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Reetz v. Hartford Life And Accident Insurance Co.

United States District Court, W.D. Washington

February 16, 2018

KRISTEN REETZ, Plaintiff,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

          ORDER

          JAMES L. ROBART United States District Judge.

         I. INTRODUCTION

         Before 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, [1] the court grants Ms. Reetz's motion for judgment and denies Hartford's motion for judgment.[2]

         II. FINDINGS OF FACT

         This 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.

         A. Initial Issuance of Disability Benefits

         Ms. 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.)[3] 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.)

         While 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 Earnings; and
3) After that, Any Occupation.

         (Id. 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.

         (Id.) “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.)

         Ms. Reetz remained at Byram until March 2014, when she took leave due to persistent pain resulting from fibromyalgia and spondyloarthropathy.[4] (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.)

         In June 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).

         B. Ms. Reetz's Medical Condition from June 2014 to May 2016

         During 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 termination.

         1. Ms. Reetz's Medical Condition in 2014 and 2015

         On December 8, 2014, Dr. Romanick observed that Ms. Reetz had “alot [sic] of back and SI[5] joint pains, upper back pain . . . and left shoulder pains.”[6] (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 1066.)

         Over 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. at 1022-23.)

         Dr. 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.)

         2. Ms. Reetz's Medical Condition in 2016

         By 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.)

         In 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.)

         By late 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 bending.” (Id.)

         Ms. 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.” (Id.)

         On May 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, ...


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