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Elizabeth Siegel v. Hartford Life Insurance Company

June 25, 2012

ELIZABETH SIEGEL, PLAINTIFF,
v.
HARTFORD LIFE INSURANCE COMPANY, DEFENDANTS.



The opinion of the court was delivered by: Hurley, Senior District Judge:

MEMORANDUM AND ORDER

On September 21, 2010, plaintiff Elizabeth Siegel ("Siegel") commenced this action seeking to recover long term disability benefits under an insurance policy issued by defendant Hartford Life Insurance Company ("Hartford"), pursuant to the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq. ("ERISA"). Presently pending before the Court are Hartford's motion and Siegel's cross-motion seeking summary judgment pursuant to Federal Rule of Civil Procedure 56. Hartford has also filed a motion to strike certain statements made in Siegel's motion papers. For the reasons set forth below, Hartford's motion for summary judgment is granted, Siegel's cross-motion for summary judgment is denied, and Hartford's motion to strike is deemed moot.

BACKGROUND

The following facts are drawn from the parties' Local Civil Rule 56.1 Statements, and are undisputed unless otherwise noted.

I. Siegel's Employment and Medical History

On May 11, 1987, Siegel began working for United Business Media ("UBM") as an Assistant Distribution Manager. In June 2006, Siegel was diagnosed with spondylolysis and degenerative disk disease. Siegel underwent lumbar spine surgery on September 6, 2006. After the surgery, Siegel continued to complain of back, neck, and leg pain. (Pl.'s 56.1 ¶¶ 3-17.) On November 6, 2007, Siegel underwent a revision surgery and lumbar fusion of the spine from L3 to S1. (Def.'s 56.1 ¶ 4; Pl.'s 56.1 ¶ 18.)

On November 16, 2007, December 16, 2007, and January 21, 2008, Siegel saw Dr. Sebastian Lattuga, her orthopedic surgeon, for follow-up appointments. Dr. Lattuga noted that Siegel was "doing well" postoperatively. (Pl.'s 56.1 ¶¶ 19, 20.) Dr. Lattuga prescribed Skelaxine and Vicodin, and directed Siegel to continue with physical therapy. (Id. ¶ 19.) Siegel returned to work on January 28, 2008.

II. Siegel's Medical Treatment Following her Return to Work

Between Siegel's return to work on January 28, 2008 and her last day of work at UBM on October 17, 2008, Siegel saw Dr. Lattuga on a number of occasions for postoperative follow-up examinations. On March 17, 2008, Dr. Lattuga noted that Siegel was "doing well postoperatively" and that lumbar x-rays showed satisfactory placement of implants. (Pl.'s 56.1 ¶ 20.) Dr. Lattuga stated that she should "continue physical therapy and refrain from any heavy[ ] lifting, carrying, or bending and take medications as needed." (AR 333.)*fn1

At a follow-up visit on May 5, 2008, Dr. Lattuga noted that Siegel was "doing well postoperatively, [and she] states [that] she is better, however [she] still needs medication." (AR 295.) On that day, Siegel's "pain severity score [was] 8/10." (Id.) For the first time, Dr. Lattuga noted: "Motor strength is abnormal, TA/EHL 4." (AR 296.) Because Siegel was "continu[ing] to have pain," Dr. Lattuga ordered a "CT scan of the lumbar spine to examine the fusion." (Id.) "In the meantime," Dr. Lattuga directed Siegel to "continue physical therapy and refrain from any heavy[] lifting, carrying, or bending" and to take her medication "as needed." (Id.)

Two weeks later, at a May 19, 2008 follow-up appointment to review the CT scan, Dr. Lattuga noted that Siegel was "continuing to improve," and that Siegel's "pain severity score [was] 7/10." (AR 293.) Dr. Lattuga determined that Siegel's fusion was "progressing" and again instructed her to continue physical therapy, refrain from heavy lifting, bending, or carrying, and to take her medication as needed. (AR 294.) In addition, Dr. Lattuga instructed Siegel to "wear a bone stimulator" as needed. (Id.)

On June 30, 2008, Dr. Lattuga again found that Siegel was "doing well postoperatively, [and] continuing to improve," with "progressing fusion." (AR 291, 292.) Dr. Lattuga further noted that Siegel "continues to complain of neck pain and upper extremity radiation," and had a "pain severity score [of] 7/10." (AR 291.) Siegel's treatment plan remained the same: "Continue physical therapy and refrain from any heavy[] lifting, carrying, or bending, wear [a] bone stimulator and take medication as needed." (AR 292.) Dr. Lattuga prescribed Vicodin for Siegel. (Id.)

At a September 5, 2008 follow-up examination, Dr. Lattuga reported that Siegel was "doing well postoperatively, better than her condition was before her second surgery." (AR 289.) Dr. Lattuga noted Siegel's complaints of "occasional leg cramping," as well as "neck pain and upper extremity radiation." (Id.) Siegel's pain severity score was 7/10. Dr. Lattuga directed Siegel to "obtain a lumbar CT scan to assess the fusion" and, in the meantime, recommended that she continue the same course of treatment: continue physical therapy, refrain from heavy lifting, carrying or bending, and wear a bone stimulator. (AR 290.) Dr. Lattuga prescribed Vicodin and Skelaxine that Siegel could take "as needed." (Id.)

On October 6, 2008, Siegel presented to Dr. Lattuga with "continued improvement of low back pain," although she "complain[ed] of neck pain and upper extremity radiation." (AR 287.) Siegel's pain severity score was 7/10. Dr. Lattuga reviewed the Lumber CT scan, taken on September 19, 2008, and noted that "[p]suedoarthrosis cannot be excluded," but that there were "no significant changes." (AR 288.) Dr. Lattuga recommended "[c]ontinued observation and restriction of activities." (Id.) Dr. Lattuga concluded: "In the meantime, [Siegel] is to continue physical therapy and refrain from any heavy[] lifting, carrying, or bending and take medication as needed. [Siegel] is to follow up in several weeks for a repeat evaluation." (Id.)

III. Siegel's Employment is Terminated

After Siegel's return to work on January 28, 2008, she worked for nine months through October 17, 2008, which was a Friday. Siegel took personal/sick time on October 20, 21, and 22, 2008 (i.e., Monday through Wednesday). On October 23, 2008, Siegel was informed by telephone that she was being laid off by UBM as part of a reduction in workforce.

That same day, on October 23, 2008, Siegel saw Dr. Lattuga for a follow-up examination. (AR 285-86.) Hartford asserts that Siegel saw Dr. Lattuga after she learned that she was to be laid off, but plaintiff denies that allegation. (See Pl.'s Response to Def.'s 56.1 ¶ 8.)*fn2 In his notes from the October 23, 2008 visit, Dr. Lattuga observed that Siegel "has continued improvement of low back pain" but also "complains of neck pain and upper extremity radiation." (AR 285.) Siegel's pain severity score was 7/10. (Id.) In the "Impression/Plan" section of Dr. Lattuga's notes from the October 23, 2008 visit, he wrote:

Patient has severe frequent exacerbations. Continued observation and restriction of activities. In the meantime, patient is to refrain from any heavy[ ] lifting, carrying, or bending and [should] take medication as needed. Patient is to follow up in several weeks for a repeat evaluation. This patient is totally disabled. (AR 286 (emphasis in the original).)

IV. Siegel's Claim for Short-Term Disability Benefits

Siegel applied for New York State Short-Term Disability ("STD") benefits through UBM's STD Plan, which was administered by Hartford. In connection with this claim, UBM provided Hartford with a Physical Demands Analysis ("PDA") that outlined the physical requirements for Siegel's position as an Assistant Business Manager. (AR 431-35.)

A. The PDA Form

The PDA was completed by Joanne Como, a UBM "HR Generalist," on December 22, 2008. The PDA has a section entitled "Sitting/Standing/Walking Requirements" that sets forth two charts. One chart indicated the number of "[t]otal hours during a typical workday" that Siegel was required to sit, stand, or walk, respectively. The chart had three rows (one row each for sitting, standing, and walking). Each row had a list of numbers from 0 through 8, and Como circled the appropriate number to indicate the number of hours Siegel was required to spend doing each of these three activities. This section of the PDA indicated that Siegel was required to sit for seven hours total during the workday, stand for 1/2 hour total during the workday, and walk for 1/2 hour total during the workday. (AR 432.)

The second chart in this section of the PDA had a format that was identical to the first, but indicated the number of "[t]otal hours at one time" that Siegel was required to sit, stand, and walk. In the "Sitting" row, the number "2" was circled. In both the "Standing" and "Walking" rows the number ".5" was circled, with the phrase "less than" handwritten above the circled ".5". (Id.) To the left of the "Total hours at one time" chart, was the handwritten phrase "determined by employee," with lines connecting that phrase to the sitting, standing, and walking rows in the chart. (Id.)

Under the two charts was the question "Alternate sitting and standing as needed?" with "Yes" or "No" checkbox. Como checked the "No" checkbox in response to this question. (Id.)

B. Siegel is Approved for STD Benefits

On January 27, 2009, Siegel was approved for STD benefits through March 18, 2009, with the possibility of an extension through April 24, 2009. (AR 113-14.)

V. Relevant Provisions of the LTD Plan

Siegel was enrolled in the Group Long Term Disability Plan for Employees of UBM (the "LTD Plan"), which was issued and administered by Hartford. The LTD Plan defines "disability" as follows:

Disability or Disabled means You are prevented from performing one or more of the Essential Duties of:

1) Your Occupation during the Elimination Period;

2) Your Occupation, for the 24 month(s) following the Elimination Period, and as a result Your Current Monthly Earnings are less than 80% of Your Indexed Pre-Disability Earnings; and

3) after that, Any Occupation. (Solem Decl., Ex. A at 028.) The LTD Plan defines "Your Occupation" as follows: "Your Occupation means Your Occupation as it is recognized in the general workplace. Your Occupation does not mean the specific job You are performing for a specific employer or at a specific location." (Id. at 031.)

The LTD Plan grants full discretionary authority to Hartford, stating:

Policy Interpretation: Who interprets the terms and conditions of The Policy?

We*fn3 have full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of The Policy. This provision applies where the interpretation of The Policy is governed by the Employee Retirement Income Security Act of 1974, as amended (ERISA). (Id. at 027 (footnote added).) The LTD Plan also provides that: "The Plan has granted the Insurance Company full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy." (Id. at 036.)

VI. Siegel's Claim for LTD Benefits

On January 27, 2009, Hartford received Siegel's claim for LTD benefits. Joshua P. Suby, a Hartford Ability Analyst, was assigned to review the claim. Suby reviewed the information in Siegel's STD file, but noted that because Siegel's file did not contain any medical records, he would need additional documentation before he could undertake "any LTD consideration." (AR 114.) By letter dated January 27, 2009, Suby provided Siegel with an Attending Physician Statement ("APS") form and Physical Capabilities Evaluation ("PCE") form to complete and return. (AR 429.)

A. Siegel's Telephone Interview

On January 28, 2009, Suby conducted a telephone interview with Siegel. During the interview, Siegel reported that her last day of work at UBM was October 17, 2008 and that she "began having spasm for about 3 weeks prior to [her last day of work], [and] finally couldn't take the pain any longer so [she] had to go [out of work]." (AR 111-12.) Siegel described her "functionality" as being unable to bend or twist at all, or to lift anything weighing more than one or two pounds. (AR 112.) She stated that she could not "turn ...


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