KENNETH L. RYSKAMP, District Judge.
Plaintiff Melissa R. Bloom ("Bloom") brought this action against Defendant Hartford Life and Accident Insurance Company ("Hartford") for wrongful termination of long-term disability benefits pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"). Bloom was a speech pathologist and participant in an employee welfare benefit plan established by her employer. As such, Bloom had coverage for long-term disability benefits under a group insurance policy issued by Hartford, which served as the claim administrator for the plan. The policy provided Hartford with "full discretion and authority" to determine entitlement to disability benefits under the plan, which stipulated payment of such benefits on a participant's satisfactory and continued proof of disability. Under the policy, disability was defined as follows:
Further, the policy defined "Your Occupation" as:
On March 17, 2009, Bloom suffered a "transient ischemic attack" — i.e., a mini-stroke — or some other cerebralvascular accident while driving with her son. She checked in at the hospital and complained of weakness and numbness in her right-side and slurred speech. Besides some right-sided numbness, her symptoms had resolved by the time she was evaluated. The hospital conducted an EEG and MRI and CT scans of the brain. The EEG registered normal and the MRI and CT scans each registered negative. Bloom was deemed "neurologically stable" by the treating neurologist, Dr. Shiftan, and was released from the hospital on March 20, 2009.
On January 28, 2010, Bloomed discontinued work as a speech pathologist. Dr. Shiftan, who remained her attending physician, diagnosed Bloom with "late effects" of a cerebrovascular accident, with a secondary diagnosis of "complex partial seizures" resulting in fatigue, memory loss, and right-sided weakness and numbness. He reported that Bloom had no physical defects, but she had cognitive impairment due to memory deficit and dysphasia (trouble communicating). As a result, Bloom applied to Hartford for long-term disability benefits in June 2010. After reviewing her application and concluding that Bloom could not work due to uncontrolled seizure activity, Hartford approved Bloom's claim on August 3, 2010.
In an initial telephone interview with Hartford, Bloom reported her seizures as "hit or miss," and noted that they "var[ied] from day to day." Further, she stated that on days when she did not have a seizure she was able to perform most tasks independently. In light of what Hartford determined were "subjective complaints of seizures," however, video surveillance was conducted on Bloom on November 29 and 30, 2010. During these two days, Bloom
On May 18, 2011, Hartford referred Bloom to an independent medical examination ("IME") performed by Dr. Grossman, a neurologist. After examining Bloom and reviewing her medical records, Dr. Grossman concluded that Bloom "should be able to work full-time without restrictions ...." Dr. Grossman noted that her neurological exam was normal and the diagnosis of her treating physician, Dr. Shiftan, was "strictly subjective" and "primarily historical only." He stated he was "hard pressed to consider and agree with [Dr. Shiftan's] diagnosis" without objective evidence to substantiate Bloom's subjective complaints. Dr. Grossman also reviewed the surveillance video and found that Bloom's manipulative capacity was normal and her manual dexterity was excellent.
Hartford sent Dr. Shiftan a copy of the IME report on June 1, 2011 and requested his comments, but it did not receive a response. Therefore, on June 28, 2011, Hartford notified Bloom of its decision to terminate her benefits. In its denial letter, Hartford detailed the findings of the surveillance video and Dr. Grossman's report, and it concluded that Bloom did not establish she was no longer prevented from performing the essential duties of her job, and therefore, she did not meet the policy definition of disability. Hartford informed Bloom of her right to appeal its decision, which she did on July 12, 2011.
In her appeal letter, Bloom emphasized the sporadic nature of her seizures and their manifestation as a cognitive deficit, not a physical incapacitation. Furthermore, Bloom claimed that she experienced "auras" before a seizure would occur, and thus, she would avoid activities she otherwise would be capable of doing during those times, like driving. Bloom included testimonial letters from family and friends attesting to her seizures and her cognitive problems. Additionally, Bloom submitted a letter from Dr. Shiftan, in which he stated that Bloom experienced "frequent seizures" and was unable to work due to difficulty with speech and concentration. He noted in the letter that Bloom's ambulatory EEG taken during her initial incident was abnormal.
In evaluation of Bloom's appeal, a medical records review was performed at Hartford's request by Dr. Engstrand, a neurologist. Dr. Engstrand reviewed Bloom's medical files, including past reports by Dr. Shiftan and the IME by Dr. Grossman, and watched the surveillance video. Dr. Engstrand attempted to contact Dr. Shiftan on numerous occasions to consult with him about Bloom's condition, but Dr. Shiftan did not return her calls. In a report issued on October 5, 2011, Dr. Engstrand concluded that Bloom was "not functionally impaired or limited in any way." She stated that while Bloom may have suffered an episode of "transient right-sided weakness" — albeit unclear whether it was a stroke, cerebralvascular accident, seizure activity, or a complex migraine — her condition and functional ability were excellent and there was "no evidence of cognitive impairment." She characterized Bloom's reports of seizures as "subjective," and
On October 6, 2011, Hartford denied Bloom's appeal, stating that "there does not appear to be any clinical or radiographic evidence that [she] actually suffers from seizures." Bloom brought this suit claiming that Hartford's decision to terminate her benefits was wrong and arbitrary and capricious, and that Hartford failed to provide Bloom a full and fair review of her claim. Particularly, Bloom contends: (1) the administrative record contains evidence of Bloom's disability; (2) Hartford failed to obtain objective evidence supporting Bloom's disability, namely, her abnormal ambulatory EEG and a failure to conduct a neuropsychological exam; (3) Hartford improperly initiated surveillance and used the surveillance video as a basis for her benefits-termination; (4) Hartford failed to acknowledge consideration of Bloom's Social Security Disability ("SSD") award in its termination letter in violation of company policy; and, (5) Hartford failed to employ a "perfection statement" to notify Bloom of information absent from the administrative record. Bloom requests that the Court reverse Hartford's determination and reinstate her long-term disability benefits, or in the alternative, remand the case back to Hartford to reconsider her claim with additional evidence.
In response, Hartford contends that Bloom did not prove she was disabled under the plan, and it was not wrong to credit the surveillance video and opinions of two independent doctors over Bloom's subjective complaints and the reports of her treating physician. Furthermore, Hartford maintains that it was not obligated to build Bloom's case for her and find objective evidence to support her claim. Hartford argues that Bloom improperly relies on evidence outside the administrative record in an attempt to bolster her claim, and that ultimately, Bloom fails to demonstrate that its decision to terminate her benefits was arbitrary and capricious.
"The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." FED.R.CIV.P. 56(a). The movant "always bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of `the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,' which it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986) (quoting FED.R.CIV.P. 56(c)(1)(A)). Where the non-moving party bears the burden of proof on an issue at trial, the movant may simply "[point] out to the district court that there is an absence of evidence to support the nonmoving party's case." Id. at 325, 106 S.Ct. 2548.
After the movant has met its burden under Rule 56(c), the burden shifts to the non-moving party to establish that there is a genuine issue of material fact. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 585, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). Although all reasonable inferences are to be drawn in favor of the non-moving party, Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986), he "must do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita, 475 U.S. at
Bloom requests the Court to consider materials outside of the administrative record in reviewing Hartford's decision. Specifically, Bloom requests that the Court admit medical records evidencing Bloom's seizure debility, including an abnormal ambulatory EEG and a recent hospital report documenting post-operative seizure activity. Moreover, Bloom seeks to introduce as exhibits to her motions multiple documents produced by Hartford during discovery. These, Bloom claims, support her argument that Hartford failed to provide a full and fair review of her claim and violated its own claims practices in reaching its decision to terminate her benefits. The exhibits include: (1) a page from Hartford's claim manual detailing its use of a "perfection statement" to notify claimants of missing information, see Ex. A. to Pl.'s Resp. to Def.'s Mot. for Summ. J.
As a general rule, deferential review of a plan administrator's
Orndorf v. Paul Revere Life Ins. Co., 404 F.3d 510, 519 (1st Cir.2005) (internal citation omitted), cert. denied, 546 U.S. 937, 126 S.Ct. 425, 163 L.Ed.2d 324 (2005).
Thus, under the deferential standard of review provided to administrators, the rule against consideration of extra-record materials to determine a claimant's eligibility for benefits prevents post-hoc relitigation of the substantive claim and encourages a full development of the record before the administrator. See Jewell v. Life Ins. Co. of N. Am., 508 F.3d 1303, 1308 (10th Cir.2007)("And if litigation should ensue, requiring the parties to have developed the record during the claim administration process deters the practice of holding back evidence for presentation to the district court as a fallback or a `surprise.'"). It does not appear, however, that the rule precludes the admissibility of evidence to support a claimant's collateral assertion of an administrator's procedural misconduct or bias.
The Eleventh Circuit has not yet weighed in on the matter, but the Supreme Court's decision in Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008) "can be read as contemplating some discovery on the issue of whether a structural conflict has morphed into an actual conflict" and procedural irregularities threaten the fair resolution of a claim. Murphy v. Deloitte & Touche Grp. Ins. Plan, 619 F.3d 1151, 1161 (10th Cir.2010). In pertinent part, Glenn reads:
Glenn, 554 U.S. at 117-18, 128 S.Ct. 2343 (internal citations omitted).
Relying on this language, district courts and sister circuits have carved out exceptions for claims alleging procedural irregularities and conflicts of interests affecting a claimant's full and fair review. See Murphy, 619 F.3d at 1161 (10th Cir.2010) ("[a]lthough the Supreme Court did not explicitly state that the district court could consider extra-record materials or that claimant could discover extra-record materials [in Glenn], it must have contemplated that, at least in some cases, discovery and consideration of extra-record materials may be necessary and appropriate as an administrative record is not likely to contain
Based on the Supreme Court's decision in Glenn and its progeny, the Court finds that extra-record evidence is admissible where Bloom can demonstrate the evidence will be used to support a claim of procedural misconduct or bias on the part of Hartford.
Myers v. Prudential Ins. Co. of Am., 581 F.Supp.2d 904, 913 (E.D.Tenn.2008).
Therefore, the Court allows Bloom to introduce those exhibits and deposition testimony into evidence which support her claim of procedural misconduct on behalf of Hartford.
The Eleventh Circuit lays out a six-step analysis for reviewing a benefits decision under ERISA:
Under this framework, Bloom initially bears the burden to prove that she is disabled and Hartford's decision to deny her long-term disability benefits was wrong. See Glazer, 524 F.3d at 1247. If Bloom meets her burden, then she must demonstrate that Hartford's decision was arbitrary and capricious, meaning Hartford had no reasonable grounds to support its decision. Id. at 1246. In considering whether Hartford's decision was arbitrary and capricious, the Court must take into account Hartford's conflict of interest in paying Bloom's claim, but its analysis remains centered on whether a reasonable basis existed for Hartford's decision. See Blankenship, 644 F.3d at 1355. Even where a conflict of interest exists, the Court must still give deference to Hartford's "discretionary decisionmaking" as a whole. See Doyle v. Liberty Life Assurance Co. of Boston, 542 F.3d 1352, 1363 (11th Cir.2008).
Upon review of the facts, the Court finds that Bloom fails to prove she was disabled at the time her benefits were terminated. Therefore, the Court holds that Hartford's decision was not "wrong." Among the evidence relied upon by Hartford to deny Bloom's claim was a surveillance video of Bloom driving and performing other focus-oriented activities and the reports of two independent physicians, each concluding that Bloom was not disabled and there was no objective evidence supporting her claim of seizure activity or related cognitive impairment.
Driving is a "dangerous activity that requires the utmost focus." Hillyer v. Hartford Life and Acc. Ins. Co., 2011 WL 925027, *14 (N.D.Ala. Jan. 31, 2011). Courts have upheld decisions to deny benefits for seizure related disabilities where there was "no indication the claimant's driving was ever restricted." Deel v. United of Omaha Life Ins. Co., 2012 WL 928349, *6 (E.D.Mich. Feb. 27, 2012); see Hobson v. Metro. Life Ins. Co., 574 F.3d 75, 87 (2d Cir.2009). Moreover, while surveillance evidence "is of limited utility .... where the evidence obtained during surveillance is not inconsistent with the claimant's own account of her activities," Marantz v. Permanente Medical Group, Inc. Long Term Disability Plan, 687 F.3d 320, 329 (7th Cir.2012), it may be used in conjunction with other medical evidence to support an administrator's decision to terminate benefits. See id.; Green v. Union Sec. Ins. Co., 646 F.3d 1042, 1052 (8th Cir.2011)(stating video evidence need not conclusively establish a claimant's disability, but it does provide another form of objective evidence upon which an ERISA
Here, the surveillance video demonstrated no objective evidence that Bloom suffered from seizures or was cognitively impaired. In the video she talked on her cell phone, shopped, visited with friends, unloaded chairs from the back of her car, and drove almost 90 miles in two days. Notably, the surveillance video contradicts the findings of her treating physician, Dr. Shiftan, who states in his appeal letter to Hartford that Bloom suffers absence seizures almost daily. The video evidence is not conclusive. As Bloom explained in a post-surveillance interview, the activities witnessed were not inconsistent with her initial reports that her seizures were "hit or miss" and she was capable of performing most tasks independently when she did not experience a seizure. When taken in conjunction with the conclusions reached by Hartford's two independent physicians that Bloom was not disabled and there was no finding of cognitive impairment, however, the surveillance video becomes a reliable form of evidence contradicting Bloom's disability claim. Thus, the Court cannot say that Hartford was wrong in relying on this evidence in terminating Bloom's benefits.
Furthermore, the Court finds that Hartford was not wrong in crediting the opinions of its reviewing physicians over that of Dr. Shiftan's. See Giertz-Richardson v. Hartford Life & Acc. Ins. Co., 536 F.Supp.2d 1280, 1291 (M.D.Fla. 2008)("While Plaintiff's doctors believe that Plaintiff was unable to work, it was not wrong for Defendant to credit the opinions of the [ ] doctors that reviewed Plaintiff's medical records over the opinions of Plaintiff's doctors."). As noted above, Dr. Shiftan's reports of Bloom's inability to work due to daily seizures are belied by the surveillance video evidence. Moreover, Dr. Shiftan's diagnosis, which does not by itself establish a disability, Jordan v. Northrop Grumman Corp., 370 F.3d 869, 880 (9th Cir.2004), is undermined by the fact that it was labeled by Drs. Grossman and Engstrand as solely subjective, and was based "on [Bloom's] subjective reports [which] are inconsistent with the clinical findings." Both doctors found there was no objective evidence to support Bloom's claims of seizures and related cognitive impairment, and they both concluded that Bloom could work without restriction or limitation. Thus, while Hartford was obligated to consider Dr. Shiftan's diagnosis and the letters from family and friends attesting to Bloom's disorder, it was not wrong to rely on the surveillance video and opinions of two independent physicians to conclude that she did not, in fact, meet her burden in proving that she could not perform the essential duties of her job and thus was disabled.
Bloom makes several substantive attacks on Hartford's decision. Bloom claims that Hartford "inexplicably reversed course" when it first approved her claim for long-term disability benefits and later terminated it. She claims that Hartford wrongfully terminated her claim based on a lack of objective evidence of her disability, in that it failed to obtain available diagnostic evidence to establish her disability, namely, an abnormal ambulatory EEG and a neuropsychological examination. Furthermore, Bloom claims that the medical opinions of Drs. Grossman and Engstrand are unreliable, as both doctors
First, under the plan, Bloom's benefits are contingent on her continuing proof of disability. Her burden is the same whether Hartford "denies a claim initially or decides to discontinue benefits after initially approving them." Richards v. Hartford Life and Acc. Ins. Co., 356 F.Supp.2d 1278, 1284 (S.D.Fla.2004), aff'd, 153 Fed.Appx. 694 (11th Cir.2005). Therefore, Hartford's prior approval of benefits does not prevent it from "subsequently finding [a] claimant fails to show ongoing disability." Meadows v. Am. Airlines, Inc., 2011 WL 1102774, *20 (S.D.Fla. Mar. 24, 2011). Importantly, Hartford's initial decision to approve Bloom's benefits was based on its conclusion that she could not work due to uncontrolled seizure activity, a determination founded on Dr. Shiftan's treatment notes of Bloom's self-reported complaints. Its latter decision to terminate her benefits, however, was based on subsequent contradicting evidence, namely, a surveillance video and an IME which indicated Bloom suffered no impairment of any kind whatsoever. Thus, the information Hartford had before it at the time of its initial decision to approve benefits and at the time of its decision to terminate benefits was drastically different. Hartford, therefore, cannot be "bound" by its prior decision to approve Bloom's benefits, and Bloom's argument to the contrary misunderstands the burdens allocated to the claimant and the administrator during the claims process. That is, Bloom "retains the burden of proving continued disability" and Hartford "has no burden of proving a change in [her] condition to justify benefits termination." Clark v. Hartford Life and Acc. Ins. Co., 2006 WL 890660, *5 (M.D.Fla. Apr. 6, 2006), aff'd, 195 Fed. Appx. 932 (11th Cir.2006) (citation omitted).
Considering the foregoing, Hartford was not wrong to terminate Bloom's benefits on her failure to demonstrate objective proof of her disability. "[W]here the plan puts the burden on the claimant to prove that she is disabled, it is implicit in the requirement of proof that the evidence be objective." Watts v. BellSouth Telecomms., Inc., 218 Fed.Appx. 854, 856 (11th Cir.2007). And where a condition is subjective in nature, "it is reasonable to expect objective medical evidence of an inability to work." Creel v. Wachovia Corp., ___ Fed.Appx. ___, ___, 2009 WL 179584, *9 (11th Cir. Jan. 27, 2009). Here, Drs. Grossman and Engstrand found Dr. Shiftan's medical reports of Bloom's conditions to be "subjective," noting that his reports were "primarily historical" and that Bloom's "subjective complaints are inconsistent with the clinical findings." While Bloom introduced testimonial letters from family and friends attesting to her seizures and cognitive dysfunction resulting therefrom, an examination conducted by Dr. Grossman and a medical review by Dr. Engstrand found no corroborative evidence to support their testimony. In fact, medical tests conducted on Bloom by Dr. Grossman demonstrated no abnormalities suggesting a seizure disorder or cognitive impairment, at all.
Furthermore, Hartford was not required to obtain objective evidence to support Bloom's claim. See Wright v. Hartford Ben. Mgmt. Servs., 2012 WL 1680094, *7 (D.N.J. May 11, 2012). As stated above, Bloom retains the burden to prove she is disabled under the plan. Therefore, it was her duty to introduce evidence sufficient to support a finding that she was disabled at the time her claim determination. Bloom's contention that Hartford may not rely on a lack of objective evidence to terminate her benefits where it failed to obtain her abnormal ambulatory EEG and to conduct neuropsychological testing, then, is unpersuasive.
Moreover, the only mention of Bloom's abnormal EEG was contained in Dr. Shiftan's appeal letter, which in one sentence he stated: "In addition, her ambulatory EEG was abnormal." Dr. Shiftan did not ascribe any particular significance to test, and it was not provided with his letter. Furthermore, Dr. Engstrand attempted to contact Dr. Shiftan on numerous occasions after he submitted his appeal letter to discuss Bloom's claim, but he did not return her calls. To hold Hartford responsible for knowing this evidence was material and for collecting it "misinterprets an ERISA administrator's role in the decisionmaking process." Sell v. UNUM Life Ins. Co. of Am., 2002 WL 31630707, *7 n. 4 (E.D.Pa.2002).
Hartford could have referred Bloom for neuropsychological testing, but the Court does not find that its decision to forego such testing was wrong. Hartford prepared a referral form to send Bloom to a neuropsychologist for cognitive testing and its representative testified that a neuropsychological exam could be expected to be performed in a situation where a claimant's treating physician reported cognitive impairment but not formal testing had been done. But, Dr. Grossman performed a standard neurological exam on Bloom and found no evidence to suggest Bloom had a seizure disorder or any cognitive abnormalities. Moreover, surveillance indicated no evidence of seizure activity; rather, Bloom appeared completely normal, capable of performing high-functioning tasks, such as driving. In light of this evidence, Hartford may have decided neuropsychological testing was not necessary. Or, Hartford may have decided a file review by Dr. Engstrand, who found no evidence of seizures or cognitive impairment, may have been more a more reliable form of assessing Bloom's condition. As Bloom indicates, Hartford's training guidelines state that "not all neurological seizure activity shows up on electrographic recordings." Given this, the Court cannot say Hartford was wrong in choosing a file review over neuropsychological testing.
In any event, as discussed below, Hartford's failure to conduct neuropsychological testing certainly does not result in a finding that Hartford's decision to terminate benefits on the evidence before it was arbitrary and capricious. See Blankenship, 644 F.3d at 1357 ("[W]e do not conclude... that [the administrator's] use of "file" reviews by its independent doctors — instead of live, physical examinations of [the claimant] — counted as evidence that
Finally, Bloom claims that the independent medical opinions on which Hartford relied were unsupportable and unreliable; however, she draws no evidence from the record to support her claim. Dr. Shiftan, Bloom's treating physician, saw her once a month, and therefore, relied mainly on her self-complaints as a basis for his diagnosis. To the contrary, Drs. Grossman and Engstrand considered a whole body of evidence, including Dr. Shiftan's treatment notes, Dr. Grossman's IME, and direct observations of Bloom via surveillance video to determine that Bloom lacked clinical support for her disorder. Bloom argues their opinions are prejudiced because they relied on the surveillance video provided by Hartford without her statements given in a follow-up interview in which she states the video is consistent with her claims of the "day-to-day" nature of her seizures. This claim is belied by evidence in the record, however. It is clear that both doctors were aware of the reported sporadic nature of Bloom's seizure disorder at the time of their review, with Dr. Engstrand specifically noting "[Bloom] states that a video investigation missed her bad days" and "tries to avoid driving." Therefore, the Court does not find Hartford was wrong to provide those doctors with the video as a form of objective evidence on which to inform their opinions.
Bloom's further attempts to discredit the medical opinions of Hartford's independent physicians are unpersuasive. She introduces Hartford's deposition testimony and internal training manual as sources which support her claim that a disability claim can be supported by subjective evidence alone and that seizure activity cannot always be objectively recorded. Even in light of this evidence, however, one does not, and cannot, jump to the conclusion that a disability claim can always be supported on subjective evidence alone, or that seizure activity can never be objectively recorded. Here, Hartford was presented with testimony from Bloom and her doctor that she experienced debilitating seizures, but it was also presented with surveillance evidence and medical reports that she experienced no seizures at all, and in either case, was fit to work without restriction. Thus, the Court finds that is was "entirely appropriate" to rely on the reviewing physicians' reports to "rebut the opinion of the treating physician[] asserting [Bloom] is disabled," Hufford v. Harris Corp., 322 F.Supp.2d 1345, 1359 (M.D.Fla. 2004), and to determine Bloom was not disabled under the plan.
While Blankenship instructs the Court to end its inquiry after determining an administrator's benefits-denial decision was not wrong, the Court simply notes that under the facts of this case and
Here, considering the facts as presented above, it is clear that a reasonable basis existed for Hartford's decision to terminate Bloom's benefits. Again, Bloom submitted no concrete, objective evidence in support of her claim that she could not work due to her seizure disorder and related cognitive disability. Dr. Shiftan's medical records were described as "primarily historical" and based on Bloom's "subjective reports" by Hartford's independent physicians. While hospital records demonstrate that Bloom complained of "petit mal seizures" and that "seizure precautions" were taken, there are no reports from any medical professional actually observing a seizure occur. Furthermore, though Bloom's family and friends wrote letters testifying as to her seizures and inhibited cognitive function, a diagnostic examination and file review performed by Hartford's independent doctors found no clinical evidence to support those claims. Even if it was the case that Bloom, or the Court, could offer an equally reasonable interpretation of the evidence to support an award of benefits in this instance, Hartford's denial of benefits cannot be reversed if a reasonable basis exists to support it. See Rutledge v. Liberty Life Ass. Co., 481 F.3d 655, 659 (8th Cir.2007) ("we must affirm if a reasonable person could have reached a similar decision, given the evidence before him, not that a reasonable person would have reached that decision") (emphasis in original). In fact, as discussed below, the majority of Bloom's challenges to Hartford's decision are procedural, not substantive in nature, as it is clear that a reasonable basis, even if disputed, exists to support Hartford's benefits-denial. Because the Court does not find the procedural irregularities surrounding Bloom's benefits determination to amount to a deprivation of a full and fair review of her claim, the Court holds that Hartford's decision to terminate Blooms benefits was supported by a reasonable basis and was not arbitrary and capricious.
Bloom claims that Hartford failed to act in accordance with its internal policies, and thus, failed to provide a full and fair review of her claim. Particularly, Bloom claims that Hartford: (1) improperly initiated and used surveillance as a basis to terminate her benefits; (2) failed to acknowledge consideration of Bloom's Social Security Disability ("SSD") award in Bloom's termination letter; and (3) failed to employ a "perfection statement" to notify Bloom of information absent from the administrative record. Based on its procedural noncompliance, Bloom argues that Hartford's decision should be reversed or Bloom's claim should be remanded for a full and fair review. While Hartford
Pursuant to ERISA § 503, the Full and Fair Review Regulations mandate certain requirements for the claims review process. See 29 U.S.C. § 1135; 29 C.F.R. § 2560.503-1. Among these is the obligation that administrators establish and maintain reasonable procedures for evaluating benefit claims. 29 C.F.R. § 2560.503-1(b). In Glenn, the Supreme Court rejected the proposition that courts should subject a conflicted administrator, imbued with discretion to approve or deny benefits, to an altered standard of review when reviewing claims of procedural misconduct. See Glenn, 554 U.S. at 115, 128 S.Ct. 2343 (observing that trust, law, which informs ERISA jurisprudence, continues to apply a deferential standard of review to a conflicted decisionmaker when determining whether he, substantively or procedurally, abused his discretion). Thus, the Court's inquiry is directed toward whether Hartford's procedural violations substantially impacted Hartford's determination of Bloom's claim such that she did not receive a full and fair review and Hartford abused its discretion in terminating her benefits. See Miller v. Am. Airlines, Inc., 632 F.3d 837, 852-53 (3d Cir.2011)("[administrator's] noncompliance with the statute weighs in favor of finding that [its] decision was arbitrary and capricious"). As discussed below, the Court finds Hartford's procedural violations did not rise to this level.
Bloom criticizes Hartford's decision to employ surveillance, claiming that Hartford prematurely conducted surveillance without a "pre-surveillance investigation." To support her claim, Bloom points to language in Hartford's claims manual which states that surveillance should be conducted "only after conducting an appropriate pre-surveillance investigation." Hartford's representative testified that a pre-surveillance investigation means "don't do surveillance as a first step." Additionally, Bloom points to Hartford's records which indicate that Bloom was "refer[ed] to siu [special investigations unit] to see if they can impact [the] claim," indicating that Hartford arbitrarily took measures to terminate her benefits.
The Court finds that any failure by Hartford to take prior steps to investigating Bloom's claim before employing surveillance did not amount to abuse of discretion. A further reading of the records cited by Bloom indicates that the claim manager also noted that Bloom's "disability appears mainly supported by subjective complaints of seizures." Thus, while it appears Hartford failed to abide by its internal policies by referring Bloom's claim for surveillance prior to some type of pre-surveillance investigation, it ultimately cannot be said that Hartford's noncompliance was arbitrary, or that it impacted Bloom's claim in such a way that she did not receive a fair review of her benefits determination. Hartford may have concluded that because Bloom's claims were entirely subjective, that other typical, pre-investigative procedures were futile. Moreover, it may have concluded that surveillance was the best method to verify her claim and condition. See Kiloh v. Hartford Life Ins. Co., 2005 WL 2105957, *13 (M.D.Fla. Aug. 31, 2005). (video surveillance has "great utility" for "verifying many components of the subjective self-reporting and the corresponding opinions rendered on such self-reporting"). In the end, the administrative record included Bloom's subsequent explanation of her ability to drive and perform other functional activities recorded in the surveillance
Bloom's other procedural challenges fall to the same fate. Hartford's failure to specifically acknowledge that Bloom's SSD award was considered in its determination to terminate her benefits "does not make [its] decision wrong or even unreasonable." Herman v. Metro. Life. Ins. Co., 689 F.Supp.2d 1316, 1326 (M.D.Fla.2010). That is because the "legal principles controlling the Social Security analysis are different from those governing the ERISA analysis." Id. This is particularly true when Hartford had objective, reliable evidence rebut Bloom's claim of disability, i.e., medical examinations and reports indicating no neurological abnormality or cognitive impairment. See also Richards, 356 F.Supp.2d at 1288-89 (recognizing that Social Security Administration decisions are "not persuasive in ERISA benefits cases").
Furthermore, Bloom's reliance on Hartford's failure to issue a "perfection statement" is equally unavailing.
Ultimately, the Court finds that Hartford's procedural violations were de minimus in nature and did not impact a full and fair review of Bloom's claims. Bloom did not demonstrate that these procedural violations amounted to a conflict of interest with "sufficient inherent or case-specific importance." Blankenship, 644 F.3d at 1357 (internal citation omitted). Thus, the Court cannot conclude that Hartford's decision to terminate Bloom's benefits was wrong or arbitrary and capricious. Therefore, the Court declines Bloom's request for remand based on procedural irregularities and upholds Hartford's decision to terminate her long-term disability benefits in this instance.
The Court has carefully considered the motions, responses, replies, applicable law, and pertinent portions of the record. For the foregoing reasons, it is hereby
Final judgment will be issued by separate order.