Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Vaughn v. Hartford Life And Accident Insurance Co.

United States District Court, D. Oregon

June 12, 2019

STEPHANIE S. VAUGHN, Plaintiff,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

          MEGAN E. GLOR, JOHN C. SHAW Megan E. Glor, Attorneys at Law, P.C. 707 N.E. Knott St., Suite 101 Portland, OR 97212 (503) 223-7400 Attorneys for Plaintiff

          RUSSELL S. BUHITE Ogletree, Deakins, Nash, Smoak & Stewart, P.C. 1201 Third Ave., Suite 5150 Seattle, WA 98101 (206) 693-7052 Attorneys for Defendant

          OPINION AND ORDER

          Anna J. Brown, United States Senior District Judge.

         This matter comes before the Court on Plaintiff Stephanie S. Vaughn's Motion (#49) for Summary Judgment, Defendant Hartford Life and Accident Insurance Company's Cross-Motion (#53) for Summary Judgment, and Plaintiff's Motion (#64) to Strike the Declaration (#63) of Russell S. Buhite in Support of Defendant's Reply. The Court concludes the record is sufficiently developed, and, therefore, oral argument is not required to resolve this matter.

         For the reasons that follow, the Court GRANTS Plaintiff's Motion (#49) for Summary Judgment and DENIES Defendant's Motion (#53) for Summary Judgment. The Court also DENIES as moot Plaintiff's Motion (#64) to Strike.

         BACKGROUND

         I. Plaintiff Vaughn's Claims

         Vaughn alleges Hartford violated ERISA law when it terminated Vaughn's Long-Term Disability (LTD) benefits. Pursuant to 29 U.S.C. § 1332(a)(1)(B) Vaughn seeks reinstatement of her LTD benefits from Hartford under the disability plan (Plan) of her employer, Northwest Permanente, P.C. (Kaiser).

         II. Procedural Facts

         Vaughn was employed by Kaiser as a family-practice physician. Hartford was the insurer for benefits under the group LTD Certificate of Insurance for Kaiser and administered Vaughn's claim for benefits.

         In March 2013 Vaughn applied for LTD benefits on the basis that her asthma, prednisone treatment for her asthma, and juvenile onset diabetes mellitus rendered her disabled under the terms of the Plan.

         In September 2013 Hartford approved Vaughn's claim effective August 12, 2013, based on its conclusion that Vaughn was unable to perform one or more of the essential duties of her occupation because of her disability. Hartford continued to pay benefits to Vaughn through October 28, 2017.

         In March 2017 Hartford conducted a review of Vaughn's claim to determine whether she remained eligible for LTD benefits and referred Vaughn's claim to its Special Investigation Unit (SIU).

         On October 19, 2017, following its investigation, Hartford terminated Vaughn's LTD benefits.

         On November 29, 2017, Vaughn filed a Complaint in this Court against Hartford for violation of ERISA.

         In February 2018 Vaughn appealed Hartford's termination of her LTD benefits.

         On March 26, 2018, Hartford upheld its decision terminating Vaughn's LTD benefits.

         On February 15, 2019, Vaughn filed a Motion (#49) for Summary Judgment in this case.

         On March 6, 2019, Hartford filed a Cross-Motion (#53) for Summary Judgment.

         On May 10, 2019, Vaughn filed a Motion (#64) to Strike the Declaration (#63) of Russell S. Buhite in support of Hartford's Reply.

         On May 24, 2019, all Motions were fully briefed, and the Court took this matter under advisement.

         STANDARDS

         I. Summary Judgment in ERISA Cases

         Although this matter is before the Court on cross-motions for summary judgment, the usual summary-judgment standard under Federal Rule of Civil Procedure 56 is not the appropriate standard in an ERISA action. When reviewing a decision to deny or to terminate benefits, "a motion for summary judgment is, in most respects, merely the conduit to bring the legal question before the district court and the usual tests of summary judgment, such as whether a genuine dispute or material fact exists, do not apply." Stephan v. Unum Life Ins. Co. of Am., 697 F.3d 917, 929-30 (9th Cir. 2012).

         II. ERISA Standard of Review

         "When a plan does not confer discretion on the administrator 'to determine eligibility for benefits or to construe the terms of the plan,' a court must review the denial of benefits de novo." Abatie v. Alta Health & Life Ins. Co., 548 F.3d 955, 963 (9th Cir. 2006)(citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). De novo is the default standard of review. Id. "But if the plan does confer discretionary authority as a matter of contractual agreement, then the standard of review shifts to abuse of discretion." Id. (emphasis in original). "For a plan to alter the standard of review from the default of de novo to the more lenient abuse of discretion, the plan must unambiguously provide discretion to the administrator." Id. (citing Kearney v. Standard Ins. Co., 175 F.3d 1084, 1090 (9th Cir. 1999)).

         DISCUSSION

         I. The standard of review in this case is de novo.

         The parties dispute the standard of review to be applied by the Court in this case.

         Vaughn contends the standard of review is de novo on the ground that the applicable Plan contains a clear grant of discretionary authority to Hartford.

         Hartford, in turn, contends the Plan vests it with discretionary authority to determine eligibility for benefits, and, therefore, the standard of review is abuse of discretion.

         A. Background

         Hartford contends the applicable Plan is governed by the 2011 Certificate of Insurance, Revised January 1, 2011, that is part of the Administrative Record (AR)(#43) filed in this case. AR 003169-80.[1] The 2011 Certificate was issued by Hartford and lists the "Policyholder" as Trustee of the Health Care Industry Group Voluntary Life and Disability Insurance Trust; the "Participating Employer" as Northwest Permanente, P.C.; the "Policy Number" as GVL-16008; and the "Policy Effective Date" as February 1, 2010. AR 003152. The 2011 Certificate provides:

The provisions of the Participating Employer's coverage under The Policy, which are important to You, are summarized in this certificate consisting of this form and any additional forms which have been made a part of this certificate.
The Policy alone is the only contract under which payment will be made. Any difference between The Policy and this certificate will be settled according to the provisions of The Policy on file with Us at Our home office.

AR 003152. The "General Provisions" of the 2011 Certificate also provide:

Policy Interpretation: Who interprets the terms and conditions of The Policy? We have full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of The Policy. This provision applies where the interpretation of The Policy is governed by the Employee Retirement Income Security Act of 1974, as amended (ERISA).

AR 003169. The "ERISA Information" form that accompanies the 2011 Certificate provides:

The benefits in your booklet-certificate (Booklet) are provided under a group insurance policy (Policy) issued by the Hartford Life and Accident Insurance Company (Insurance Company) and are subject to the Policy's terms and conditions. The Policy in incorporated into, and forms a part of, the Plan. The Plan has designated and named the Insurance Company as the claims fiduciary for benefits provided under the Policy. The Plan has granted the Insurance Company full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy.

AR 003181.

         According to Vaughn, however, her claim is governed by the 2013 Certificate of Insurance, Revised December 1, 2013, which does not grant Hartford discretionary authority. Vaughn, therefore, argues the standard of review is de novo. The Court notes the 2013 Certificate on which Vaughn relies is not part of the Administrative Record, but it is attached as Exhibit A to her Declaration (#50) in Support of Plaintiff's Motion for Summary Judgment. The 2013 Certificate indicates the Plan was "Revised December 1, 2013" and states "[t]he benefits described herein are those in effect as of December 1, 2013." Ex. A at 8. Significantly, the "General Provisions" section of the 2013 Certificate does not contain language that grants Hartford the "discretion and authority to determine eligibility for benefits and interpret the terms of the policy." Like the 2011 Certificate, however, the 2013 Certificate has an "ERISA Information" form that provides: "The Plan has granted the Insurance Company full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy." Ex. A at 36.

         B. Analysis

         1. Applicable Plan.

         In order to determine the proper standard of review, the Court must resolve which version of the Plan is applicable to Vaughn's claim.

         The 2011 Certificate was the Plan in effect on March 4, 2013, when Vaughn applied for LTD benefits. Vaughn, however, contends her claim for wrongful termination of her LTD benefits accrued on the day that her benefits were terminated, which the parties acknowledge occurred in November 2017. Thus, Vaughn asserts the relevant Plan is the one in effect when Hartford terminated Vaughn's LTD benefits in November 2017, which was the 2013 Certificate.

         In Grosz-Salomon v. Paul Revere Life Insurance Company the Ninth Circuit determined which one of two policies controlled and the applicable standard of review. 237 F.3d 1154 (9th Cir. 2001). In Grosz-Salomon an employee challenged the disability insurer's termination of her benefits. The policy in effect when the employee applied for and was granted benefits did not contain a discretionary authority provision. Subsequently, the benefits plan was amended to include a discretionary authority provision and that plan was in effect when the insurer terminated the employee's benefits. The district court did not resolve whether the amended plan language controlled because ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.