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O'Gorman v. Hartford Life and Accident Insurance Co.

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

August 9, 2017

JENNI INWOOD O'GORMAN, Plaintiff,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

          ORDER

          THE HONORABLE RICHARD A. JONES, UNITED STATES DISTRICT JUDGE.

         I. INTRODUCTION

         This matter comes before the Court on Plaintiff Jenni Inwood O'Gorman's Motion for Judgment under Federal Rule of Civil Procedure 52 based on an administrative record created in an underlying Employee Retirement Income Security Act (ERISA) dispute. Dkt. # 16. Defendant Hartford Accident Life and Insurance Company (“Hartford”) opposes Plaintiff's motion. Plaintiff brought this action under ERISA, 29 U.S.C. § 1001, et seq. asking the Court to declare her “disabled” under the Long-Term Disability (LTD) Plan (“the Plan”) provided through her employer by Hartford and, subsequently, to award her LTD benefits under the Plan.

         II. LEGAL STANDARD

         Typically, a request to reach judgment prior to trial would be made under a Rule 56 motion for summary judgment, however under such a motion the Court is forbidden to make factual findings or weigh evidence. T.W. Elec. Servs., Inc. v. Pac. Elec. Contractor's Ass'n, 809 F.2d 626, 630 (9th Cir. 1987). Instead, the parties here propose the Court conduct a trial on the administrative record under Rule 52. See Dkt. # 10. The procedure for such a trial is outlined in Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir. 1999) (noting that “the district court may try the case on the record that the administrator had before it.”). In a trial on the administrative record, the district judge reviews the evidence to determine “whether [the Plaintiff] is disabled within the terms of the policy.” Id. Further, “in a trial on the record, but not on summary judgment, the judge can evaluate the persuasiveness of conflicting testimony and decide which is more likely true.” Id.

         “ERISA does not set out the appropriate standard of review for actions under § 1132(a)(1)(B) challenging eligibility determinations.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 (1989). However, where, as here, the parties have stipulated to de novo review, the Court may accept the stipulation and review the administrative record accordingly. Bigham v. Liberty Life Assurance Co. of Boston, 148 F.Supp.3d 1159, 1161 (W.D. Wash. 2015); Bunger v. Unum Life Ins. Co. of Am., 196 F.Supp.3d 1175, 1177 (W.D. Wash. 2016). This de novo standard requires the Court to make findings of fact and weigh the evidence. See Walker v. Am. Home Shield Long Term Disability Plan, 180 F.3d 1065, 1069 (9th Cir. 1999) (de novo review applies to plan administrator's factual findings as well as plan interpretation). The Court issues the following findings and conclusions, pursuant to Rule 52.

         III. FINDINGS OF FACT

         1. Plaintiff Jenni Inwood O'Gorman was employed by Continental Mills, Inc. as a “Data Analyst.” HARTRCD 294.[1] This position required the ability to “interpret an extensive variety of data and deal with a variety of data collection points, ” “define problems, ” “collect data, ” establish facts, ” “draw valid conclusions, ” “analyze data critically and edit objectively, ” “read, analyze, and interpret consumer data and translate into action items, ” write reports, business correspondence, and procedural manuals, ” “chart processes, ” and “translate them into user documentation.” HARTRCD 189. Additionally, Plaintiff was required to “generat[e] reports . . . highlighting consumer data, ” “[d]evelop [r]eport queries and take responsibility for the management of new and existing report files, ” “provide reporting assistance to other departments, ” “monitor and review cases for coding accuracy, ” “utilize computer systems” to provide reports to an internal audience, and conduct audits. Id.

         2. Plaintiff was offered LTD benefits by her employer through a Plan administered by Hartford, Policy Number GRH-677928. HARTPLN 6. As a full-time employee working a minimum of 32 hours per week, Plaintiff was eligible for LTD benefits.

         3. The Plan provided in relevant part:

         Disability or Disabled means You are prevented from performing one or more of the Essential Duties of:

1) Your Occupation during the Elimination Period;
2) Your Occupation, for the 24 month(s) following the Elimination Period, and as a result Your Current Monthly Earnings are less than 80% of Your Indexed Pre-disability Earnings; and
3) after that, Any Occupation.
Your Disability must result from . . . sickness[.]
. . .

         Essential Duty means a duty that:

1) is substantial, not incidental;
2) is fundamental or inherent to the occupation; and
3) cannot reasonably be omitted or changes.
Your ability to work the number of hours in Your regularly scheduled work week is an Essential Duty.
. . .

         Any Occupation means any occupation for which You are qualified by education, training or experience, and that has an ...


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