In Sund v. Hartford Life & Accident Ins. Co., No. 21-CV-05218-JST, 2023 WL 5181624 (N.D. Cal. Aug. 11, 2023) California Northern District Judge Jon S. Tigar granted judgment to Plaintiff finding on de novo review that Plaintiff demonstrated by a preponderance of the evidence that he was disabled under the terms of the LTD Policy and wrongfully denied benefits.
Plaintiff was employed as a global commodity manager for a division of Amazon.com Services. In August 2018, during a work trip in China, Plaintiff slipped on wet marble and fell, landing backwards on his low back. Plaintiff sought treatment at a local hospital where x-rays and a CT scan confirmed an L2 compression fracture. He was provided a back brace and pain medications before returning to the U.S. for further treatment and physical therapy with multiple physicians and specialists. On October 8, 2018, while he continued to treat his condition, Plaintiff was cleared to return to modified duty work: “No lifting, pushing or pulling. Avoid bending, twisting, climbing. May alternate sit/stand on as tolerated basis. Avoid prolonged standing/walking, maximum 15 minutes per hour.” Plaintiff’s last day worked was February 1, 2019, and he was formally terminated in June 2020 after Amazon was unable to find a position that could accommodate his ongoing restrictions.
Hartford denied Plaintiff’s long-term disability claim on June 1, 2020, concluding that Plaintiff’s workplace restrictions did not preclude work in his sedentary occupation. Plaintiff appealed submitting additional evidence including updated records, a statement of support from his treating physician Dr. Anisa Richardson, a physical capacity evaluation, a rebuttal occupational analysis, and statements of support from Plaintiff and his family. Dr. Richardson opined that Plaintiff had been unable to return to his full function, had minimal improvement with physical therapy, and was unable to bend, walk or sit for prolonged periods. She noted that Plaintiff needed to lie prone to rest if he did any of these activities longer than 20 minutes and had difficulty lifting any objects greater than 5 pounds. The occupational analysis concluded that Plaintiff’s job fell within the light strength category, not sedentary, and required standing and walking most of the day, which Plaintiff could not do.
Hartford hired Dr. Sarah White to conduct an “independent medical review.” Dr. White reviewed the records, but did not speak with any of Plaintiff’s physicians, nor did she physically examine Plaintiff. Dr. White issued a report opining that Plaintiff could sustain full-time work activity on a permanent basis, provided he limited lifting, carrying, pushing and pulling to 20 pounds occasionally and 10 pounds frequently, occasional kneeling, crouching, climbing and balancing and bending at the waist, and standing or walking for 1 hour continuously for a total of 6 hours per day. Dr. White also claimed the medical records did not support the need for Plaintiff to lie down throughout the day or to have endurance restrictions. Dr. Richardson disagreed with Dr. White’s report finding that it did not address Plaintiff’s increased exacerbation of back pain by engaging in work activities or his need to recover from that increased pain. Dr. White affirmed her prior opinion and claimed that Dr. Richardson’s opinions were inconsistent with the clinical findings. Hartford upheld the denial decision on July 11, 2021, and the instant action ensued.
On de novo review, the Court found that Plaintiff demonstrated by a preponderance of the evidence that he was disabled under the terms of the plan and that he could not perform either a sedentary or light occupation. The Court reasoned that Plaintiff’s doctors concluded that his L2 compression fracture prevents him from sitting for more than one-third of the day, a lesser period of time than the one found disabling in Armani v. Nw. Mut. Life Ins. Co., 840 F.3d 1159, 1163 (9th Cir. 2016) (the claimant cannot perform a sedentary occupation because it requires sitting most of the time). Moreover, Plaintiff’s lifting and carrying capabilities preclude him from performing light work.
The Court found Hartford’s arguments unavailing. Contrary to Hartford’s assertion, Plaintiff had received consistent medical treatment, with any gaps explained by his ongoing workers’ compensation case or because his physicians stated he was not a candidate for treatment. Plaintiff consistently reported that his back pain was exacerbated when he performed his occupational duties. Hartford’s criticism of Plaintiff’s ability to walk for several miles at a time was disingenuous given that it was done at the encouragement of his doctors, and it was noted that the walking also exacerbated his pain. The Court further noted the fact that Plaintiff worked part-time for Amazon for a period of time prior to his claim did not demonstrate he was not disabled. Under the Policy, the ability to work for 30 hours per week is an essential duty that Plaintiff was unable to perform. And, even though Dr. Richardson did not begin treating Plaintiff until June 2019, the Court found that her conclusions were both credible and consistent with those of Plaintiff’s other treating providers. Finally, the Court found that Dr. White’s opinions should be afforded less weight than those of Plaintiff’s treating physicians because Plaintiff’s physicians had a substantially greater opportunity to observe him and because Dr. White was the only physician to conclude that Plaintiff did not have a sitting restriction or could lift/carry up to 20 pounds.
If Hartford or another disability insurer has denied your disability insurance claim, contact us for assistance.
*Please note that this blog is a summary of a reported legal decision and does not constitute legal advice. This blog has not been updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The case above was handled by other law firms, but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law, P.C. may be able to advise you so please contact us.
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