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Diana Ingravallo v. Hartford Life and Accident Insurance Company

March 29, 2013

DIANA INGRAVALLO, PLAINTIFF,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, AS ADMINISTRATOR OF THE DELTA AIRLINES, INC., LONG TERM DISABILITY GROUP POLICY, DEFENDANT.



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

MEMORANDUM AND ORDER

Pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), Diana Ingravallo seeks judicial review of the denial of long-term disability benefits under a policy administered by Hartford Life and Accident Insurance Company ("Hartford"). See

29 U.S.C. § 1132(a)(1)(B). The parties cross-move for summary judgment on the administrative record ("AR").*fn1 For the following reasons, Ingravallo's motion is granted and Hartford's is denied.

I

Ingravallo worked as an "air import coordinator" for BDP International. It is undisputed that her job was "sedentary," meaning that it required her to sit for most of the workday, with brief periods of standing or walking, and to occasionally lift or carry no more than 10 pounds of weight. It is further undisputed that the job involved an 8-hour workday and a 40-hour work week.

Ingravallo participated in her employer's long-term disability plan, which was administered by Hartford. The policy defined "disability," for the first 60 months of benefits as "Injury or Sickness [that] causes physical or mental impairment to such a degree of severity that You are . . . continuously unable to perform the Material and Substantial Duties of Your Regular Occupation; and . . . not gainfully employed." AR 000007.*fn2 The plan delegated to Hartford "sole discretionary authority . . . to determine [participants'] eligibility for benefits and to interpret the terms and provisions of the plan and any policy issued in connection with it." AR 000024.

In 1996 or 1997, Ingravallo was diagnosed with relapsing-remitting multiple sclerosis ("MS"). In 2000 and 2003 her condition required hospitalization for intravenous administration of medication. In both cases, she was able to return to work. She gave birth to her first child at the end of 2004.

In May 2005, Ingravallo complained to her neurologist, Dr. Andreas Neophytides, of difficult walking and urinary urgency. Dr. Neophytides found new signs of myelopathy*fn3 and again had Ingravallo hospitalized for intravenous medication. The 2005 exacerbation led Dr. Neophytides to opine that Ingravallo was "no longer able to work in any capacity," and to advise that she "retire from work on a permanent basis." AR 000845.

Ingravallo followed her doctor's advice and applied for short-term disability benefits. In support, Dr. Neophytides submitted a "Medical Assessment Tool" noting weakness and spasticity in the lower extremities, as well as incontinence. To treat what he described as "closely spaced exacerbations of myelopahy," he prescribed an immunosuppressive and anti-inflammatory regimen consisting of daily injections of Betaseron and monthly injections of Solumedrol; he also prescribed Lexapro to treat related depression. AR 001391. On July 6, 2005, Hartford approved the application "to allow for [treatment] of most recent flare-up and efficacy of med[ication]s." AR 000212.

As her short-term benefits approached exhaustion, Ingravallo applied for long-term benefits. She reported weakness and numbness in her hands and legs; impaired memory, vision and coordination; urinary urgency; fatigue; and depression. Dr. Neophytides submitted a "Functional Assessment Tool" in which he stated that Ingravallo was not capable of full-time employment due to paraparesis (partial paralysis of the legs) and incontinence. He opined that Ingravallo would never be able to return to work because her "moderately advanced" relapsing-remitting MS was "turning into secondary progressive" MS, a more serious stage of the disease in which many sufferers "begin continuously deteriorating" without remission. AR 000085, 000787. Based on this evidence, Hartford approved the application for long-term benefits. In addition, it offered Ingravallo assistance in applying for Social Security benefits. The Social Security Administration rendered a "fully favorable" decision on her application in August 2006. Hartford applied the Social Security benefits as an offset to the amount of benefits it paid.

Hartford reviewed Ingravallo's circumstances roughly once a year. In September 2006, Ingravallo reported "constant numbness [and] weakness" in her legs and "chronic fatigue." AR 001367. Dr. Neophytides added that she had complained of urinary urgency and difficulty walking, and that a physical exam had revealed signs of a spastic gait and hyperreflexia (overactive reflexes). He described Ingravallo's condition as "improved," but opined that she could stand or walk for no more than "several minutes" and could sit for no more than "[one] hour at a time." AR 000757. Hartford approved the continuation of benefits.

In October 2007, Ingravallo reported "constant fatigue" and "numbness in hands [and] legs [and] feet." AR 001319. She also reported the birth of her second child. Dr. Neophytides reported continuing signs of paraparesis and hyperreflexia, and newly observed "Babinski signs" in both feet.*fn4 Dr. Neophytides opined that Ingravallo could not be expected to lift or carry any amount of weight, or to engage in activities that required reaching, fingering or handling, bending at the waist, or kneeling or stooping. He also restricted her from driving. Dr. Neophytides did not offer an opinion on Ingravallo's ability to stand, walk or sit, or the total amount of time she could do those activities in a day. Hartford nevertheless approved the continuation of benefits.

In October 2008, Ingravallo stated that her symptoms had become "worse" since the birth of her second child the previous year. AR 001299. She reported that she required assistance to dress, bathe and use the toilet. Her husband and mother were responsible for cooking and taking care of the children. She further complained of cognitive difficulties handling money and her medication. She stated that she was no longer able to work, cook or shop. Dr. Neophytides continued to report hyperreflexia and Babinski responses; he opined that Ingravallo could sit for only two hours at a time, and could not stand or walk for any length of time. He continued to opine that Ingravallo could not be expected to lift or carry any amount of weight, or to engage in activities that required reaching, fingering or handling, bending at the waist, or kneeling or stooping. He did not report any signs of cognitive impairment.

Because Ingravallo reported needing assistance with daily activities, Hartford investigated whether she qualified for the plan's "catastrophic" disability benefit. In that regard, it sought confirmation of her limitations from Dr. Neophytides. Dr. Neophytides opined that Ingravallo did not require assistance in any daily activities.

The inconsistency between Ingravallo's and Dr. Neophytides's reports led Hartford to refer the claim to its Special Investigations Unit ("SIU"). As additional reasons for the referral, Hartford noted that Ingravallo was "able to get pregnant and deliver a child in 10/07," and that her self-reported restrictions "appear[ed] extreme for [her] reported condition." AR 001555.

Hartford's SIU placed Ingravallo under video surveillance. A video taken on November 14, 2008, shows Ingravallo pushing a baby stroller from her home to a pharmacy two blocks away. She returns approximately 90 minutes later, with several plastic bags hanging from the stroller. A video taken on November 15, 2008, shows Ingravallo unloading grocery bags from the trunk of her car. She returns to retrieve a toddler and, later, two plastic jugs.

Hartford concluded that the surveillance videos showed Ingravallo performing activities "outside of her self-stated limitations and her physician provided limitations." AR 001559. It assigned a claims examiner to conduct an in-person interview with Ingravallo. During the interview, which took place on January 28, 2009, Ingravallo was shown the surveillance videos. She acknowledged that the videos ...


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