United States District Court, W.D. Washington
L. ROBART United States District Judge.
the court are Plaintiff Kristen Reetz's and Defendant
Hartford Life and Accident Insurance Company's
(“Hartford”) cross motions for judgment under
Federal Rule of Civil Procedure 52, (Pl. Mot. (Dkt. # 29));
(Def. Mot. (Dkt. # 31).) Each party opposes the other's
motion for judgment. (Pl. Resp. (Dkt. # 33); Def. Resp. (Dkt.
# 32).) The court has considered the motions, the
parties' submissions in opposition to and in support of
the motions, the administrative record, and the applicable
law. Being fully advised,  the court grants Ms. Reetz's motion
for judgment and denies Hartford's motion for
FINDINGS OF FACT
case arises from Hartford's denial of long-term
disability (“LTD”) benefits to Ms. Reetz.
(See Compl. (Dkt. # 1) ¶¶ 5.2-5.3.) Ms.
Reetz's medical history, as well as the facts behind
Hartford's termination of LTD benefits, are long and
complex. The court details the relevant facts below.
Initial Issuance of Disability Benefits
Reetz began working at Byram Health Care, Inc.
(“Byram”) as a senior customer service
representative in October 1999. (Admin. Record
(“AR”) (Dkt. ## 21-23) at 1393.) As described by
Byram, this position is a sedentary level occupation,
requiring six hours of sitting at a time, for a total of
seven hours of sitting per day. (Id. at 1214;
see also Id. at 256 (Hartford describing the
position as “involving sitting most of the
time”).) Alternating sitting and standing as needed is
not allowed. (Id.) There would be a 30-minute break
during the eight-hour work day, and a typical work-week
consists of 40 total work hours, with 35 of those hours spent
sitting. (See id.)
at Byram, Ms. Reetz participated in a LTD benefit plan,
administered by Hartford. (AR at 33; see generally
Id. at 8-51.) The Plan provides benefits to covered
employees who become disabled through sickness or accidental
injury and defines “disability” as:
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 2 year(s) following the
Elimination Period, and as a result Your Current Monthly
Earnings are less than 80% of Your Indexed Pre-disability
3) After that, Any Occupation.
at 21 (emphasis omitted).) “Essential duties” are
further defined as a duty that:
1) Is substantial, not incidental;
2) Is fundamental or inherent to the occupation; and
3) Cannot be reasonably omitted or changed Your ability to
work the number of hours in Your regularly scheduled work
week in an Essential duty.
“Your Occupation” does not mean the specific job
that the claimant is performing for a specific employer at a
specific location; rather, it is the job that is recognized
in the general workplace. (Id. at 24.) “Any
Occupation, ” however, means any job for which the
claimant is qualified, by education, training, or experience.
(Id. at 21.) Thus, the Plan offers benefits for the
90-day elimination period and the two years following that
period if the claimant cannot perform the essential duties of
his or her own occupation. But after those two years, the
Plan will only pay benefits if the claimant is unable to
perform the essential duties of any occupation for which he
or she is qualified. The parties agree that the Plan is an
employee benefit plan within the meaning of the Employee
Retirement Income Security Act of 1974 (“ERISA”),
29 U.S.C. § 1001, et seq. (Compl. ¶ 4.6;
see Def. Mot. at 7.)
Reetz remained at Byram until March 2014, when she took leave
due to persistent pain resulting from fibromyalgia and
spondyloarthropathy. (AR at 1450.) Ms. Reetz submitted a claim
for benefits under the Plan on March 10, 2014, and Hartford
paid short-term disability (“STD”) benefits from
March 7, 2014 to June 5, 2014. (Id. at 1450, 1452.)
It is unclear from Hartford's communication what the
basis was for these STD benefits. (See Id. at
1452-53.) However, Ms. Reetz was being treated by Dr. Sue
Romanick for persistent pain in her lower back, hips, and
joints. (See, e.g., id. at 1495.) Dr. Grace
Chapman further recognized that Ms. Reetz's health issues
were contributing to severe depression and anxiety.
(Id. at 1487.)
2014, Hartford began investigating Ms. Reetz's claim for
LTD benefits. (Id. at 1392-1406.) By this point, Ms.
Reetz had also undergone knee surgery in the spring of 2014
and fell on that knee during recovery in late May,
aggravating the injury. (Id. at 1364-65; 1360
(noting “new re-aggravation” with the right
knee).) Dr. Cherylann Brown, Ms. Reetz's therapist,
further diagnosed her with major depressive disorder.
(Id. // at 1385.) Additionally, Ms. Reetz's back
pain persisted. Dr. Carolyn Marquadt, Ms. Reetz's primary
treating physician, commented that Ms. Reetz “has
trouble with sitting or standing” and that her back
pain has “more recently . . . been flared up.”
(Id. at 1061.) Hartford approved LTD benefits on
June 23, 2014 (id. at 457), and paid LTD benefits to
Ms. Reetz through April 2016 “because [she was] unable
to perform the duties of [her] [o]ccupation due to symptoms
and impairments resulting from symptoms for [her] back and
fibromyalgia" (id. at 338).
Ms. Reetz's Medical Condition from June 2014 to May
the time she received LTD benefits, Ms. Reetz continued to
seek treatment for her fibromyalgia and spondyloarthropathy.
The court reviews Ms. Reetz's medical history for the
years 2014, 2015, and the first half of 2016 leading up to
Ms. Reetz's Medical Condition in 2014 and 2015
December 8, 2014, Dr. Romanick observed that Ms. Reetz had
“alot [sic] of back and SI joint pains, upper back pain
. . . and left shoulder pains.” (Id. at 1052.) Dr.
Romanick again noted on March 8, 2015, that Ms. Reetz's
“fibromyalgia is flaring and associated with
debilitating pains and inability to sleep.”
(Id. at 1050.) In May 2015, Ms. Reetz self-reported
that her low back pain was worse; sitting aggravated the
pain, whereas laying down relieved the pain. (Id. at
the summer of 2015, Ms. Reetz received L5-S1 facet
injections-injections of medicine into the small joints of
the lower back for pain relief. (See Id. at 1017.)
Dr. Marquadt reports that these injections reduced Ms.
Reetz's pain “by about 50%, ” but that by
July 2015, “the symptoms [were] slowly coming
back.” (Id. at 1017-18.) At that point, Ms.
Reetz “still [could not] sit for long periods of
time.” (Id. at 1018.) By August 2015, Dr.
Marquadt reports that Ms. Reetz's “back has been
worse, ” that her “pain is 9 out of 10, ”
and that she “has trouble with sitting, standing, or
walking for long periods of time.” (Id. at
1022.) Because Ms. Reetz's “pain is more severe,
” Dr. Marquadt administered a Toradol injection to
“help with some of her discomfort.” (Id.
Marquadt referred Ms. Reetz to Dr. Jennifer Lee at the
Swedish Pain Center, and Dr. Lee evaluated Ms. Reetz on
November 20, 2015. (Id. at 966-72.) Dr. Lee wrote
that Ms. Reetz's pain “has been steady in
severity” and is “aggravated by prolonged
standing, sitting or laying on her back.” (Id.
at 966.) Dr. Lee recommended “bilat L3, L4, L5 medical
branch blocks, ” a procedure where an anesthetic is
injected near small medial nerves that are connected to the
facet joints to determine whether the facet joint is the
source of the pain. (Id. at 972.) Dr. Marquadt
reviewed this recommendation when she saw Ms. Reetz for a
follow-up on December 3, 2015. (See Id. at 955.) Dr.
Marquadt, through her physical examination, noted that Ms.
Reetz has “a lot of pain through the suboccupital
ridge” with “[t]ension through the neck, upper
trapezius, levator scapulae, and rhomboids.”
(Id.) Dr. Marquadt again indicated that her
impression was “1. Lumbar facet arthropathy. 2.
Spondyloarthropathy. 3. Cervicogenic and muscle tension
headaches. 4. Fibromyalgia.” (Id.)
Ms. Reetz's Medical Condition in 2016
2016, Ms. Reetz's pain seemed to increase. On January 5,
2016, Dr. Chapman noted that despite low-impact exercise, Ms.
Reetz reports her pain “has increased the past 3
weeks.” (Id. at 835.) On January 20, 2016, Dr.
Thomas Erdmann, Ms. Reetz's new primary care physician,
assessed her to be suffering from chronic pain, fibromyalgia,
and lumbar facet joint pain. (Id. at 838.) Dr.
Erdmann documented Ms. Reetz's pain as “constant
with exacerbations, aching, throbbing, shooting, stabbing,
[and] burning in nature” that “is worse with
sitting and walking.” (Id. at 840.) On January
29, 2016, Ms. Reetz returned to Dr. Marquadt for another
Toradol injection. (Id. at 740-41.) Dr. Marquadt
describes Ms. Reetz's pain as “very flared
up” (id. at 741), elaborating:
Since I saw her last, her back is quite severe. Today it is 9
out of 10. She cannot move. It is achy. It is constant. She
does not get pain going into the lower extremities. She is
getting some aching into her buttock. She has trouble with
sitting or standing.
(Id. at 739.)
March 2016, Dr. Marquadt followed up with Ms. Reetz after Ms.
Reetz had received a radiofrequency neurotomy, an injection
procedure where electrically produced heat is applied to
compressed nerves in an attempt to interrupt pain signals to
and from the brain. (Id. at 749.) Dr. Marquadt again
noted that Ms. Reetz seemed to have trouble sitting, bending,
or twisting and that she is “somewhat more despondent
today due to discomfort.” (Id. at 750.)
Although the radiofrequency had helped, “her overall
function has not improved to the point where she can tolerate
sitting for more than half an hour at a time.”
(Id. at 751.)
April, Ms. Reetz reported to Dr. Marquadt that she
experiences “a really bad pinching/stabbing
feeling” that “stops [her] from moving[, ] it
hurts so bad.” (Id. at 755.) If she
“sit[s] for almost any amount of time, [she] go[es]
numb all the way to [her] right foot.” (Id.)
Overall, Ms. Reetz reported that “it's just getting
worse.” (Id.) Dr. Marquadt advised her to make
an appointment if the pain persisted. (Id.) On April
20, 2016, Ms. Reetz saw Dr. Erdmann for a follow-up
appointment on her chronic pain. (Id. at 858.) She
reported that her pain is “constant” and is
“worse with sitting, standing, twisting and
Reetz also continued to seek physical therapy treatment for
her knee pain. On April 4, 2016, she reported to her physical
therapist, Ms. Alison Read, that her “[k]nee is hurting
pretty good today. Yesterday was laundry day (up and down
stairs).” (Id. at 876.) The physical therapist
included in her notes that Ms. Reetz was “[f]eeling a
fibromyalgia flare up.” (Id.) Later that
month, on April 29, 2016, Ms. Reetz reported that her
“[k]nee is feeling great” and that she had no
problems running errands at both Costco and Walmart the
previous day. (Id. at 590.) However, she also
reported that she is “[f]eeling [a] fibro flare.”
4, 2016, Ms. Reetz saw Dr. Erdmann and reported that she is
“experiencing increasing pain in her back, as well as
legs and foot, from Fibromyalgia and
spondyloarthropathy.” (Id. at 863.) Similarly,
on May 6, 2016, Ms. Reetz notified Ms. Read that her
“pain overall is unchanged in the last couple
months” and that sitting and standing are aggravating
factors. (Id. at 591-92.) Ms. Read noted on that
date that Ms. Reetz suffers from “back pain that is
aggravated with all motions of direction.”
(Id. at 594.) Ms. Reetz then saw Dr. Marquadt on May
11, 2016. Dr. Marquadt indicated that “things have been
worse” (id. at 761): Ms. Reetz “cannot
sit for long periods of time, ...