936 F. Supp. 2d 868
S.D. Ohio2013Background
- Zenadocchio, a BAE Systems Financial Analyst, received 26 weeks of STD under Policy GLT-674180 administered by Hartford; LTD was approved then terminated by Hartford for May 2011 through April 2012 under Own Occupation.
- The Plan grants Hartford full discretion to determine eligibility and interpret terms, subjecting denial decisions to ERISA review; the case proceeds on Hartford’s denial of LTD benefits.
- Two occupational analyses concluded the Financial Analyst role is sedentary; functional demands are largely cognitive with limited physical strain.
- Hartford pursued a multi-faceted review including physician statements, peer reviews, and surveillance; Hartford terminated LTD benefits based on these reviews.
- Zenadocchio appeals under ERISA, seeking remand for a full and fair review; the court grants plaintiff’s motion in part and remands for reconsideration.
- The court’s remedy is remand to Hartford for a full and fair review within 90 days.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review applied to Hartford’s denial | Zenadocchio argues discretionary authority is shown and review should be de novo | Hartford contends discretionary review applies and arbitrary-and-capricious standard governs | Discretionary standard applies; review is arbitrary and capricious as to adequacy of reasoning |
| Credit given to treating physicians vs. file reviews | Wolfe’s treating-opinion should be given substantial weight | Hartford may rely on file reviews and objective evidence limits | Hartford’s disregard of Wolfe’s opinion and reliance on file reviews was arbitrary and capricious |
| Use of objective evidence under plan provisions | Plan allows objective evidence but does not require it exclusively | Objective evidence demanded; lack of it justifies denial | Plan does not require exclusive objective evidence; Hartford’s selective reliance was improper |
| Consideration of mental functional capacity | Mental limitations must be considered when assessing ability to perform duties | Hartford relied primarily on physical restrictions | Hartford failed to adequately analyze mental capacity in relation to essential duties and thus acted arbitrarily |
| Remedy</Issue> | Remand for full and fair review is appropriate to correct process deficiencies | Remand may be unnecessary if entitlement is clear | Remand for a full and fair review is appropriate and required |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (Supreme Court 1989) (establishes standard of review for ERISA benefits with discretionary authority)
- Wulf v. Quantum Chemical Corp., 26 F.3d 1368 (6th Cir. 1994) (discretionary authority requires a clear grant to replace de novo review)
- Calvert v. Firstar Fin., Inc., 409 F.3d 286 (6th Cir. 2005) (explains breadth of administrator’s power for discretionary review)
- Rose v. Hartford Financial Servs. Group, 268 Fed.Appx. 444 (6th Cir. 2008) (insurer’s reliance on file review and need for fair process in credibility determinations)
- Kalis v. Liberty Mut./Liberty Life Assur. Co., 419 F.3d 501 (6th Cir. 2005) (illustrates conflict-of-interest considerations in review)