United States District Court, W.D. Washington, Seattle
JAIME S. LOUIS, Plaintiff,
THE HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.
FINDINGS OF FACT AND CONCLUSIONS OF LAW
J. Pechman, United States Senior District Judge
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).
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.
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:
The Plan Issued to Oracle America, Inc.
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.
Plan pays Long-Term Disability (“LTD”) benefits
to otherwise eligible participants who become
“Disabled” under the terms of the Plan. PLAN
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.
Elimination Period referenced in the definition of Total
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
2. with the exception of benefits required by state law, the
expiration of any Employer sponsored short term disability
benefits or salary continuation program.
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].
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.
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.
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.
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
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
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.”
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
Plaintiff Misses Work Intermittently; Oracle Terminates
Plaintiff's Employment on October 13, 2017, Which
Triggers the 90-day Elimination Period.
Plaintiff worked at Oracle as a Senior Principal Product
Strategist, a sedentary position. HARTLOU 000085-87.
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 ...