United States District Court, W.D. Washington, Tacoma
TRACIE D. MORGAN, Plaintiff,
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.
OPINION AND ORDER
BENJAMIN H. SETTLE United States District Judge
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.
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.
November 16, 2016, Hartford moved for summary judgment. Dkt.
20. On January 26, 2017, the Court denied the motion for
summary judgment. Dkt. 27.
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.
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.
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.
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.
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. 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;
2) not Gainfully Employed.
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
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.
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.
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.
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.
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