cir. 2011). In this vein, the inquiry focuses on the
decision to terminate Minutello’s benefits rather than on the pre-termination investigation. Funk
v. CIGNA Group Insurance, 648 F.3d 182, 191, n. 11 (3d Cir. 2011).
Although Minutello has not supplemented the record with evidence illustrating the
degree to which Hartford’s conflict of interest should be factored into the analysis, the mere
existence of that conflict weighs in her favor. Glenn, 554 U.S. at 115-118. Under the present
circumstances, however, it is not a “determinative factor.” Fleisher v. Standard Insurance Co.,
679 F.3d 116, 122, n. 3 (3d Cir. 2012). Since Hartford’s factual findings are clearly
“reasonable,” they cannot be disturbed. Conkright, 130 S.Ct. at 1651. This remains the case
even if it is assumed that Hartford took no affirmative steps to reduce any potential bias resulting
from its own financial interests. Glenn, 554 U.S. at 117.
17
C.
Hartford’s Weighing of the Evidence
The crux of Minutello’s argument is that Hartford abused its discretion in deciding to
credit the opinion of Dr. Richless over that of Dr. Singh. ECF No. 22 at 6-8. In Black & Decker
Disability Plan v. Nord, 538 U.S. 822, 825, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003), the
Supreme Court held that “plan administrators are not obliged to accord special deference to the
opinions of treating physicians.” In the present context, the relevant question is whether
Hartford “arbitrarily” refused to credit “reliable evidence” submitted by Minutello, including the
assessment provided by Dr. Singh. Nord, 538 U.S. at 834.
On November 29, 2010, Fitzgerald interviewed Minutello in her home. ECF No. 17 at
47-67. During her encounter with Fitzgerald, Minutello stated that she could lift or carry objects
weighing up to twenty pounds. Id. at 49. She also acknowledged that she could drive or sit for a
maximum of two hours at a time. Id. at 51. In Fitzgerald’s presence, Minutello viewed the
surveillance videos that had been created by the SIU. ECF Nos. 20 & 32 at ¶ 38. She later
signed a statement characterizing the depictions of her in those videos as accurate representations
of her “average level of functionality.” ECF No. 17 at 55.
Behrle contacted Dr. Singh on March 24, 2011, and asked him to assess Minutello’s
work-related abilities and limitations. ECF No. 17-1 at 132-134. Dr. Singh was provided with
copies of the surveillance videos and the written report prepared by Fitzgerald. Id. at 132.
Behrle’s letter instructed Dr. Singh to consider the “additional information” supplied by Hartford
“in conjunction with [his] medical findings.” Id. Dr. Singh did not respond to Hartford’s request
for information about Minutello’s condition. ECF Nos. 20 & 32 at ¶ 41. The documentary
record suggests that Hartford may have referred Minutello for an independent medical
examination because Dr. Singh had not responded to Behrle’s inquiry. ECF No. 17-1 at 25-26.
18
Dr. Richless examined Minutello on May 31, 2011. ECF No. 17-1 at 410-417. He found
her work-related abilities to be unrestricted. Id. at 415-416. In a written report, Dr. Richless
summarized his examination findings by stating as follows:
Ms. Minutello is a 51-year-old female with mild SLE (lupus) and possible mild
mixed connective tissue disorder who is able to work without accommodations in
a 40-hour capacity at any job that would meet her educational level and average
physical abilities for a 51-year-old female. There are no specific limitations on
lifting, twisting, bending, or climbing. She may stand, walk, and sit unrestricted.
She would have no difficulty operating controls.
Id. at 416. Hartford paid Dr. Richless $1,085.00 to perform the examination. Id. at 419.
The examination report prepared by Dr. Richless was forwarded to Dr. Singh. ECF No.
17-1 at 126. On June 16, 2011, someone from Dr. Singh’s office contacted Hartford and
expressed doubts about Dr. Richless’ “credentials” and the reliability of his findings. ECF No.
17 at 78. Cobb invited Dr. Singh to explain why he disagreed with Dr. Richless. Id. Dr. Singh
never responded to Cobb’s inquiry. ECF Nos. 20 & 32 at ¶ 51. Hartford decided to terminate
Minutello’s long-term disability benefits shortly after the completion of Bryant’s vocational
assessment. Id. at ¶¶ 52-54.
In a letter dated July 26, 2011, Dennis informed Minutello that her benefits were being
terminated. ECF No. 17-1 at 118-124. In the portion of the letter articulating Hartford’s
weighing of the medical evidence, Dennis stated as follows:
Our Medical Case Manager (MCM) reviewed your entire claim file on 02/01/11
and sent a letter along with copies of the surveillance documentation, videos, and
interview statements to Dr. Singh for review. Dr. Singh was asked to comment
on your maximum level of functionality. However, as of 05/09/11, Dr. Singh had
not responded to the request.
In order to give your claim every consideration, the MCM involved the services
of an independent medical consultant and scheduled an Independent Medical
Evaluation (IME) to be conducted on 05/31/11. The evaluation was performed by
Dr. Lloyd Richless, Family Practice. You attended the evaluation as scheduled.
19
As a part of his evaluation, Dr. Richless contacted Dr. Singh’s office on 06/01/11
to obtain additional medical information. In his report, Dr. Richless stated that
based upon the physical examination findings, the history, diagnostic studies, and
all consultant reports, you do not have any significant physical limitations and can
perform all functions of a 51-year-old female without accommodation. He stated
that you may stand, walk, and sit unrestricted and that you would have no
difficulty operating controls. Dr. Richless concluded that you would be able to
work without accommodations in a 40 hour capacity at any job that would meet
your educational level and average physical abilities for a 51 year-old female.
On 06/09/11, our Medical Case Manager sent a copy of Dr. Richless’s report to
Dr. Singh and asked that he comment within 15 days. On 06/16/11, Dr. Singh’s
office contacted the MCM and advised that Dr. Singh was concerned with the
credentials of Dr. Richless and the conclusion of his evaluation. Dr. Singh was
encouraged to express his concerns in his response. As of 06/30/11, Dr. Singh
had not provided a response.
In reviewing your claim, The [sic] Hartford considered your claim file as a whole
for the purposes of determining your entitlement for plan benefits. Based on the
response from Dr. Richless, as well as the investigative documentation obtained,
the weight of the evidence in your file supports that you are physically capable of
performing full-time work in a sedentary to light occupation.
Id. at 121-122. Dennis’ letter further explained that, based on Bryant’s vocational assessment,
Minutello was deemed to be capable of working as a manager of a liquor establishment or a
reservations manager for a hotel or restaurant. Id. at 122.
Dr. Singh reassessed Minutello’s work-related abilities and limitations on September 30,
2011. ECF No. 17-1 at 298-302. He reported that Minutello could sit, stand or walk for less
than two hours during the course of an eight-hour workday. Id. at 300. Dr. Singh indicated that
Minutello could continuously sit or stand for no more than ten minutes at a time. Id. at 299. He
further opined that she could never lift or carry objects weighing ten pounds or more, and that
she could rarely lift or carry objects weighing less than ten pounds.4 Id. at 300. Dr. Singh
predicted that Minutello’s impairments would necessitate more than four absences per month if
4
Dr. Singh had previously reported that Minutello could occasionally lift or carry objects weighing up to (and
including) ten pounds. ECF No. 17 at 20.
20
she were to be employed on a full-time basis. Id. at 301. The assessment form completed by Dr.
Singh was sent to the Claim Appeal Unit. Id. at 294-297.
Hartford referred Minutello to Aaron for a functional capacity evaluation. ECF Nos. 20
& 32 at ¶ 66. The evaluation was performed on December 13, 2011. ECF No. 17-1 at 251.
During the evaluation, Minutello “safely” lifted a 22-pound object from the floor to her waist and
a 17-pound object from her waist to her eyes. Id. at 258-259. Aaron opined that Minutello was
capable of performing “light” work, which requires one to occasionally lift or carry objects
weighing up to twenty pounds and frequently lift or carry objects weighing up to ten pounds. Id.
at 252. He went on to state that his opinion described Minutello’s “minimum” abilities, and that
her “self-limiting and inconsistent behavior” had made it impossible for him to determine her
“maximum” abilities. Id. Hartford paid Aaron $1,100.00 for his services. Id. at 263.
After reviewing the results of Aaron’s evaluation, Hartford decided to uphold its earlier
decision terminating Minutello’s long-term disability benefits. ECF Nos. 20 & 32 at ¶ 70. The
decision was communicated to Minutello’s counsel in a letter from Guthrie dated December 20,
2011. ECF No. 17-1 at 107-110. In her letter, Guthrie pointed out that the extreme lifting and
carrying limitations identified by Dr. Singh were inconsistent with Minutello’s earlier statements
to Fitzgerald. Id. at 108. Relying on the findings of Dr. Gorske, Dr. Richless and Aaron,
Guthrie stated that “Dr. Singh’s reported limitations precluding work capacity d[id] not appear to
be consistent with the documented examination findings and professional observations of other
sources.” Id. at 109. She further advised that Hartford’s “appeal decision” was “final,” and that
Minutello would need to commence a civil action under the ERISA in order to seek further
review. Id. at 110.
21
Minutello assails Hartford for discontinuing her long-term disability benefits after paying
them for a decade. ECF No. 22 at 5-6. The termination of a plan participant’s existing benefits
in the absence of “new medical information” constitutes an “irregularity” that must be weighed
against the plan administrator’s decision. Miller v. American Airlines, Inc., 632 F.3d 837, 848
(3d Cir. 2011). In this case, however, Hartford based its termination decision on new evidence
of Minutello’s condition. That evidence included the surveillance videos created by the SIU,
Minutello’s statements to Fitzgerald, Dr. Richless’ examination findings, and the results of
Aaron’s functional capacity evaluation. ECF Nos. 20 & 32 at ¶¶ 25-39, 42-49, 66-69. Under
these circumstances, no inference of impropriety can be drawn from the change in Hartford’s
position. Since the focus of the Court’s inquiry is on Hartford’s final decision, the fact that an
increase in Minutello’s monthly entitlement may have triggered the SIU’s investigation into her
condition is of no dispositive significance.5 Funk, 648 F.3d at 191, n. 11.
Some federal courts have taken judicial notice of medical resources describing the
characteristics of “lupus.” Wible v. Aetna Life Insurance Co., 375 F.Supp.2d 956, 965-966
(C.D.Cal. 2005); Rodriguez v. Loctite Puerto Rico, Inc., 967 F.Supp. 653, 657-658 (D.P.R.
1997). A website maintained by the Lupus Foundation of America defines “lupus” as follows:
Lupus is a chronic, autoimmune disease that can damage any part of the body
(skin, joints, and/or organs inside the body). Chronic means that the signs and
symptoms tend to last longer than six weeks and often for many years. In lupus,
something goes wrong with your immune system, which is the part of the body
that fights off viruses, bacteria, and germs ("foreign invaders," like the flu).
Normally our immune system produces proteins called antibodies that protect the
body from these invaders. Autoimmune means your immune system cannot tell
the difference between these foreign invaders and your body’s healthy tissues
5
A conflict of interest is relevant to the analysis only because an administrator’s “fiduciary interest may counsel in
favor of granting a borderline claim while its immediate financial interest counsels to the contrary.” Metropolitan
Life Insurance Co. v. Glenn, 554 U.S. 105, 112, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). A recipient whose
benefits are properly terminated as a result of an investigation motivated by financial considerations is not entitled to
have his or her benefits reinstated. Blankenship v. Metropolitan Life Insurance Co., 644 F.3d 1350, 1355 (11th Cir.
2011)(explaining that a conflict of interest does not alter the “basic analysis,” which centers on “whether a
reasonable basis existed for the administrator’s benefits decision”).
22
("auto" means "self") and creates autoantibodies that attack and destroy healthy
tissue. These autoantibodies cause inflammation, pain, and damage in various
parts of the body.
www.lupus.org (as visited on August 1, 2013). Minutello asks the Court to take judicial notice
of this definition. ECF No. 22 at 8. Hartford objects to Minutello’s request on the ground that
the Court has no way to verify the accuracy of statements posted on the website. ECF No. 27 at
7. Since the Court’s review is limited to the information that was before Hartford at the time of
its decision, statements appearing on a private website are not relevant to the inquiry. Cavert
Acquisition Co. v. NLRB, 83 F.3d 598, 609-610 (3d Cir. 1996); Gernes v. Health & Welfare Plan
of Metropolitan Cabinet, 841 F.Supp.2d 502, 514 (D.Mass. 2012).
In any event, Hartford does not dispute Minutello’s assertion that lupus can “cause
inflammation, pain, and damage in various parts of the body.” Instead, Hartford simply contends
that Minutello’s lupus is not disabling. ECF No. 27 at 10. An individual experiencing pain may
still be capable of engaging in “light” or “sedentary” work activities. Welch v. Heckler, 808 F.2d
264, 270 (3d Cir. 1986). “[E]ven if two different plaintiffs alleging substantial limitations suffer
from the same impairment, the nuances of its effect on their daily lives will invariably manifest
themselves in distinct ways.” Emory v. AstraZeneca Pharmaceuticals, LP, 401 F.3d 174, 182
(3d Cir. 2005). The question in this case is whether Hartford abused its discretion in determining
that Minutello’s lupus did not prevent her from maintaining a full-time job. Dr. Richless found
Minutello’s lupus to be “mild.” ECF No. 17-1 at 416. His examination uncovered no specific
work-related limitations. Id. at 415-416. After completing his functional capacity evaluation,
Aaron concluded that Minutello’s impairments would not preclude her from performing the
duties of a “light” job. Id. at 251-261. Unlike the assessments provided by Dr. Richless and
23
Aaron, which relate to the precise issue before the Court, statements describing the painful
effects of lupus in generic terms are of minimal probative value.
Hartford ultimately determined that the “limitations and restrictions” identified by Dr.
Singh were not “consistent with the documented examination findings and professional
observations of other sources.” ECF No. 17-1 at 109. Minutello argues that the impact of her
impairments cannot be measured solely by reference to objective evidence. ECF No. 22 at 8-14;
ECF No. 32 at 9-13. In support of her position, she relies on Mitchell v. Eastman Kodak Co.,
113 F.3d 433 (3d Cir. 1997). ECF No. 22 at 10-11. In Mitchell, the United States Court of
Appeals for the Third Circuit held that a plan administrator had abused its discretion in denying a
claimant’s application for benefits solely because he had failed to present “objective medical
evidence” of chronic fatigue syndrome. Mitchell, 113 F.3d at 442-443. The decision in Mitchell
was premised on the fact that “there [wa]s no ‘dipstick’ laboratory test” capable of detecting that
particular impairment. Id. at 443, quoting Sisco v. United States Dept. of Health & Human
Services, 10 F.3d 739, 744 (10th Cir. 1993).
The present circumstances are meaningfully different from those presented in Mitchell.
Hartford did not terminate Minutello’s benefits on the ground that she had failed to establish the
existence of her lupus. The termination decision was based on evidence suggesting that
Minutello could work despite the limitations resulting from that impairment. ECF No. 17-1 at
107-110. For this reason, the rule established in Mitchell is not implicated in this case.
Wernicki-Stevens v. Reliance Standard Life Insurance Co., 641 F.Supp.2d 418, 426-427 (E.D.Pa.
2009). Furthermore, the record in Mitchell contained “undisputed evidence” of the claimant’s
disability. Mitchell, 113 F.3d at 442. The evidence of Minutello’s disability, which consists
mostly of information provided by Dr. Singh, is contradicted by depictions of Minutello in the
24
SIU’s surveillance videos, Fitzgerald’s observations of Minutello’s demeanor, Dr. Richless’
examination findings, and the results of Aaron’s functional capacity evaluation. ECF Nos. 20 &
32 at ¶¶ 25-39, 42-49, 66-69. Nothing in Mitchell undermines Hartford’s decision to discontinue
Minutello’s benefits. Wernicki-Stevens, 641 F.Supp.2d at 426-427.
Minutello questions the propriety of Hartford’s reliance on surveillance videos as a basis
for terminating her benefits. ECF No. 22 at 14-18. As a general matter, “video surveillance
remains a proper method of investigating disability insurance claims.” Eppley v. Provident Life
& Accident Insurance Co., 789 F.Supp.2d 546, 573 (E.D.Pa. 2011). The probative value of
videotaped depictions of a claimant’s activities generally depends on what those depictions
demonstrate in relation to the administrative record as a whole. Id. at 573-574. A plan
administrator abuses its discretion when it terminates a claimant’s benefits based on footage
demonstrating his or her ability to engage in minimal activities for brief periods of time.
Migliaro v. IBM Long-Term Disability Plan, 231 F.Supp.2d 1167, 1178 (M.D.Fla. 2002); Dorsey
v. Provident Life & Accident Insuruance Co., 167 F.Supp.2d 846, 856 (E.D.Pa. 2001); Clausen v.
Standard Insurance Co., 961 F.Supp. 1446, 1457 (D.Colo. 1997). An individual need not
“vegetate in a dark room excluded from all forms of human and social activity” in order to
qualify as “disabled.” Smith v. Califano, 637 F.2d 968, 971 (3d Cir. 1981). On the other hand,
videotaped depictions of a claimant engaging in certain activities may be relied upon to refute a
treating physician’s assertion that the claimant is incapable of engaging in those activities. Vlass
v. Raytheon Employers Disability Trust, 244 F.3d 27, 31-32 (1st Cir. 2001). When such
depictions are accompanied by medical reports declaring a claimant fit for duty, they may justify
a finding that he or she is not disabled. McGarrah v. Hartford Life Insurance Co., 234 F.3d
25
1026, 1032 (8th Cir. 2000); Patterson v. Caterpillar, Inc., 70 F.3d 503, 505-506 (7th Cir. 1995);
Osbun v. Auburn Foundry, Inc., 293 F.Supp.2d 863, 869-870 (N.D.Ind. 2003).
A videotape created by the SIU on July 19, 2010, shows Minutello and her daughter
lifting a large desk from a van and carrying it into a garage. ECF No. 17 at 29. The footage
captured on that videotape, which has been viewed by the Court, does not depict an individual
who can never lift objects weighing more than ten pounds, or who can lift a maximum of twenty
pounds at a time. ECF No. 17 at 49; ECF No. 17-1 at 300. Although Hartford was required to
give serious consideration to the statements submitted by Dr. Singh and the subjective
complaints voiced by Minutello, it was not required to credit “visible fiction.” Scott v. Harris,
550 U.S. 372, 379-381, 127 S.Ct. 1769, 167 L.Ed.2d 686 (2007). While the surveillance videos
were not alone sufficient to establish Minutello’s ability to work on a full-time basis, they
undoubtedly provided Hartford with a reasonable basis for concluding that the extreme
limitations described by Dr. Singh and Minutello were lacking in evidentiary support. Vlass, 244
F.3d at 31-32.
Minutello posits that Hartford acted unreasonably in relying on Aaron’s functional
capacity evaluation as a basis for denying her appeal. ECF No. 22 at 15. In support of her
position, Minutello relies on Stup v. UNUM Life Insurance Co., 390 F.3d 301 (4th Cir. 2004). Id.
In Stup, the United States Court of Appeals for the Fourth Circuit held that a plan administrator
had abused its discretion by denying a claim based on the results of a functional capacity
evaluation lasting for only two-and-a-half hours. Stup, 390 F.3d at 309-310. The facts in Stup,
however, were meaningfully different from the facts in this case. The claimant in Stup had been
unable to complete the evaluation because of pain, leaving the physical therapist conducting the
test with the impression that the results of the evaluation were not “truly indicative” of the
26
claimant’s functional capabilities. Id. at 304. In light of the physical therapist’s “equivocal and
tentative interpretation” of the test results, the Court of Appeals concluded that they were not
indicative of the claimant’s ability to work. Id. at 309-310. The instant case is different in that
Aaron found the results of his evaluation to be an accurate reflection of Minutello’s minimum
abilities, suggesting that her maximum abilities could not be ascertained from the test results.
ECF No. 17-1 at 252. Since Aaron unequivocally opined that Minutello was capable of
performing “light” work, the reasoning employed in Stup does not undermine Hartford’s
termination decision. Id.
A plan administrator’s failure to procure an independent medical examination or a
functional capacity evaluation before denying a claim or discontinuing a claimant’s benefits may
“raise questions about the thoroughness and accuracy of the benefits determination.” Calvert v.
Firstar Finance, Inc., 409 F.3d 286, 295 (6th Cir. 2005). If Hartford had made its termination
decision without asking Minutello to undergo a physical examination or a functional capacity
evaluation, its failure to “objectively measure her physical abilities” would have constituted a
ground for setting that decision aside. Lamanna v. Special Agents Mutual Benefits Association,
546 F.Supp.2d 261, 296 (W.D.Pa. 2008). In this case, Hartford based its initial decision on the
surveillance videos created by the SIU, Fitzgerald’s observations of Minutello during a face-toface interview, and the results of Dr. Richless’ independent medical examination. ECF No. 17-1
at 121-122. When Minutello appealed that decision, she sent a copy of Dr. Singh’s assessment
to the Claim Appeal Unit. ECF No. 17-1 at 294-302. The documentary record confirms that the
functional capacity evaluation was conducted in order to resolve the inconsistency between Dr.
Singh’s opinion and the other evidence available to Hartford. A notation entered by Guthrie on
November 11, 2011, recorded the following observations:
27
Appeal Specialist notes that while Dr. Singh provides extremely strict limitations
and restrictions, the IME report by Dr. Richless recommended no restrictions or
limitations. Given that claimant does have documented lupus and ongoing selfreported complaints, it is very likely that her functionality is somewhere between
the assessments of Dr. Singh and Dr. Richless. Appeal Specialist also notes that
while the surveillance clearly documents greater functionality than that reported
by the claimant, it is not clear that claimant would have the capacity to sustain
that level of activity on a full-time basis given the minimal amount of time she
was observed out of the home over 4 days. It is also unclear whether claimant has
the capacity for Light level work. Will arrange for her to undergo an FCE.
Id. at 8. Aaron later determined that, at a minimum, Minutello could engage in “light” work
activities. Id. at 252. The results of the functional capacity evaluation ultimately led Hartford to
uphold its earlier termination decision. Id. The thoroughness of Hartford’s review procedure
weighs in favor, rather than against, its position in this case. Elliott v. Metropolitan Life
Insurance Co., 473 F.3d 613, 621 (6th Cir. 2006).
The record indicates that Hartford made its decision on the basis of the evidentiary record
as a whole. Eppley, 789 F.Supp.2d at 573-574. Hartford was not required to “accord special
deference” to the opinions expressed by Dr. Singh. Nord, 538 U.S. at 825. Minutello cannot
impugn the ultimate termination decision simply by asserting that each piece of evidence relied
upon by Hartford, when viewed in isolation, was not sufficiently probative to outweigh Dr.
Singh’s assessment. The Court is not free to substitute its own view of the evidence for
Hartford’s factual findings. Orvosh v. Program of Group Insurance, 222 F.3d 123, 129 (3d Cir.
2000).
Although physicians are qualified to determine whether an individual is capable of
performing certain work-related tasks, they often lack the vocational expertise needed to
determine whether certain functional limitations would preclude him or her from maintaining a
specific job. Willis v. Baxter International, Inc., 175 F.Supp.2d 819, 832 (W.D.N.C. 2001). For
28
this reason, a plan administrator may need to consult a vocational expert before deciding whether
jobs consistent with a claimant’s abilities and limitations are readily available.6 Gunderson v.
W.R. Grace & Co. Long Term Disability Income Plan, 874 F.2d 496, 499 (8th Cir. 1989).
Hartford fulfilled this obligation by procuring Bryant’s vocational assessment. ECF No. 17-1 at
383-396.
Minutello asserts that Bryant’s assessment failed to account for the impact that her pain
had on her ability to work. ECF No. 32 at 8. This argument blurs the distinction between
medical evidence and vocational evidence. Bryant’s vocational analysis was based on the
findings of Dr. Richless’ examination. ECF No. 17-1 at 383. The positions identified by Bryant
were classified as “light” jobs. Id. at 394-396. Aaron later concluded that Minutello could
perform the duties of a “light” job. Id. at 251-261. In her letter to Minutello’s counsel, Guthrie
pointed out that the functional capacity identified by Aaron was consistent with the jobs
described in Bryant’s vocational assessment. Id. at 110. Since no disconnect existed between
Hartford’s medical and vocational findings, its reliance on Bryant’s assessment did not constitute
an abuse of discretion. Tesche v. Continental Casualty Co., 109 Fed.Appx. 495, 496-498 (3d
Cir. 2004)(unpublished).
D.
The Relevance of Minutello’s “Disability” Under the Social Security Act
In connection with her participation in the Plan, Minutello was required to apply for
benefits under the Social Security Act. ECF No. 17-2 at 16. The SSA concluded that Minutello
had become statutorily “disabled” on June 1, 2001. ECF No. 17-1 at 1093. Minutello argues
6
It is not clear whether Hartford was required to procure a vocational analysis in this case. Holland v. International
Paper Co. Retirement Plan, 576 F.3d 240, 249-251 (5th Cir. 2009)(finding no need for vocational evidence where
the plan in question only required the plan administrator to “ensure that the applicant [wa]s capable of performing
any occupation or employment for which he [wa]s qualified by his education, training, or experience”). Since
Hartford obtained Bryant’s assessment, there is no need for the Court to consider whether the termination decision
would have been permissible without that assessment.
29
that Hartford abused its discretion by terminating her long-term disability benefits despite her
continued receipt of Social Security disability benefits.7 ECF No. 22 at 15-16.
Legislative bodies and plan administrators are free to define specific terms as they see fit.
Lopez v. Gonzalez, 549 U.S. 47, 54, 127 S.Ct. 625, 166 L.Ed.2d 462 (2006). The fact that
someone is “disabled” for one purpose does not inevitably mean that he or she is “disabled” for
all purposes. Cleveland v. Policy Management Systems Corp., 526 U.S. 795, 801-807, 119 S.Ct.
1597, 143 L.Ed.2d 966 (1999). In certain instances, however, an award of benefits under the
Social Security Act can weigh in favor of a finding that the recipient is also entitled to benefits
under a plan governed by the ERISA. Glenn, 554 U.S. at 118. Where a plan definition closely
resembles the Social Security Act’s definition of the term “disability,” a determination made by
the SSA may carry significant weight. Hines v. Unum Life Insurance Co., 110 F.Supp.2d 458,
468 (W.D.Va. 2000).
A person is “disabled” within the meaning of the Social Security Act if he or she is
“unable to engage in any substantial gainful activity by reason of any medically determinable
physical or mental impairment which can be expected to result in death or which has lasted or
can be expected to last for a continuous period of not less than twelve months.”8 42 U.S.C. §
1382c(a)(3). In order to qualify for Social Security disability benefits, a claimant must not only
be “unable to do his [or her] previous work,” but must also be unable to “engage in any other
kind of substantial gainful work which exists in the national economy.” 42 U.S.C. §§
423(d)(2)(A), 1382c(a)(3)(B). The SSA awarded benefits to Minutello on February 17, 2002.
7
The documentary record indicates that Minutello was still receiving benefits under the Social Security Act when
Hartford terminated her long-term disability benefits under the Plan. ECF No. 17-1 at 123.
8
This definition appears in Title XVI of the Social Security Act [42 U.S.C. §§ 1381-1383f], which governs the
provision of supplemental security income benefits. Title II of the Social Security Act [42 U.S.C. §§ 401-433],
which governs the provision of disability insurance benefits, defines the term “disability” in a way that mirrors Title
XVI’s language describing an individual as “disabled.” 42 U.S.C. § 423(d)(1)(A).
30
ECF No. 17-1 at 1093. The award was based on a determination that she had become “disabled”
on June 1, 2001. Id.
Minutello initially received long-term disability benefits under the Plan because of her
inability to continue performing the duties of her own position. ECF No. 17-1 at 862-863. In
order to receive benefits beyond June 2, 2003, she needed to show that she could not perform the
duties of “an[y] occupation for which [she was] qualified by education, training or experience.”9
ECF No. 17-2 at 24. Hartford ultimately concluded that Minutello was “disabled” under this
more demanding standard. ECF Nos. 20 & 32 at ¶ 12. Minutello’s long-term disability benefits
continued until July 25, 2011, when Hartford determined that she was no longer “disabled.”
ECF No. 17-1 at 122.
The disability standard used by the Plan for the period of time postdating June 2, 2003,
resembles the standard applicable to claims brought under the Social Security Act. Barnhart v.
Thomas, 540 U.S. 20, 25, 124 S.Ct. 376, 157 L.Ed.2d 333 (2003)(explaining that the SSA
considers a claimant’s “age, education, and past work experience” in order to determine whether
he or she “is capable of performing other jobs existing in significant numbers in the national
economy”). In order to secure Social Security disability benefits, however, Minutello did not
have to establish that she would be unable to work for the rest of her life. Instead, she only
needed to demonstrate that her impairments were likely to prevent her from working for the
statutory twelve-month period. Barnhart v. Thomas, 535 U.S. 212, 214-222, 122 S.Ct. 1265, 152
L.Ed.2d 330 (2002). The SSA’s decision awarding benefits to Minutello constituted a
determination that she would not be able to work before June 1, 2002. ECF No. 17-1 at 1093. It
did not constitute a projection that she would remain disabled beyond July 25, 2011.
9
The Plan’s definition of the term “Any Occupation” also requires the relevant position to have an “earnings
potential” determined in accordance with a specified formula. ECF No. 17-2 at 24.
31
In order to terminate Minutello’s benefits under the Social Security Act, the SSA would
need to proceed in accordance with a detailed protocol. Hagans v. Commissioner of Social
Security, 694 F.3d 287, 307-308 (3d Cir. 2012). Unlike the SSA, Hartford was not required to
measure Minutello’s condition “against a uniform set of federal criteria.” Nord, 538 U.S. at 833.
Under regulations promulgated by the Commissioner of Social Security, an assessment
submitted by a treating physician is entitled to more weight than an opinion expressed by a
consultative examiner. 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). That rule does not control
the discretion of plan administrators. Nord, 538 U.S. at 830-834. Furthermore, Hartford’s
termination decision was based almost exclusively on evidence that was not available when the
SSA awarded Minutello benefits under the Social Security Act. ECF Nos. 20 & 32 at ¶¶ 25-39,
42-49, 66-69. Under these circumstances, the SSA’s earlier determination had little relevance to
Minutello’s continued eligibility for benefits under the Plan. Hobson v. Metropolitan Life
Insurance Co., 574 F.3d 75, 91-92 (2d Cir. 2009).
IV.
Conclusion
In enacting the ERISA, Congress sought to alleviate disputes between competing
interests. Renfro v. Unisys Corp., 671 F.3d 314, 321 (3d Cir. 2011). Although the ERISA
strives to “offer employees enhanced protection for their benefits,” it does not “create a system
that is so complex that administrative costs, or litigation expenses, unduly discourage employers
from offering welfare benefit plans in the first place.” Varity Corp. v. Howe, 516 U.S. 489, 497,
116 S.Ct. 1065, 134 L.Ed.2d 130 (1996). The ERISA must be interpreted and applied “in light
of its objectives of ensuring the enforcement of employees’ rights under existing employee
benefit plans and encouraging employers to create additional employee benefit plans.” Haisley,
776 F.Supp.2d at 43. The relevant policy language unambiguously provides Hartford with “full
32
discretion and authority to determine eligibility for benefits” under the Plan. ECF No. 17-2 at
17. A decision setting aside Hartford’s determination concerning Minutello’s eligibility “might
lead those employers with existing plans to reduce benefits, and those without such plans to
refrain from adopting them.” Fort Halifax Packing Co., Inc. v. Coyne, 482 U.S. 1, 11, 107 S.Ct.
2211, 96 L.Ed.2d 1 (1987). By deferring to Hartford’s eminently reasonable decision in this
case, the Court preserves the incentive that Starwood has to offer its employees the benefits that
Minutello enjoyed for a decade. Conkright, 130 S.Ct. at 1648-1649.
In this context, the Court has no authority to substitute its own judgment for that of
Hartford. Lucash v. Strick Corp., 602 F.Supp. 430, 434 (E.D.Pa. 1984). No opinion is expressed
as to whether Hartford correctly ascertained Minutello’s functional abilities and limitations.
Since Hartford’s factual findings are “reasonable,” they cannot be disturbed. Firestone, 489 U.S.
at 111. The motion for summary judgment filed by Hartford (ECF No. 18) will be granted, and
the motion for summary judgment filed by Minutello (ECF No. 23) will be denied. An
appropriate order follows.
McVerry, J.
cc:
All counsel of record
33
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
THERESA R. MINUTELLO,
Plaintiff,
v.
HARTFORD LIFE AND ACCIDENT
INSURANCE COMPANY,
Defendant.
)
)
)
)
)
)
)
)
)
)
2:12-cv-01240
ORDER
AND NOW, this 12th day of August, 2013, in accordance with the foregoing
Memorandum Opinion, it is hereby ORDERED, ADJUDGED, and DECREED that the
Defendant’s Motion for Summary Judgment (ECF No. 18) is GRANTED, and that the Plantiff’s
Motion for Summary Judgment (ECF No. 23) is DENIED. The Clerk is directed to docket this
case as closed.
BY THE COURT:
s/ Terrence F. McVerry
Terrence F. McVerry
United States District Judge
cc:
All counsel of record
34
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