District Court Finds Hartford Did Not Abuse Its Discretion in Denying LTD Benefits Because Claimant Could Perform the Same Occupation at Other Companies

In Artz v. Hartford Life & Accident Ins. Co., No. 21-CV-0391-BHL, 2023 WL 3752006 (E.D. Wis. June 1, 2023), Wisconsin Eastern District Judge Brett H. Ludwig granted judgment to Hartford finding that Plaintiff had not shown that the insurer’s decision to deny his ERISA claim for LTD benefits was arbitrary or capricious. Hartford did not abuse its discretion in concluding that while Plaintiff’s Multiple Sclerosis (“MS”) precluded him from working as a Senior Electric Distribution Controller for his employer, it did not prevent him from working in the same position at other companies, and thus he did not qualify for long term disability benefits under the plan’s requirements.

Plaintiff had been employed in his Controller position at WEC Energy Group (“WEC”) since 1998, working rotating 12-hour shifts. He was diagnosed with MS in 2003, but continued in his position for over 16 years, in part because his position was primarily sedentary. Plaintiff stopped working in November 2019 and submitted an LTD claim to Hartford after he began experiencing worsening fatigue and his doctors found that his MS was relapsing. Plaintiff subsequently provided Hartford with a statement from his treating provider opining that he could work only eight hours per day and only on the day (not night) shift. After receiving this opinion, Hartford asked WEC if it could accommodate the recommended restrictions. WEC replied that it could not.

To be considered disabled under the plan, a plan participant must show that he or she is not able to perform the Essential Duties of his or her occupation for a significant period of time. The plan is clear, however, that a participant’s occupation is not the same as his actual position with his actual employer. Rather, the term refers to the participant’s occupation “as it is recognized in the general workplace… [it] does not mean the specific job [y]ou are performing for a specific employer at a specific location.” An individual’s ability to work the number of hours in his “regularly scheduled workweek” is an essential duty.

Hartford obtained a medical review by Independent neurologist Dr. Sherry Leitch, who spoke directly with Plaintiff’s treating physician and stated that Plaintiff’s most significant issues were his lower extremity weakness and fatigue that led to cognitive issues. Plaintiff’s physician also reported difficulty working his twelve-hour shifts because after eight hours, Plaintiff’s hand dexterity and standing and walking endurance sharply dropped off. He further noted that Plaintiff had balance issues, meaning he would not be able to “stoop, push, pull, kneel, or bend.” After completing her review, Dr. Leitch concluded that Plaintiff would be able to work eight hours per day, for forty hours per week, but could not work more than eight hours consecutively and that his cognitive function would be affected by fatigue if he did work more than eight hours.

In a subsequent vocational review, Hartford’s reviewer likened Plaintiff’s occupation to that of a “Power-Distribution Engineer.” The reviewer noted that this occupation in the general workplace is sedentary and does not require “squatting, stooping, or walking on uneven surfaces” or working shifts longer than eight hours. Plaintiff’s duties at WEC deviated from this general description in part. At WEC, Plaintiff’s position was primarily sedentary work but, unlike the way this position was generally performed in the national economy, the job at WEC did require occasional, light physical activity like bending, squatting, or stooping. The vocational reviewer concluded that Plaintiff thus could perform the duties of this position in the general economy.  On June 5, 2020, Hartford denied Plaintiff’s LTD claim.

Plaintiff appealed relying largely on a treating provider opinion that he could only work four hours per day; he did not submit any additional documentation. Hartford obtained three medical reviews by Dr. Stephen Selkirk, MD, Neurology; Dr. Joseph Palermo, DO, Internal Medicine; and Dr. Michael Sugarman, PhD, Neuropsychology. All three concluded Plaintiff was able to work eight-hour days. Each of the physicians noted the absence of objective documentation of Plaintiff’s ability to focus and characterized his self-reports of mental fatigue as highly unreliable.

The Court found that Plaintiff failed to demonstrate that Hartford’s decision was arbitrary or capricious.  The Court confirmed that Hartford’s plan defines Plaintiff’ Occupation by reference to the national economy, not his actual position at WEC. Moreover, Hartford’s vocational expert used several resources (the Dictionary of Occupational Titles, OASYS, and O*NET) to demonstrate that Plaintiff’s occupation as a Power-Distribution Engineer does not require working shifts longer than the eight hours.

The Court also concluded with regard to the weight of the medical evidence that Hartford provided adequate explanation and rationale for its denial. In its initial denial, Hartford stated that it based its decision on the policy language and after reviewing his entire file. Hartford explained that it sought an independent medical review based on the somewhat conflicting assessments of physical function of Plaintiff’s treating providers, and that vocational review confirmed that Plaintiff’s ability to work an eight-hour workday was sufficient for him to be employed in his occupation in the national economy. The Court found that while Hartford based its decision, in part, on the lack of objective evidence of Plaintiff’s condition, contrary to Plaintiff’s suggestion, this is not an impermissible “bare conclusion.” The Court concluded that Hartford offered reasoned explanations for its denial of his LTD claim and addressed the material medical issues raised. That Plaintiff disagreed with those explanations and conclusions did not make them arbitrary and capricious.

The Court also found that Hartford’s alleged conflict of interest was not an independent basis for reversal of the denial decision, and that Hartford did not fail to consider Plaintiff’s award of Social Security disability benefits as part of its claims analysis.

As this case demonstrates, it can be difficult to convince insurers of disability, even with treating physician support. If Hartford has denied or terminated your disability insurance claim, contact us for assistance.