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4th Cir. - Published - Discretionary Authority

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  • 4th Cir. - Published - Discretionary Authority

    Here's a new published decision out of the Fourth Circuit entitled Scott Griffin v. Hartford Life and Accident Insurance Company. The first issue that the court addresses is that the plaintiff contends that an abuse of discretion is not appropriate and the court should review it de novo because the Hartford employees that actually reached the decision were paid by Hartford Fire Insurance Company and not Hartford Life. Hartford, in response, contends that while Hartford Life executed the decision, the employees that made that decision are paid through Hartford Fire, but are acting as employees of Hartford Life and that they are all under the appropriate umbrella. The plaintiff only learned that the relevant employees were paid by Hartford Fire during discovery. The court agrees that Hartford Life made the actual decision, was appropriately given discretionary authority under the terms of the plan, and, therefore, the abuse of discretion is the appropriate standard of review.

    We agree. The record plainly indicates that the individual decisionmakers involved with Griffin's claim were acting as agents of Hartford Life, such that Hartford Life, not Hartford Fire, determined that Griffin was no longer eligible for long-term disability benefits. All correspondence with Griffin was signed by individuals as employees of Hartford Life, and uncontested affidavits confirm that the employees involved with Griffin's claim were acting in that capacity. The only evidence suggesting that the relevant employees were instead employees of Hartford Fire was the W-2 tax forms indicating that Hartford Fire paid the employees' salaries. But, as Hartford Life explained, Hartford Fire was given the responsibility to pay all of the employees of subsidiary and affiliated companies in The Hartford group "for administrative purposes," and Hartford Fire was not involved in any of the underwriting, issuing of policies, investigations, communications, or decisions in this case. We also note that numerous federal courts faced with similar factual circumstances have reached the same conclusion. See, e.g., Potts v. Hartford Life & Accident Ins. Co., 272 F. Supp. 3d 690, 704?06 (W.D. Pa. 2017) (finding, in identical circumstances, that claim reviewers worked for Hartford Life even though they were paid by Hartford Fire); Owens v. Liberty Life Assurance Co. of Boston, 184 F. Supp. 3d 580, 585?86 (W.D. Ky. 2016) (finding that claim reviewers worked for Liberty Life even though they were paid by Liberty Mutual); Zurndorfer v. Unum Life Ins. Co. of America, 543 F. Supp. 2d 242, 256?57 (S.D.N.Y. 2008) (finding that claim reviewers were authorized agents acting on behalf of Unum America even though they were officially employed and paid by its parent company).
    Next, the court turns to whether or not Hartford abused its discretionary authority. The court concludes that Hartford's review was principled and reasoned and was not an abuse of discretion.

    Based on the information that Griffin supplied and that Hartford Life was able to obtain, Hartford Life then engaged in an employability analysis and concluded that there were several sedentary positions available within a close distance of Griffin and within his capabilities. The report of the analysis clearly identified positions for which Griffin possessed the required skills and qualifications. Griffin protests that these positions were not occupations for which he already had the necessary "education, training[,] or experience," as the policy requires, because the report stated that he could perform these jobs after receiving "minimal training." But the fact that the identified positions, like any other new position, might require initial orientation did not disqualify them as suitable alternative occupations for which Griffin was qualified. Hartford Life thus reasonably concluded that Griffin was not incapable of performing any occupation, as he was required to demonstrate under the policy to be qualified as disabled.

    • • •

    At bottom, the record reveals that the entire claims process was thorough, deliberate, and reasoned, and the evidence available to Hartford Life reasonably supported the discretionary decision it made. In making its decision, Hartford Life relied on observations of Griffin made by its investigators, Griffin's answers during his in-person interview, and general statements from his past medical providers that he likely had more functionality than he thought and that he had appeared to be moving normally. And again, the long-term disability policy states explicitly that it is Griffin's obligation, not Hartford Life's, to "furnish Proof of Loss," defined in part as evidence of the claimant's disability. As the district court noted, Griffin's only substantive evidence of his current disability was his own self-reporting regarding his condition, none of which provided objective medical evidence of his current functionality.
    The plaintiff then argues that Hartford abused its discretion because his condition did not change yet they went from approving his benefits to denying him. The court, I believe, leaves this argument open in the future, but does find that his condition did improve and, therefore, Hartford's decision was not an abuse of discretion. Finally, the court concludes that Hartford was not obligated under the terms of the plan to have the plaintiff physically examined.

    Griffin also insists that a provision in the policy required Hartford Life to have him physically examined before finding him ineligible for benefits. But this again is belied by the actual language of that provision. While the policy does provide that Hartford Life could require Griffin to submit to a medical examination if it were to deem it necessary to determine his eligibility, that provision does not impose a duty on Hartford Life to do so. Griffin nonetheless argues that even if Hartford Life was not contractually required to have him physically examined, it was still unreasonable for Hartford Life to deny his claim without the benefit of such an examination. While we acknowledge that there might be circumstances where that absence renders the decisionmaking process unreasonable, this is not such a case. Griffin directed Hartford life to Dr. Carmouche, Dr. Bravo, and Dr. McGlothlin, and none was able or willing to provide evidence sufficient to justify finding Griffin to be disabled. Moreover, Hartford Life collected additional information through its own efforts that led to the same conclusion. We cannot conclude that Hartford Life acted unreasonably in not seeking the opinion of yet another examiner, especially when it found that doing so would be cost-prohibitive. While ERISA administrators may not deny benefits without an adequate evidentiary basis, they are "under no duty to secure specific forms of evidence." Elliott v. Sara Lee Corp., 190 F.3d 601, 609 (4th Cir. 1999); see also Berry v. Ciba-Geigy Corp., 761 F.2d 1003, 1008 (4th Cir. 1985) (noting that it was "not incumbent on [the administrator] as a matter of law to secure evidence" in support of a claim of disability when it possessed reliable evidence that the claimant was not disabled).
    The opinion is attached below.
    Attached Files