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Morgan v. Hartford Life and Accident Insurance Co.

United States District Court, W.D. Washington, Tacoma

March 5, 2017

TRACIE D. MORGAN, Plaintiff,


          BENJAMIN H. SETTLE United States District Judge

         This matter comes before the Court on the merits of Plaintiff Tracie D. Morgan's (“Morgan”) claim against Defendant Hartford Life and Accident Insurance Company (“Hartford”) for wrongful denial of benefits under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). Dkt. 1. The Court, having considered the parties' pleadings and the remainder of the record, finds in favor of Morgan and orders the parties to (1) submit further briefing on the issues of attorney fees and prejudgment interest, and (2) meet and confer to craft a stipulated proposed judgment.


         On March 9, 2016, Tracie Morgan filed a complaint for long-term disability benefits against Hartford. Dkt. 1. Morgan presently brings a claim for wrongful denial of benefits under an ERISA long-term disability plan. Id.

         On November 16, 2016, Hartford moved for summary judgment. Dkt. 20. On January 26, 2017, the Court denied the motion for summary judgment. Dkt. 27.

         On January 31, 2017, the parties submitted trial briefs and proposed findings of fact. Dkts. 29-32. On January 31, 2017, the Court held a pretrial conference at which the parties stipulated that (1) the case should be submitted as a bench trial on the administrative record, and (2) no further evidentiary hearings were necessary. Dkt. 34.

         On February 9, 2017, the Court ordered that the parties submit simultaneous additional briefing on specific issues. Dkt. 33. On February 24, 2017, the parties filed their supplemental briefs. Dkts. 35, 36. On March 3, 2017, the parties submitted supplemental responses. Dkts. 37, 38.


         A. Morgan's Employment

         In 2015, Morgan was employed as an Operations Specialist in the Dynacraft division at PACCAR, Inc. Morgan's position involved duties that would be classified as a “heavy physical demand occupation.” ARCF000005; ARCF000089-90; ARCF000140- 44. The duties of Morgan's actual occupation included “the use of power and manual hand tools, carrying up to 15 pounds, pushing parts up to 75 pounds in a cart, constantly handling, fingering, and reaching at waist level, and occasionally reaching above shoulder and below waist level.” ARCF000005; AR000089. Also, Morgan's actual position required that she stand for her entire eight-hour workday. ARCF000005.

         An occupational analysis of the Operations Specialist position by a “Rehabilitation Claims Manager” indicates that, in the national economy, the position is a “medium physical demand occupation, ” requiring “frequent reaching, handling, fingering, near acuity, and depth perception with occasional stooping, crouching, feeling and color vision required.” ARCF000005; ARCF000090. The occupational analysis report does not describe a specific standing requirement as a “physical demand” or “essential duty” of the Operations Specialist in the national economy. ARCF000005. However, the report states that the “environmental conditions” of the occupation in the national economy “may still involve long periods of standing, sitting, or working on ladders.” Id.

         B. Plan Terms

         An ERISA fiduciary must distribute benefits “in accordance with the documents and instruments governing the plan.” 29 U.S.C. § 1104(a)(1)(D). Under the governing plan, claimants like Morgan are eligible to receive monthly benefits “if [they] are Disabled according to the Occupation Qualifier provision.” ARPD00010.[1] The “Occupation Qualifier provision” states that:

“Disability means that . . . Injury or Sickness causes physical or mental impairment to such a degree of severity that you are:
1) continuously unable to perform the Material and Substantial Duties of Your Regular Occupation; and
2) not Gainfully Employed.


         The plan sets out claim filing procedures, requiring that claimants submit “proof of loss, ” or “Proof of Disability.” ARPD000018. “Failure to do so may delay, suspend or terminate Your benefits.” Id. As part of the “Proof of Disability, ” a claimant must submit:

Objective medical findings which support Your Disability. Objective medical findings include but are not limited to tests, procedures, or clinical examinations standardly accepted in the practice of medicine, for Your disabling condition(s).

Id. The claim filing procedures also require that a claimant show “[t]he extent of Your Disability, including restrictions and limitations which are preventing You from performing Your Regular Occupation.” Id. Despite the requirement that a claimant provide objective medical findings that support her claim, the plan also limits coverage for any “Disability beyond 12 months after the elimination period if it is due to a diagnosed condition which manifests itself primarily with Self-Reported Symptoms.” ARPD000013.

         C. Morgan's Claim

         April 8, 2015, Morgan initiated a claim with Hartford for disability benefits. ARCF000082. On May 11, 2015, Dr. Cornelia Moynihan, ND, indicated that Morgan was suffering chronic fatigue from infectious mononucleosis or a “flare up of EBV [Epstein-Barr Virus].” ARCF000242. However, follow-up serologies revealed results indicating former infection with no current illness. ARCF000244-46. Morgan continued to suffer symptoms of fatigue and an inability to concentrate. ARCF000255. On June 18, 2015, Dr. Moynihan referred Morgan to Dr. Larry Stonesifer, MD, for an endocrine evaluation. ARCF000253.

         Morgan continued to visit Dr. Moynihan for follow-up appointments. On June 26, 2015, Dr. Moynihan authorized Morgan to work four hours per day. ARCF000343. On July 1, 2015, Dr. Moynihan increased Morgan's work capacity to 4.5 hours each day. ARCF000347. On July 22, 2015, Dr. Moynihan noted that Morgan continued to suffer fatigue and added nausea. ARCF000352.

         On July 28, 2015, Morgan met with Dr. Stonesifer. ARCF000265. Dr. Stonesifer assessed Morgan with chronic fatigue and possible reactive hypoglycemia. Id. Dr. Stonesifer ordered additional tests, including an insulin tolerance test. Id. On July 29, 2015, Dr. Moynihan ordered that Morgan not work from July 30, 2015, through August 21, 2015. ARCF000374. In the same note, Dr. Moynihan stated that Morgan could return to work for 3 hours per day beginning on August 24, 2015. Id.

         On August 19, 2015, Morgan returned for a follow-up with Dr. Stonesifer. ARCF000267. Reviewing Morgan's lab results, Dr. Stonesifer noted that Morgan's “insulin tolerance test was diagnostic of growth hormone deficiency.” Id. However, he noted that “for definitive diagnosis, we will need the Cortrosyn Stim study.” Id.

         On August 24, 2015, Morgan returned to work on a three-hour-per-day schedule. ARCF000405. On August 28, 2015, Dr. Moynihan authorized Morgan to increase her schedule on ...

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