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Louis v. Hartford Life and Accident Insurance Co.

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

January 3, 2020

JAIME S. LOUIS, Plaintiff,
v.
THE HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

          FINDINGS OF FACT AND CONCLUSIONS OF LAW

          Marsha J. Pechman, United States Senior District Judge

         This matter came on for bench trial on December 20, 2019, before the Court sitting without a jury. Plaintiff was represented by Jay C. Kinney of Kinney Law Group. Defendant The Hartford Life and Accident Insurance Company was represented by Sarah Swale of Jensen Morse Baker, PLLC. Jurisdiction is vested in this Court by virtue of 29 U.S.C. § 1132(e).

         On August 19, 2019, Defendant Hartford submitted the Administrative Record to the Court (Dkt. 15, Exhibit 1), as well as the applicable Plan documents (Dkt. 15, Exhibit 2). The parties agree that the Administrative Record and Plan documents comprise the documentary evidence in this case.

         The Court considered the evidence presented, the exhibits admitted into evidence, and the arguments of counsel. The Court has weighed the exhibits, evidence, and argument de novo using the required “preponderance of the evidence” standard. Plaintiff advised the Court at the commencement of the hearing that he was abandoning any claims of disability based on his dermatological issues and would rely solely on proof of his disability based on his impaired gastrointestinal conditions. Now the Court, being fully advised in the premises, makes its Findings of Fact and Conclusions of Law as follows:

         FINDINGS OF FACT

         A. The Plan Issued to Oracle America, Inc.

         1. The Hartford issued a Group Insurance Policy to Oracle America, Inc. (“Oracle”), the former employer of Plaintiff Jaime S. Louis (“Plaintiff”). Oracle, as the Policyholder, established the Group Long Term Disability Plan for Employees of Oracle America, Inc. (the “Plan”). PLAN 000001-53.

         2. The Plan pays Long-Term Disability (“LTD”) benefits to otherwise eligible participants who become “Disabled” under the terms of the Plan. PLAN 000007-8.

         3. The Plan defines disability - in this case “Total Disability” - as follows:

Total Disability or Totally Disabled: means during the Elimination Period and for the next 24 month(s), as a result of injury or sickness, You are unable to perform with reasonable continuity the Essential Duties necessary to pursue Your occupation in the usual or customary way.

PLAN 000025.

         4. The Elimination Period referenced in the definition of Total Disability provides:

The Elimination Period is the period of time You must be Disabled before benefits become payable. It is the last to be satisfied of the following:
1. the first 90 consecutive day(s) of any one period of Disability; or
2. with the exception of benefits required by state law, the expiration of any Employer sponsored short term disability benefits or salary continuation program.

PLAN 000008.

         5. The Benefits Section of the Plan further provides:

When do benefits become payable?
You will be paid a monthly benefit if:
1. You become Disabled while insured under this plan;
2. You are Disabled throughout the Elimination Period;
3. You remain Disabled beyond the Elimination Period;
1. You are, and have been during the Elimination Period, under the Regular Care of a Physician; and
4. You submit proof of loss.

PLAN 000010 [sic].

         6. Where a claimant is terminated from his employment for any reason, coverage terminates on the termination date unless the employee can prove that he was totally disabled on the date of the termination and remained continuously and totally disabled for the next 90 days. PLAN 000017-18.

         7. By virtue of his employment with Oracle, Plaintiff was an eligible participant in the Plan at all times relevant hereto, and his claim for benefits is governed by the terms and definitions contained in the Plan.

         8. To qualify for benefits under the terms of the Plan, Plaintiff had to prove that his medical condition or diagnosis rendered him unable to perform his job “with reasonable continuity” on the date of his termination and for the “the first 90 consecutive days” and “throughout the Elimination Period.” PLAN 0008, 10, 17-18, 25.

         9. This interpretation of the plain language of the Plan must be read in conjunction with the limited exception in the Plan for a claimant who returns to work during the Elimination Period:

What happens if You return to work but become Disabled again?
Attempts to return to work as an Active Full-Time or Part-Time Employee during the Elimination Period will not interrupt the Elimination Period, provided no more than 30 such return-days are taken.
Any day You were Actively at Work will not count towards the Elimination Period.

PLAN 000011. This limited exception only makes sense if “Totally Disabled” is read to mean “unable to work as a result of injury or sickness for 90 days within a 120-day period.”

         10. Further, since Plaintiff's employment was terminated by Oracle on October 13, 2017, he could not restart the 90-day Elimination Period on a later date (as he could not actively return to work after that date). Id.; HARTLOU 000074, 85-86.

         B. Plaintiff Misses Work Intermittently; Oracle Terminates Plaintiff's Employment on October 13, 2017, Which Triggers the 90-day Elimination Period.

         1. Plaintiff worked at Oracle as a Senior Principal Product Strategist, a sedentary position. HARTLOU 000085-87.

         2. Starting in May 2017, Plaintiff began missing work intermittently, but not with enough frequency to satisfy the 90-day Elimination Period under the Recurrent Disability definition in the Plan for any 90-day period during the ...


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