Second Circuit Affirms Judgment in Favor of Hartford on ERISA Claims for Long-Term Disability and Life-Waiver-of-Premium Benefits

In Khesin v. Hartford Life & Accident Insurance Company, No. 22-1766, 2024 WL 1404576 (2d Cir. Apr. 2, 2024), Plaintiff-Appellant Daniel Khesin appealed the district court’s judgment in favor of Hartford Life & Accident Insurance Company on his claims for long-term disability (“LTD”) and life-waiver-of-premium (“LWOP”) benefits. Khesin sought LTD and LWOP benefits after his condition of neuromyelitis optica rendered him unable to work. Hartford paid Khesin two years of LTD benefits and denied benefits thereafter. Hartford never approved Khesin’s LWOP claim. Reviewing de novo Khesin’s challenge of the district court’s conclusion that he is not disabled within the meaning of the insurance policies, the Second Circuit affirmed the judgment of the district court.

The court considered Khesin’s several challenges to the district court’s conclusion. With respect to the LTD claim, Khesin argued that Hartford did not adequately consider his non-exertional limitations, including subjective complaints of pain, fatigue, or lack of concentration. The court disagreed. It found that Hartford relied on seven independent consultants who did consider his subjective complaints.

With respect to the LWOP claim, Khesin argued that the district court erred in finding that Hartford was not required to obtain a vocational analysis. Khesin argued that under Demirovic v. Building Service 32 B-J Pension Fund, 467 F.3d 208 (2d Cir. 2006), the phrase “any reasonable job” required Hartford to obtain a vocational analysis to support its denial of his LWOP claim. The court distinguished Demirovic from the present dispute since that matter involved the interpretation of “total and permanent disability” in a disability pension case. The Demirovic court concluded that the phrase “any gainful employment” required consideration of a claimant’s vocational characteristics. Otherwise, disability pensions would only be available for the most grievously incapacitated claimants. The court found that the “any reasonable job” language in the LWOP plan was not the same as similar language in LTD plans (which provides income protection benefits) since it is reasonable to infer that LWOP benefits are meant to be a short-term benefit for the most grievously incapacitated claimants who otherwise have no reasonable opportunity to obtain life insurance on the open market.

Khesin also argued that with respect to the LTD and LWOP claims, Hartford proffered several post-hoc rationalizations that the district court relied on erroneously. The court found that the district court’s credit of one of Hartford’s consultant physicians just added weight to Hartford’s original conclusion that the clinical evidence did not support an entitlement to benefits. The district court did not stray from rationales reasonably discernible from Hartford’s decision.

Under the arbitrary-and-capricious standard, the court declined Khesin’s invitation to reweigh the evidence as if it were considering the issue of eligibility anew. Judgment affirmed.