Seventh Circuit Upholds Hartford’s Denial of Disability Benefits to Claimant with Multiple Sclerosis

In Artz v. Hartford Life & Accident Ins. Co., No. 23-2269, __F.4th__, 2024 WL 1986000 (7th Cir. May 6, 2024), the Seventh Circuit affirmed the district court’s grant of summary judgment to Defendant Hartford Life & Accident Insurance Company on Plaintiff-Appellant Donald Artz’s claim for long-term disability benefits under ERISA Section 502(a)(1)(B). Artz claimed disability under his employer’s disability plan due to the fatigue and cognitive difficulties associated with multiple sclerosis and his inability to work his employer’s required 12-hour shifts. The court determined that Hartford’s denial of LTD benefits was not arbitrary and capricious, where Hartford relied on multiple doctors who found that Artz could work 8-hour days, 40 hours per week, and where Hartford found that Artz’s own occupation of a power-distribution engineer, as performed in the general workplace, does not require the ability to work 12-hour days.

Artz worked for WEC Energy Group as an electric distribution controller for about 21 years when worsening fatigue associated with his MS diagnosis prevented him from meeting the demands of his employer who declined to accommodate Artz’s need to work no more than 8 hours in one shift. Hartford, the insurer and administrator of the employer’s short-term and long-term disability plans, approved and paid Artz’s claim for short-term disability benefits. The Social Security Administration also found Artz to be disabled under its rules and awarded him Social Security Disability Insurance (“SSDI”) benefits. However, when Artz applied for LTD benefits, Hartford took the position that Artz was not disabled. His treating doctors did not agree on Artz’s functional capacity: his neurologist opined that Artz could work 8 hours per day, 40 hours per week; his occupational therapist opined that he could work 4 hours per day, 20 hours per week; and his occupational medicine physician opined that he was not capable of gainful employment. Hartford obtained an alleged independent assessment from neurologist Dr. Sherry Leitch who concluded that Artz could work up to 8 hours per day between the hours of 6:30 a.m. and 4:30 p.m. Hartford then performed an occupational analysis and found that the essential duties of Artz’s occupation equated to that of a power-distribution engineer and that in the general workplace, 12-hour days are not essential to this occupation. Based on this, Hartford denied the claim and invited Artz to appeal, including to submit his SSDI records.

Artz appealed Hartford’s denial of benefits but did not submit new medical information or his SSDI records. On appeal, Hartford obtained allegedly independent assessments from a neuropsychologist and another neurologist. Both found no evidence to support any restrictions from full-time work. In response to these reviews, Artz’s neurologist stated that he disagreed but did not provide any explanation. Hartford denied Artz’s appeal based on the totality of the evidence and that the LTD plan differed from SSDI in critical ways. The district court found in favor of Hartford and Artz appealed.

The Seventh Circuit noted that Hartford has discretionary authority to decide eligibility for benefits, and as such, the court will not overturn the denial of benefits absent special circumstances such as fraud or bad faith. Hartford’s decision needs only rational support in the record. While recognizing “Artz has MS and has exhibited extraordinary strength struggling with its symptoms for years,” the court found that Artz did not bring forth enough evidence at summary judgment to prove he meets the plan’s definition of disability. The critical contention is whether 12-hour shifts are an essential duty. Though Artz’s job required 12-hour shifts, there was no evidence in the record that contradicted Hartford’s claim that working shifts longer than 8 hours is not an essential duty.

In response to Artz’s argument that his fatigue and cognitive difficulties made it such that he could not work 8-hour shifts, the court pointed to the opinions of medical professionals who found that he could. The burden is on Artz to demonstrate disability and Hartford was not required to order additional testing. The court distinguished this case from its opinion in Hennen v. Metropolitan Life Insurance Company, 904 F.3d 532 (7th Cir. 2018), where the court faulted MetLife for not arranging follow up testing when five out of six doctors found clinical evidence of radiculopathy and the sixth doctor suggested that more tests were needed. Here, the court found rational support for Hartford’s decision without additional testing.

Lastly, the court gave short shrift to the argument that Hartford’s approval of STD benefits and the SSA’s approval of SSDI benefits demonstrates that Hartford’s denial was influenced by its financial conflict of interest. The court noted that Artz did not provide his Social Security records to Hartford and that its approval of STD benefits did not prohibit Hartford from collecting new information and deciding differently for LTD benefits.