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Rotondi v. Hartford Life and Accident Group

September 22, 2010

JOSEPH C. ROTONDI, PLAINTIFF,
v.
HARTFORD LIFE AND ACCIDENT GROUP, DEFENDANT.



The opinion of the court was delivered by: Paul G. Gardephe, U.S.D.J.

MEMORANDUM OPINION AND ORDER

In this action brought under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), Plaintiff Joseph C. Rotondi alleges that Defendant Hartford Life and Accident Group ("Hartford") wrongfully terminated his employer-sponsored long term disability ("LTD") benefits. Plaintiff and Defendant filed cross motions for summary judgment on December 14, 2009. (Docket Nos. 7 & 18)

Plaintiff argues that Hartford's decision to terminate his LTD benefits was arbitrary and capricious because Hartford neglected to conduct an independent medical examination of him and rejected the findings of his treating physician. Plaintiff further contends that Hartford's "dual role as both the administrator and payer of benefits" constitutes a conflict of interest, and that this conflict played a role in Hartford's benefit determination. (Pltf. Br. 1) Defendant argues that Plaintiff's claim is time-barred and that, in any event, the administrative record supports its decision to terminate Rotondi's LTD benefits. (Def. Br. 2) Because Rotondi's claim is in fact time-barred, and because he has failed to show that Hartford acted in an arbitrary and capricious manner in terminating his LTD benefits, Defendant's motion for summary judgment will be GRANTED and Plaintiff's motion for summary judgment will be DENIED.

BACKGROUND

Plaintiff was employed as a machinist by R.R. Donnelly & Sons Co. from February 1987 until October 2001 (Pltf. Rule 56.1 Stat. ¶ 1; Def. Rule 56.1. Stat. ¶ 1)*fn1

Machinist positions typically require two hours of sitting, three hours of standing, and less than 1 hour of walking per eight hour day and are categorized as "sedentary" and "light" work. (Def. Rule 56.1 Stat. ¶¶ 2-3) As part of his employment, Plaintiff was covered by a group long term disability insurance policy (the "LTD Plan") provided by Defendant under the R.R. Donnelly & Sons' Welfare Benefit Trust's employee welfare benefit plan. (Id. ¶ 2; Def. Rule 56.1 Stat. ¶ 8) The LTD Plan is governed by ERISA. Under the LTD Plan, Defendant has discretionary authority to determine eligibility for Plan benefits. (Def. Counter Rule 56.1 Stat. ¶ 3; Pltf. Rule 56.1 Stat. ¶ 3)

Rotondi worked a block away from the World Trade Center, and was at work on September 11, 2001, the day of the terrorist attacks. Rotondi suffered physical and psychological injuries (Pltf. Rule 56.1 Stat. ¶ 4), and he ceased working at R.R. Donnelly on October 9, 2001. (Id. ¶22) Defendant approved Rotondi's original claim for short term disability benefits for a knee injury he suffered on September 11, 2001 (Id. 5; Def. Rule 56.1. Stat. ¶¶ 20, 23), and he received short term disability benefits from October 22, 2001 through April 14, 2002. (Id. ¶ 23) Plaintiff was also diagnosed with post-traumatic stress disorder related to the events of September 11, 2001. (Id. ¶ 21)

I. RELEVANT PROVISIONS OF THE LONG TERM DISABILITY PLAN

Under the LTD Plan, "Disability" or "Disabled" is defined as:

(1) during the Elimination Period; and

(2) for the next 18 months, you are prevented by:

a. accidental bodily injury;

b. sickness;

c. Mental Illness;

d. Substance Abuse; or

e. pregnancy, from performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly Base Earnings are no more than 80% of your Indexed Pre-Disability Earnings.

After that, you must be so prevented from performing one or more of the Essential Duties of Any Occupation, and as a result your Current Monthly Base Earnings are no more than 60% of your Indexed Pre-disability Earnings. . . .

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. (Powell Decl., Ex. A at 0005) (emphasis in original). "Mental Illness means any psychological, behavioral or emotional disorder or ailment of mind, including physical manifestations of psychological, behavioral or emotional disorders, but excluding demonstrable, structural brain damage." The LTD Plan limits benefits for Mental Illness to 18 months. (Id. at 00013) (emphasis in original).

The LTD Plan's limitation of actions clause states that "[l]egal action cannot be taken against The Hartford: (1) sooner than 60 days after Proof of Loss has been furnished; or (2) 3 years after the time written Proof of Loss is required to be furnished according to the terms of the Policy." (Id. at 00017) "Written Proof of Loss must be sent [] within 90 days after the start of the period for which we owe payment," and "may [be] request[ed] [] throughout your Disability. In such cases, [Hartford] must receive the proof within 30 days of our request." (Id. at 0016) The LTD Plan defines "Proof of Loss" as "includ[ing] but [] not limited to the following":

(1) Documentation of

a. the date your Disability began;

b. the cause of your Disability;

c. the prognosis of your Disability;

d. your Earnings or income, included but not limited to copies of your filed and signed federal and state tax returns; and evidence that you are under the Regular Care of a Physician;

(2) any and all medical information, including x-ray films and photocopies of medical records, including histories, physical, mental, or diagnostic examinations, and treatment notes;

(3) the names and addresses of all

a. Physicians and practitioners of healing arts you have seen or consulted;

b. hospitals or other medical facilities in which you have been seen or treated; and

c. pharmacies which have filled your ...


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