Opinion
CIVIL ACTION NO. 3:03-CV-0457-B.
May 19, 2005
AMENDED MEMORANDUM ORDER
When the Court entered its memorandum order in this case on May 18, 2005, footnote no. 4, contained herein, was omitted. Hence, the Court has entered this amended order which includes footnote no. 4. The addition of footnote n. 4 does not effect any substantive change to the Court's May 18, 2005 memorandum order.
The following motions are before the Court: (1) the Motion of Plaintiff Timothy R. Collinsworth ("Collinsworth") for Summary Judgment on his claims against Hartford in their entirety and (2) the Cross Motion of Defendant Hartford Life and Accident Insurance Co. ("Hartford") for Summary Judgment on all of Collinsworth's claims against it, filed May 7, 2004 and May 10, 2004, respectively. Having reviewed the pleadings and evidence on file, the Court GRANTS Collinsworth's Motion for Summary Judgment in its entirety, and DENIES Hartford's Motion for Summary Judgment in its entirety for the reasons that follow.
I. BACKGROUND FACTS,
The facts are derived from the parties' pleadings and the evidence contained in the summary judgment record. Unless characterized as a contention by one of the parties, these facts are undisputed. Per Judge Lynn's Order June 2, 2004, the Court will review Hartford's factual determinations as plan administrator for abuse of discretion, considering only the contents of the administrative record. See also Vega v. Nat'l Life Ins. Servs., Inc., 188 F.3d 287, 300 (5th Cir. 1999) (noting that the "procedural rules encourage parties to resolve their dispute at the administrator's level.").
Both parties have objected to evidence that the other has submitted with its respective briefing in support of the motions for summary judgment or responses thereto. Because the Court has found it unnecessary to rely upon the majority of the challenged testimony, it declines at this time to consider each of the objections and instead addresses specific objections to those portions of the disputed evidence the Court regards as relevant to the resolution of particular summary judgment issues. The remainder of the parties' objections are DENIED as moot.
Before setting forth the factual timeline, the Court notes that throughout both its motion briefing and its opposition briefing, Hartford makes numerous conclusory assertions of fact with no evidentiary citations, in violation of Local Rule 7.2(e), which provides:
"If a party's motion or response is accompanied by an appendix, the party's brief must include citations to each page of the appendix that supports each assertion that the party makes concerning any documentary or non-documentary evidence on which the party relies to support or oppose the motion."
Moreover, as the Fifth Circuit noted in Skotak v. Tenneco Resins, Inc., 953 F.2d 909, 915-16 n. 7 (5th Cir. 1992), Rule 56, (Summary Judgment) does not impose a duty upon the Court to "sift through the record" for evidence supporting Hartford's position. This is especially true where a party, such as Hartford, the Plan Administrator, is "well aware of the existence of such evidence." Skotak, 953 F.2d at 916 n. 7.
A. Collinsworth Suffered a Stroke.
Collinsworth is a forty-eight year old resident of Dallas, Texas. In 1986, Collinsworth, a Tyco employee, suffered a stroke which rendered his left side partially paralyzed. (Summary Detail Report, Administrative Record HL 71). He returned to work three months later and continued working at Tyco until June 29, 2001. ( Id.). Collinsworth continued working at Tyco with limited functioning on his left side until his last day at work on June 29, 2001. See, e.g., (D MSJ 3; D Resp. 5, Administrative Record, HL 436-44).
In the Group Disability Policy (the "Policy"), "Disability or Disabled" is defined as follows: "during the Elimination Period and for the next 24 months you are prevented by: 1. accidental injury; 2. sickness; 3. mental illness; 4. substance abuse; or 5. pregnancy, from performing one or more of the Essential Duties of Your Occupation[.]" (Administrative Record, HL 32). Collinsworth claims that Hartford abused its discretion in denying him benefits for the Elimination Period and the following 24 months because he was unable to perform one or more of the essential functions of his job. See generally (Complaint, P MSJ and P MSJ Brief). B. Collinsworth's Condition Worsens.
As Collinsworth continued his employment, he claims that his condition gradually worsened, and that "[a]s of 1999, [he] was experiencing considerable pain from the constant walking, climbing, bending, and lifting required of his job." (Collinsworth Aff., PAE 574). Collinsworth also alleges that one of the side effects of his worsening condition was that his weakened legs caused him to lose his balance and made walking difficult, but cites no evidence from the Administrative Record to support these assertions. ( Id.). Collinsworth's last day of work was July 29, 2001. (Administrative Record HL 436-444).
According to Collinsworth, on July 1, 2001, he fell onto his left side, injuring his back, while at home on his patio. ( Id.; see also Administrative Record HL 97 (Thomas Summary Detail Report). Collinsworth claims that, following his fall, his condition worsened and he was unable to work. ( Id.). Although Hartford claims that the fall took place a month after he ceased work, there is no evidence in the Administrative Record to support this assertion. (D Resp. 6). All evidence indicates that the fall Collinsworth suffered on his patio which allegedly exacerbated his injuries, including his central pain syndrome, took place on July 1, 2001. ( Id.; see also Administrative Record, LTD App., Attending Physician Statement of Dr. Goyal HL 444.). The progress notes of Collinsworth's treating physician, Dr. Goyal, on July 12, 2001 state that Collinsworth's fall was about "two weeks" before his visit with the doctor, and that at that time the doctor noticed a superficial bruise on his hand, and the Summary Detail Report also mentions the July 1 date. (Dr. Goyle's Progress Notes of July 12, 2001, Administrative Record HL 389). The Attending Physician Statement attached to Collinsworth's LTD Application likewise supports the July 1, 2002 timeframe. (Administrative Record, APS, HL 444). C. Collinsworth Applies for Disability Benefits.
It is undisputed that Collinsworth was a Tyco employee enrolled in the company's LTD group plan insured by Hartford, and that Collinsworth had for applied short term disability benefits and his application was granted with benefits continuing through January 8, 2002. (D MSJ 2; Administrative Record, HL Exh. A). Additionally, Hartford recognizes that Collinsworth was granted Social Security Disability benefits beginning January 2002, setting his date of disability as July 2, 2001. ( Id.).
Collinsworth completed an application to Hartford for LTD benefits on October 29, 2001, claiming that he was permanently unable to work because of alleged "numbness in both hands and feet," especially on his left side. (Application for LTD Benefits "LTD App.," Administrative Record HL 439). In his application for LTD benefits, Collinsworth stated that "[a]ny movement caused pain." ( Id.). He also noted that he suffered from depression, anxiety, headaches, "rigidity" and "motor dysfunction." ( Id.).
Collinsworth's physician, Dr. Goyal, believed that after his fall in July 2001, Collinsworth was no longer able to perform the job duties he had previously been performing and that his central pain syndrome worsened and that medication did not do enough to alleviate the pain to allow him to work as he had before the fall. See, e.g., (Administrative Record, April 4, 2002 letter from Dr. Goyal to Hartford, PAE 269). A May 7, 2002 letter from his psychiatrist, Dr. Pole, to Hartford likewise indicated that Collinsworth's symptoms of depression had "worsened" and that he had "concentration difficulties" and was "unable to work." (Administrative Record, HL 105).
While Hartford makes the bald statement that Dr. Goyal's notes of July 12, 2001 state that Collinsworth "did not appear to be in any pain," (D Resp. 6), the notes actually reflect a diagnosis of chronic pain syndrome and noted that Collinsworth complained of pain throughout "his whole body," especially on his left side. (Dr. Goyle's Progress Notes of July 12, 2001, Administrative Record HL 389).
As the Court will address in more detail later, the parties disagree regarding the essential functions of Collinsworth's job. Hartford claims that, according to the Administrative record, Collinsworth's position was sedentary, and merely required him to sit and inspect products weighing one pound or less and replace them if they were satisfactory, or, if it was unsatisfactory, note the reason on a computer. (D MSJ 3, Administrative Record, Exh. A HL83 and HL 348-349). Hartford further contends that the Administrative Record demonstrates that although Collinsworth occasionally was required to move a box containing products, this was not "an essential duty of the job." ( Id.) (noting a comment by a Tyco quality control supervisor). Collinsworth points out that, according to his supervisor, Joe Cannon, Collinsworth's job as a "Quality Electronic Auditor" required him to sit for 8 hours and walk for 1 hour. (P MSJ 3, Administrative Record 92). He was also frequently required to lift up to 10 pounds and occasionally 20-50 pounds ( Id.). He occasionally had to "stoop, crouch, reach, and finger," and frequently had to "handle and feel." ( Id.). Cannon noted that "repetitive motions" could be done with one hand. ( Id.). Hartford requested that Cannon complete a PDAF form. (Administrative Record, PDAF, HL 348-49).
D. Medical Documentation of Collinsworth's Disability.
1. Dr. Goyal — Collinsworth's Primary Treating Physician.
On October 29, 2001, Collinsworth's primary care physician, Dr. Goyal, completed his "Attending Physician's Statement," ("APS") in which his primary diagnosis for Collinsworth's disability was partial paralysis on his left side as a result of the stroke he suffered in 1986, and his secondary diagnosis was of depression, hyperlipidermia, and hypertension. (Administrative Record HL 236). Dr. Goyal also indicated that Collinsworth's ability to "lift/carry, push, and pull" as well as his ability to "stand, walk, drive, and use a keyboard" or engage in repetitive hand motion was limited by his chronic pain. ( Id.). On November 28, 2001, Dr. Goyal completed the Hartford Physical Capacities Evaluation Form ("PCE"), in which he indicated what physical activities Collinsworth was capable of performing. (Administrative Record, PCE, PAE 404-05). Dr. Goyal clarified his October 29, 2001 APS via letter on February 2, 2002, stating that Collinsworth was only able to sit for 6-8 hours with breaks, not straight through. (Administrative Record HL 348-341). Moreover, Dr. Goyal predicted that Collinsworth would retain these physical limitations "indefinitely," and clearly stated in an April 4, 2002 letter to Hartford that Collinsworth was, in his opinion, "too incapacitated to do any useful work at present and should be considered permanently disabled both physically and mentally." (Administrative Record, HL 108).2. Drs. Jaremko and Pole — Collinsworth's Mental Condition.
On December 12, 2001, Collinsworth's psychologist, Dr. Jaremko, completed the Hartford "Mental Disorders" form, noting that Collinsworth's depression "somewhat compromised" both his ability to concentrate and his attention span. (Administrative Record, PAE 412-13). Dr. Jaremko likewise found that, in his opinion, Collinsworth was able to work. ( Id.).
Hartford claims that Collinsworth worked successfully despite a long history of depression (D MSJ 6, Administrative Record HL 428) and that the notes of his treating mental practitioners indicate that "Collinsworth's depression and stress were stemming not from his job at Tyco, but rather from an EEOC claim he filed against Tyco for discrimination." (D MSJ 6, citing Administrative Record 425-32). However, Collinsworth did not begin seeing Dr. Jaremko until after the alleged fall in July of 2001. (Administrative Record, PAE 412-13). Dr. Jaremko believes that after the fall, Collinsworth was forced to face his disability as he had not for fifteen years, and that he was having difficulty doing so. (Administrative Record 425-32).
3. Hartford Examines the Demands of Collinsworth's Job.
Hartford employee Antoinette Thomas ("Thomas") was initially responsible for reviewing Collinsworth's LTD claim. (Administrative Record, Summary Detail Report, PAE 77-83). While both Collinsworth's supervisor, Joe Cannon, and the QA manager, Maureen Fitzgerald, confirmed that Collinsworth was a "product checker/inspector" for many years, Thomas had difficulty locating an appropriate job description. ( Id., PAE 81-83).
On February 6, 2002, Thomas conducted a telephone interview with Cannon, Collinsworth's supervisor, and based on Cannon's answers, completed Hartford's Physical Demands Analysis Form ("PDAF"). (Administrative Record, Summary Detail Report, PAE 81-83, PDAF, HL 348-49). On February 20, 2002, Thomas first recommended denial of Collinsworth's claim, but discovered that it was based on an inaccurate job description — that of an Engineering Associate. ( Id., PAE 84).
Cannon later changed locations within the company, and, apparently unable to reach Collinsworth's new supervisor, Thomas spoke on February 25, 2002 with Maureen Fitzgerald ("Fitzgerald") the QA manager. ( Id.). Thomas asked Fitzgerald whether Collinsworth had to move boxes weighing over twenty pounds, and Fitzgerald replied that Collinsworth did occasionally have to move product, but that doing so was not an essential function of his job. There is no indication in the record, however, that Fitzgerald understood the definition of an essential function as it was set out in the Policy. (P MSJ 5, Administrative Record, Summary Detail Report, PAE 83). She confirmed, however, that Cannon's physical description of the job as noted in the PDAF was correct. ( Id.; PDAF, HL 348-49). Fitzgerald also commented that "[Collinsworth's] job did require concentration as he needed to check the quality of the product carefully." ( Id.). In the Summary Detail Report that day, Thomas noted that she still was not clear what occupation Collinsworth was working in when he ceased work because of his alleged disability and that she needed to locate a job description. ( Id. at 81-82). Two days later, Thomas noted that the job description previously on file may have been incorrect ( Id. at 80), but that, per the job description for "technical associate" (which is the position Hartford maintains Collinsworth had at the time he ceased employment), Collinsworth was required to lift boxes of product weighing up to 15 pounds. ( Id. at 80, 78).
Finally, on February 28, 2001, Thomas noted in the Summary Detail Report that Collinsworth's own occupation required him to "lift up to 10 lbs. [sic] frequently and occasionally 20-50 lbs. and only occasional[ly] lift/carry 20-50 lbs." ( Id. at 78). She concluded that, "[o]verall, considering this information, it [did] not appear that [Collinsworth] was [totally disabled in his own occupation] as his attending physician [(Dr. Goyal)] indicates he can sit 6-8 hrs and lift up to 10 [lbs.] [sic] frequently and up to 50 lbs. occasionally." Based on this analysis, Thomas recommended denial of Collinsworth's claim for LTD benefits. ( Id. at 78).
Collinsworth claims that Thomas made this decision without ever doing a comparison or analysis between Collinsworth's limitations as described by his treating physicians and Tyco's description of his job's physical demands — without comparing the PCE to the PDAF. ( Id. at 8-9; Administrative Record, PAE 77-79, PDAF 348-49). In the PCE, Dr. Goyal specifically states that Collinsworth cannot ever lift 50 pounds, and in his February letter to Hartford, he notes that Collinsworth cannot sit 6-8 hours without a break.
Finally, Hartford referred Collinsworth's file to its Clinical Nurse Manager, Doris Chartier ("Chartier") for review, and asserts that "[a]fter reviewing all medical evidence presented, Chartier came to the conclusion there was no mental or physical disability that would prevent Collinsworth from performing the essential duties of his occupation." (D MSJ 6-7; Administrative Record 342-344).
E. Hartford's Denial of LTD Benefits to Collinsworth.
Hartford claimed that "[b]ased upon a review of all information submitted and the opinion of Chartier, [it] denied Collinsworth's claim on Ma[r]ch [sic] 6, 2002 by sending a letter denying Collinsworth's LTD benefits claim to him on March 6, 2002." (Administrative Record, PAE 325-329). Thomas sent Collinsworth the denial letter, which also included a list of all medical documentation that was reviewed prior to making that determination. ( Id.). Collinsworth argues that the letter indicates that the decision relied on incorrect information (such as the amount of weight he could lift), incomplete analysis (such as failing to mention the concentration his job required), and failure to consider or even identify the essential duties of his job. ( Id., P MSJ 11).
F. Dr. Jaremko Objects to Hartford's Alleged Misuse of His Notes.
On March 14, 2002, Dr. Jaremko sent a letter to Hartford following his receipt of the company's denial of Collinsworth's claim, stating that he "in no way agree[d] with the conclusions reached in [the] evaluation." (Administrative Record, HL 109). According to Dr. Jaremko, Hartford had "taken [his] notes out of context and used them to support the conclusion that Mr. Collinsworth [was] improved." Dr. Jaremko emphasized that Collinsworth's "depressive disorder had worsened" and that he was "no longer able to perform the same duties." ( Id.).
G. Collinsworth Appeals Hartford's Initial Denial of His Claim.
On April 1, 2002, Collinsworth sent a letter to Hartford in an effort to appeal the denial of his claim for LTD benefits, reiterating his claimed physical limitations. (P MSJ 13; Administrative Record, PAE 212-226; D MSJ 8, HL 209, 212-224). Collinsworth also included a "packet of material" with his appeal and "noted some critical omissions in the first denial letter, i.e., that Dr. Goyal's stated limitations for Plaintiff would last indefinitely." (P MSJ 14; Administrative Record, PAE 223). Dr. Goyal likewise submitted another letter to Hartford on April 4, 2002, noting that Collinsworth's fall on his patio in July 2001 increased his pain, (Administrative Record, PAE 269), and stated that medication and therapy had not helped Collinsworth "to any significant degree." ( Id.). Dr. Goyal also commented that Collinsworth was "too incapacitated to do any useful work at present and should be considered permanently disabled both physically and mentally." ( Id.).
H. Panel Medical Records Review.
Hartford hired Drs. Leonard Sutton ("Sutton") and Melvyn Lurie ("Lurie") of the University Disability Consortium ("UDC") to conduct an independent "Panel Medical Records Review" of Collinsworth's claim. (D MSJ 8). In conducting the review, the doctors examined certain medical documentation, including some of Dr. Goyal's notes as well as the APS Dr. Goyal filled out on October 29, 2001. (Administrative Record, Summary Detail Report, PAE 348).
Dr. Lurie talked with Collinsworth's psychologist, Dr. Jaremko, and followed up with a letter to him on May 21, 2002 (Administrative Record, HL 191). In the letter, Dr. Lurie noted that Collinsworth had been able to work for years following his stroke, and that he became depressed and sought treatment from Dr. Jaremko after the fall he suffered in the summer of 2001. ( Id.). Further, Dr. Lurie noted that Dr. Jaremko had indicated to him that Collinsworth's primary disability derived from his physical, rather than mental, limitations. (D MSJ 8; Administrative Record, 191).
Dr. Lurie completed the psychiatric portion of the review, concluded that Collinsworth was primarily physically disabled and "only secondarily" psychiatrically disabled, but found that Collinsworth was restricted from work requiring "intense concentration." (Administrative Record, HL 202).
Dr. Sutton talked with Collinsworth's treating physician, and followed up with a letter to Dr. Goyal regarding the conversation and noted that Dr. Goyal had indicated that although Collinsworth had a limp, he could move about fairly well, but was "chronically limited in the productive use of his left arm and leg." (D MSJ 8; Administrative Record, HL 192-93). Additionally, Dr. Sutton stated that Dr. Goyal commented to him that he was not certain of the etiology of Collinsworth's alleged pain, and that although he did not believe Collinsworth's physical disabilities would prevent him from working in a sedentary position, he believed that his "depression and emotional state would not allow him to work gainfully." ( Id.). Dr. Sutton then concluded in a review dated May 21, 2002 that there was "no meaningful objective clinical or laboratory data to support a physical basis preclusion from sedentary work capacity." (Administrative Record HL 196). Importantly, however, Dr. Sutton did not, however, consider Dr. Goyal's comment regarding clarification of his sitting restriction. (Administrative Record, HL 195-96).
Collinsworth alleges the Panel's summary omits and mischaracterizes certain findings by Dr. Goyal and fails to consider the PDAF, PCE or Dr. Goyal's "clarification of the sitting restriction." (P MSJ 15, Administrative Record HL 195-202; PDAF, HL 348-49). Moreover, Collinsworth claims that "[t]here is no evidence that Dr. Sutton considered Plaintiff's consistent diagnoses of chronic pain by Dr. Goyal as indicated in [Dr. Goyal's] notes, or the effects of it on [Collinsworth's] ability to perform the tasks required by his job description." (P MSJ 16; Administrative Record, Panel Review HL 195-202; Dr. Goyal's Office Notes, PAE 370, 374, 375, 377). I. Dombrowski's Review and the Second Denial.
Upon receiving the reports of Drs. Sutton and Lurie, Robert Dombrowski ("Dombrowski") of Hartford compiled the Summary Detail Report which he finalized on May 9, 2002. (P MSJ 17; Administrative Record, PAE 75). In compiling his report, Collinsworth claims that Dombrowski failed to review the PDAF or the PCE and compare the two as evidenced by the lack of any comment regarding the two documents in his review contained in the Summary Detail Report. (P MSJ 18-19; Administrative Record, Summary Detail Report, PAE 73-75; Dombrowski Dep., 530-31; PDAF, HL 348-49). Dombrowski also testified in his deposition that he only compared the PDAF with the PCE "in some cases." (Administrative Record, Dombrowski Dep. 530-31).
Hartford sent Collinsworth a second denial letter on June 26, 2002. (P MSJ 21, 27; Administrative Record, PAE 152). In the letter, Hartford specifically states that "The formal job description provided by your employer indicates that this occupation included process and final product audits and review of customer complaints and returns. The physical requirements needed were listed by your employer and prior supervisor [(Cannon)] consistent [sic] with sedentary level work. In particular, it was listed that your occupation requires primarily sitting and can be done with one hand." ( Id.).
J. Collinsworth Appeals the Decision of the Review Committee.
After receipt of the second denial letter, Collinsworth alleges that he "act[ed] in reliance upon what the [Summary Plan Description] said . . . and submitted a letter on August 9, 2002, to the Tyco Benefits Review Committee, in which he, paragraph by paragraph, disputes, corrects, or otherwise addresses Hartford's second denial letter." (P MSJ 27; Administrative Record, PAE 503-04). In response, Roberta Murray, Tyco's Manager of Employee Benefits and Disability, informed Collinsworth that "[s]ince [Tyco was] fully insured by the Hartford there is nothing that Tyco Electronics can do to reverse the decision made by the Hartford. Your only course of action at this time would be to seek legal advice." (P MSJ 27-28; Administrative Record, PAE 171-72). Collinsworth then "addressed a letter to Steve Faigan of Tyco on August 27, 2002, in which he detailed Hartford's two denials of his claims and his understanding of the [Summary Plan Description] and his desire that the Tyco Benefits Review Committee review his claim." (P MSJ 28; Administrative Record, PAE 168-70). On September 16, 2002, Dombrowski notified Collinsworth that he had received his August 27, 2002 letter, that Hartford's decision was final, and that Collinsworth had the right to file suit under ERISA. (Administrative Record, PAE 167). Collinsworth claims that this closure of administrative remedies was in contravention of the procedures set forth in the Summary Plan Description. (P MSJ 28).
Collinsworth filed this ERISA lawsuit on March 4, 2003 in the Northern District of Texas, seeking declaratory relief under 28 U.S.C. §§ 2201 and 2202 for a determination of his rights to disability benefits under Tyco's employee benefits plan. ("Complaint"). Before the Court is Collinsworth's motion for summary judgment, filed May 4, 2004 seeking a declaratory judgment that Hartford arbitrarily and capriciously denied his claim, and that he "is entitled to the benefits due him under the first period of time in the policy, the elimination period plus 24 months." (P MSJ Brief 2-3). Also before the Court is Hartford's Motion for Summary Judgment, filed May 10, 2004, seeking judgment in its favor on all of Collinsworth's claims against it.
The Court notes that Hartford has also moved for summary judgment on Collinsworth's "breach of fiduciary" claim, to the extent he has alleged one. (D MSJ at 15-16). Likewise, Hartford has moved for summary judgment on any state law claims Collinsworth has made for damages for emotional distress and mental anguish. ( Id.). Upon review of Collinsworth's complaint, the Court does not find (cont.) that he has alleged any state law claims, and notes that he has only sought any compensatory damages "authorized by law." Moreover, Collinsworth does not address any purported state law claims, either in his motion or his responsive pleadings to Hartford's motion for summary judgment. Thus, because the Court does not find that Collinsworth has alleged any state law claims, it will not address this portion of Hartford's motion.
II. ANALYSIS
A. Legal Standard and Evidentiary Burdens.Under Rule 56(c) of the Federal Rules of Civil Procedure, summary judgment is appropriate when the pleadings and record evidence show that no genuine issue of material fact exists and that, as a matter of law, the movant is entitled to judgment. Hart v. Hairston, 343 F.3d 762, 764 (5th Cir. 2003). In a motion for summary judgment, the burden is on the movant to prove that no genuine issue of material fact exists. Provident Life Accident Ins. Co. v. Goel, 274 F.3d 984, 991 (5th Cir. 2001). To determine whether a genuine issue exists for trial, the court must view all of the evidence in the light most favorable to the non-movant, and the evidence must be sufficient such that a reasonable jury could return a verdict for the non-movant. See Chaplin v. NationsCredit Corp., 307 F.3d 368, 371-72 (5th Cir. 2002).
Once a movant demonstrates that there are no genuine issues of material fact as to the issues on which he seeks summary judgment, the burden shifts to the nonmovant to point to evidence in the record sufficient to support a resolution of the issue of fact in its favor. Celotex, 477 U.S. at 324; Anderson, 477 U.S. at 255 (citations omitted). The role of the Court deciding a motion for summary judgment is not "to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial." Anderson, 477 U.S. at 248.
In reviewing Collinsworth's motion for summary judgment on the plan administrator's denial of benefits, the Court may only find for the Plaintiff if Hartford lacked substantial evidence to support its decision, rendering the decision arbitrary and capricious. Ellis v. Liberty Life Assur. Co. of Boston, 394 F.3d 262, 273 (5th Cir. 2004).
B. ERISA.
1. Standard of Review.
It is undisputed that ERISA governs the policy in question. Collinsworth filed his motion for summary judgment on May 7, 2004, asserting that Hartford did not properly reserve discretionary authority, and that the appropriate standard of review is de novo. (P MSJ Brief). In analyzing a claim for benefits allegedly due under an ERISA plan, the district court reviews the plan administrator's determination for abuse of discretion when the plan expressly gives the administrator discretionary authority. Vercher v. Alexander Alexander Inc., 379 F.3d 222, 226 (5th Cir. 2004). Moreover, even in cases where such authority is not conferred, the court reviews any factual determinations made by the administrator for abuse of discretion. Id. (citations omitted).
On June 2, 2004, Judge Lynn of this Court entered a Memorandum Opinion and Order overruling Collinsworth's objections to the findings of Magistrate Judge Ramirez denying Collinsworth's motion to compel discovery responses, and held that Collinsworth's claim for LTD benefits "constitutes a review of [Hartford's] factual determinations," and should therefore be reviewed for abuse of discretion, considering only the contents of the administrative record." (Order 1-2). The case was transferred to this Court on July 17, 2004. The Court will therefore decide, as a matter of law, whether Hartford abused its discretion. See Meditrust Fin. Servs. Corp. v. Sterling Chems., Inc., 168 F.3d 211, 213-15 (5th Cir. 1999). Because the Court will be utilizing the abuse of discretion standard in making its factual determination regarding Thompson's claim, the Court "may consider only the evidence available to the plan administrator." Bellaire Gen. Hosp. v. Blue Cross Blue Shield of Mich., 97 F.3d 822, 827 (5th Cir. Tex. 1996). The Court may not disturb the administrator's factual conclusions unless they are arbitrary or capricious. Meditrust Fin. Serv. Corp. v. Sterling Chem., Inc., 168 F.3d 211, 213 (5th Cir. 1993) ("a court will reverse an administrator's decision only for abuse of discretion.").
2. Denial of Collinsworth's Claim for LTD Benefits.
Collinsworth has brought this suit pursuant to ERISA section 1132(a)(1)(B), which allows qualified employee benefit plan participants or beneficiaries to bring civil suit to recover benefits due under the plan. ( Tait v. Barbknecht Tait Profit Sharing Plan, et al., 997 F. Supp. 763, 768-69 (N.D. Tex. 1998) (Fish, J.). It is undisputed that Collinsworth was a participant under the Plan. Hartford claims that it denied Collinsworth's claim for benefits based on its interpretation that all of the documentation and evidence supported its ultimate conclusion that "Collinsworth was not precluded by a physical or mental condition from performing the essential duties of his own occupation." (D MSJ 1).
As set forth in the Fifth Circuit's opinion in Wildbur v. Arco Chem. Co., 974 F.2d 631, 637 (5th Cir. 1992), Courts reviewing a plan administrator's denial of a qualified participant's claim for benefits determine two issues: "whether the administrator's interpretation is legally correct," and if not, "whether the decision constituted an abuse of discretion." Id., Tait, 997 F. Supp. at 769. In analyzing whether Hartford's plan interpretation was legally correct, the Court considers three factors. Tait, 997 F. Supp. at 769 (citing Abraham v. Exxon Corp., 85 F.3d 1126, 1131 (5th Cir. 1996)) (citations omitted); Wildbur, 974 F.2d at 637-38. First, the Court determines whether the plan has been given a uniform construction. Id. Second, the Court determines "whether the interpretation is consistent with a fair reading of the plan." Id. Finally, the Court determines "whether a different interpretation will result in unanticipated costs." Id.
While this Court must evaluate Hartford's findings of fact based on the evidence before the Administrator, the Court may consider other evidence relevant under the two-step analysis of legal interpretation and abuse of discretion. Wildbur, 974 F.2d at 639. Because neither party has provided evidence regarding whether Hartford uniformly construed the Plan or whether Collinsworth's interpretation of the plan would result in unanticipated costs (and the Court finds no evidence that it would), the Court need not address these two factors. Accord, Tait, 997 F. Supp. at 769, 771.
Thus, the focus is whether Hartford's interpretation of the plan is a fair reading of the plan provisions. Tait, 997 F. Supp. At 771. While Hartford's briefs indicate that it did indeed base its determination on whether Collinsworth could perform the essential duties of his own occupation, the Court finds that Hartford abused its discretion in concluding that Collinsworth could perform the essential functions of his position at Tyco. Hartford's interpretation is inconsistent with a fair reading of the Plan.
The Plan provides as follows:
Disability or Disabled means that during the Elimination Period and for the next 24 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 . . ."
. . .Essential Duty means a duty that:
1. is substantial, not incidental;
2. is fundamental or inherent to the occupation; and
3. can not be reasonably omitted or changed.
While Hartford makes repeated references throughout its motion for summary judgment and its opposition to Collinsworth's motion that Collinsworth had been performing and thus could continue performing the essential functions of his job at Tyco, these references are unsupported and directly conflict with the evidence clearly indicating that (1) Collinsworth's condition, both mentally and physically, deteriorated after his fall in July, 2001, and (2) Collinsworth was physically and mentally incapable of performing the essential duties of his job. The Court recognizes that if Hartford's "decision is supported by substantial evidence and is not arbitrary and capricious, it must prevail." The Administrative Record however, demonstrates that Hartford lacked substantial evidence to support its decision, rendering its decision was arbitrary and capricious. See Ellis, 394 F.3d at 273.
3. Hartford Abused its Discretion and Was Legally Incorrect in Comparing the Requirements of Collinsworth's Job With His Assumed Abilities Before His Fall in July 2001.
Hartford was legally incorrect in comparing Collinsworth's physical and mental abilities before his fall with the purported essential requirements of his job. Hartford ignores the factual basis for Collinsworth's physical disability claim, which is that his condition worsened as a result of his fall on July 1, 2002. In his visit to Dr. Goyal, almost two weeks after the fall, Collinsworth still had the remnants of a bruise. (Administrative Record, Dr. Goyal's July 12, 2001 Office Notes, PAE 389). Moreover, Dr. Goyal indicated in the APS accompanying Collinsworth's LTD claim that he began treating Collinsworth for the disability leading to his LTD application on July 12, 2001. (Administrative Record, Physician Statement, PAE 443-44). Likewise, Hartford abused its discretion by ignoring evidence that Collinsworth's mental condition worsened after the fall. Collinsworth did not begin seeing Dr. Jaremko until after his fall, and Dr. Jeremko specifically emphasized in his correspondence with Hartford following its initial denial of Collinsworth's claim for LTD benefits that Collinsworth's "depressive disorder had worsened" and that he was "no longer able to perform the same duties [as he had before the fall]." ( Id.).
4. Hartford Abused Its Discretion in Concluding that Collinsworth was Not Totally Disabled from Performing the Essential Duties of His Own Occupation By His Physical Condition.
Next, the Court finds that Hartford likewise abused its discretion in concluding that Collinsworth could perform the essential duties of his own occupation. The record is replete with evidence that there were numerous essential duties of Collinsworth's occupation that he could not perform. Collinsworth argues that Hartford ignored the information in the Administrative Record, namely the PDAF, completed by Thomas following her interview with Cannon, Collinsworth's supervisor, and the PCE, completed by Dr. Goyal. (P MSJ Brief). On February 28, 2001, Thomas reaffirmed her previous recommendation to deny Collinsworth's claims for benefits. In her recommendation, she specifically stated that Collinsworth's job required him to occasionally lift/carry up to 50 pounds, and concluded that Collinsworth was thus not disabled from performing the essential duties of his job in part because his attending physician, Dr. Goyal indicated that he could occasionally lift up to 50 pounds. (Administrative Record, Summary Detail Report, PAE at 77-78). She also based her denial on Dr. Goyal's notation that Collinsworth could sit 6-8 hours, when Dr. Goyal had specifically clarified that he did not mean that Collinsworth could sit for that long without breaks. ( Id.; Administrative Record, PCE, PAE 404).
Collinsworth asserts that "[t]he PDAF tracks the same physical demands requirements categories as those found in the PCE." (P MSJ 6; Administrative Record HL 348-49). Because "[t]he PDAF is the only physical demands analysis in the record." Collinsworth argues that "it must be presumed that the PDAF form completed by Cannon was based on the essential duties of the Plaintiff's job." ( Id.). The Court agrees. Hartford's response to Collinsworth's accusation that it ignored the PDAF is that the PDAF conflicted with the fact that Collinsworth was performing the essential duties of his job prior to ceasing work, and thus, the requirements in the PDAF could not have been correct. See, e.g. (D Reply 8). Hartford's analysis begins with their assumption that Collinsworth's condition at the time he applied for LTD benefits was exactly as it was prior to his fall, and ends with an attempt to fill in the physical functions that someone with his previous condition could perform rather than ask whether he was able to perform the essential requirements of his job as described. (Policy). This conclusion is arbitrary and capricious and legally incorrect because all evidence indicates that Collinsworth's fall worsened his condition. Viewing the Administrative Record as a whole, Hartford lacked substantial evidence to support its decision, and the Administrator arbitrarily and capriciously found that Collinsworth could perform the essential duties of his job without any rational connection between the facts and the decision. See Vega, 188 F.3d at 302 (noting that it is an abuse of discretion if there is no concrete evidence in the record supporting the denial of a claim).
5. Hartford Abused Its Discretion in Concluding that Collinsworth was Not Totally Disabled from Performing the Essential Duties of His Own Occupation By His Mental Condition.
Hartford likewise abused its discretion and was legally incorrect in omitting the ability to concentrate as an essential function of Collinsworth's occupation and in concluding that he was not mentally disabled form performing this essential function. The evidence shows that there is no genuine issue of material fact that Collinsworth's job required concentration because he had to "check the product carefully." (Administrative Record, Summary Detail Report; PAE 83). All evidence available to Hartford, however, indicated that Collinsworth was too depressed to work and that he was unable of working at a job requiring "intense concentration." Dr. Pole likewise confirmed that Collinsworth had "concentration difficulties" and was "unable to work." (Administrative Record, HL 105). Finally, even Dr. Lurie concluded that Collinsworth was restricted from work requiring "intense concentration." (Administrative Record HL 202).
6. Hartford Abused Its Discretion in Concluding Upon Reviewing Collinsworth's Appeal That He was Not Totally Disabled from Performing the Essential Duties of His Own Occupation By His Physical and Mental Conditions.
Hartford's review after Collinsworth's appeal was likewise arbitrary and capricious. There is no genuine issue of material fact that Dombrowski conducted the review without comparing the PDAF with the PCE or APS. (P MSJ 18-19; Administrative Record, Summary Detail Report, PAE 73-75; Dombrowski Dep., 530-31; PDAF, HL 348-49). Nor did Hartford specifically identify the essential physical requirements of Collinsworth's job in its second denial letter of June 26, 2002, even though Hartford noted that Tyco and Cannon had provided Hartford with the job's "physical requirements." (P MSJ 21, 27; Administrative Record, PAE 152). Nor did the letter note the clarification Dr. Goyal had made regarding the sitting restriction, which was at this point part of the record. ( Id.).
Moreover, Hartford notes in its letter that it also relied upon the independent review of Drs. Sutton and Lurie and comments that "Dr. Sutton reviewed all records on file . . .," but in his detailed list of records reviewed, Dr. Sutton does not mention the PDAF or the PCE. (Administrative Record, Panel Medical Records Review, PAE at 195-95). And while the Administrative Record is replete with evidence that Dr. Goyal had diagnosed Collinsworth with Chronic Pain Syndrome, (Administrative Record, PAE at 370 (7/12/01), 374 (8/08/01), 375 (10/29/01), 377 (12/18/01)), and Dombrowski admitted in his deposition that he accepted Collinsworth's reports of being in pain as true (Administrative Record, Dombrowski Dep., PAE 520, 549), the second denial letter indicates that Hartford assumed just the opposite. (Administrative Record, PAE 153). Finally, Hartford concludes in the letter that "there is not satisfactory proof that your physical condition changed to a degree that would preclude you from performing your occupation as you had prior to your fall . . ." which, again, is legally the incorrect standard, because the question is whether Collinsworth was physically disabled from performing all of the essential requirements of his job. Thus, the Court finds that Hartford abused its discretion and was legally incorrect in construing the policy to require proof of etiology of Collinsworth's pain and in disregarding Collinsworth's self-reports of pain and finding that Collinsworth was not totally disabled and entitled to benefits for the elimination period plus the following 24 months.
The second denial letter likewise determines that Collinsworth is not mentally disabled form performing his job, completely omitting the essential requirement of an ability to concentrate and the noted restrictions by Dr. Jaremko and by Dr. Lurie during his original report. ( Id. at 154). The letter concludes that "there [was] not satisfactory evidence of a psychiatric impairment that would have precluded you from working as you had prior to your last day worked." ( Id.). There is no mention of Collinsworth's ability to perform the essential duties of his own occupation during the elimination period. The Court thus finds that Hartford likewise abused its discretion in concluding that Collinsworth was not mentally disabled from performing the essential duties of his job, which required concentration.
In light of the medical evidence indicating that Collinsworth's condition worsened as a result of his fall on July 1, 2001, the medical evidence indicating his physical and mental inabilities to perform more than one of the essential requirements of his occuption, Hartford abused its discretion in finding that Collinsworth was not totally disabled by his physical and mental conditions during the elimination period and following 24 month period. Hartford's actions were in violation of ERISA. The Court GRANTS Collinsworth's motion for summary judgment as to his disability benefits claim for this period.
C. Attorneys' Fees.
Collinsworth also seeks an award of his attorneys' fees. Although ERISA allows the Court to award reasonable attorneys' fees and costs to either party, that decision is purely discretionary. Bellaire Gen. Hosp. v. Blue Cross Blue Shield of Mich., 97 F.3d 822, 832-33 (5th Cir. 1996). Courts should consider (1) the degree of bad faith exercised by Hartford, (2) Hartford's ability to pay the award, (3) whether an award would deter other persons from acting similarly under similar circumstances, (4) whether Collinsworth seeks to benefit all ERISA participants and beneficiaries or seeks to resolve a significant ERISA legal question, and (5) the relative merits of each party's position. Todd v. AIG Life Ins. Co., 47 F.2d 1448, 1458 (5th Cir. 1995). Rather than address the issue of attorneys' fees at this time, the Court instructs the parties to confer in an effort to reach an agreement on the issue. If they are unable to agree, the Court instructs Collinsworth to file a brief in support of his motion for attorneys' fees, along with supporting documentation of the amount of fees requested, within thirty days of the entry of this Order. Hartford will have twenty days to file a response as well as any objection to the amount of fees.
III. CONCLUSION
For the reasons discussed, the Court finds that there are no genuine issues of material fact that the terms of the Plan require granting of disability benefits for the elimination period plus 24 months as provided under the Plan, retroactive to July 1, 2002, and thus GRANTS Collinsworth's motion for summary judgment in its entirety. The Court DENIES Hartford's motion in its entirety.
SO ORDERED.