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Weske v. Hartford Life and Accident Insurance Co.

United States District Court, D. Minnesota

February 12, 2015

Karyn K. Weske, Plaintiff,
v.
Hartford Life and Accident Insurance Company, Defendant.

Jacob J. Jagdfeld, Esq. and Johnson Becker, PLLC, counsel for plaintiff.

Eric N. Linsk, Esq. and Lockridge Grindal Nauen, PLLP, counsel for defendant.

AMENDED ORDER

DAVID S. DOTY, District Judge.

This matter is before the court upon the cross-motions for summary judgment by plaintiff Karyn K. Weske and defendant Hartford Life and Accident Insurance Company (Hartford). Based on a review of the file, record, and proceedings herein, and for the following reasons, the court grants Weske's motion in part and denies Hartford's motion.

BACKGROUND

This insurance benefit dispute arises out of Hartford's denial of long-term disability benefits to Weske. Weske had disability insurance under an employee-welfare benefit plan (Plan) sponsored by her former employer, Medtronic, Inc., and insured by Hartford. See HART000001-47.[1] The Policy expressly grants Hartford "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of The Policy." Id. at 000018.

In April 2012, Weske fell off her roof and sustained multiple serious orthopaedic injuries to her ba ck, feet, ankles, and left wrist. See id. at 355-56, 419, 422. Weske has undergone numerous surgeries to repair her injuries, including follow-up surgeries to remove hardware placed during surgeries immediately following the accident. Id. at 311-14. Weske's most recent surgery was on April 23, 2013, during which Dr. Paul Cammack removed hardware from her left ankle and applied a corticosteroid injection to her left foot, and Dr. Mark Fisher removed hardware from her left wrist. Id.

At the time of her accident, Weske was a Senior Customer Service Representative for Medtronic. According to a Physical Demands Analysis (PDA) completed by Medtronic, Weske's position required her to use a computer, telephone, calculator, and head set for eight hours per day, five days per week. Id. at 106-07. Her schedule included one hour for lunch and two fifteen minute breaks. Id. A typical workday required Weske to sit for five hours, stand for three hours, and walk for.5 hours. Id. The PDA indicates that Weske was permitted to sit or stand as needed. Id.

After the accident, Weske was unable to work. She received short-term salary continuance benefits until the fall of 2012. Id. at 186. Thereafter, Weske filed a claim for long-term disability benefits under the Policy, and Hartford approved her claim effective October 17, 2012. Id. at 186, 379-84. Hartford explained that benefits would continue for the first twelve months as long as Weske remained unable to perform one or more of the "Essential Duties of Your Occupation."[2] Id. at 186-87. "Essential Duty" is defined as a duty that "1) is substantial, not incidental; 2) is fundamental or inherent to the occupation; and 3) cannot be reasonably omitted or changed." Id. at 19, 187. "Your Occupation" is defined as "Your Occupation as it is recognized in the general workplace." Id. at 22; 187. The Policy expressly states that "Your Occupation does not mean the specific job You are performing for a specific employer or at a specific location." Id. Hartford concluded that Weske's occupation was sedentary, involving sitting most of the time, occasional walking or standing for brief periods, and occasional lifting. Id. at 136, 182. Hartford further explained that Weske would be required to periodically provide continued proof of disability. Id. at 188.

In a letter dated March 25, 2013, Hartford notified Weske that her disability benefits were terminated effective March 1, 2013.[3] Id. at 180. Hartford explained that based on communications with Fischer and Cammack, the PDA, and an occupational analysis, Weske no longer met the definition of disabled under the Policy. Id. at 181-82. Hartford specifically noted that on March 1, 2013, Fisher, who treated Weske's left wrist, indicated occasional ability to lift more than twenty pounds bilaterally and "frequent ability to reach at all levels and finger/handle." Id. at 182, 372. As to Cammack, who treated Weske's ankle and foot, Hartford noted that although Cammack had not released Weske to return to work, he also did not indicate any restrictions or limitations in his notes. Id. at 182, 297. That information was conveyed in a voicemail from Cammack's office assistant on March 14. See id. There is no evidence in the record that Hartford requested additional information from Cammack. Based on the information gathered, Hartford concluded that Weske could return to work in "Your Occupation." Id. at 182. In doing so, Hartford failed to note Weske's documented scheduled surgery on April 23, 2013, to remove hardware from her ankle and wrist. See id. at 180-82, 297, 371.

Weske appealed the denial on April 15, 2013. Id. at 364. Weske argued that she remained disabled due to pain in her back and feet, which was not well-managed through pain medication. Id. She explained that she had upcoming surgery to alleviate her ankle and foot pain and that she anticipated back surgery in approximately one year.[4] Id. Weske also provided an April 11, 2013, letter from Cammack, which supported her claim of disability before the April surgery:

It's my opinion that this surgery is medically necessary. She is unable to stand and walk due to trouble she is having with her feet. She is having a difficult time being mobile enough to maintain any kind of gainful employment. In the interim between her two surgeries, she has really not been able to look for meaningful work, as she has had a second surgery upcoming.... Again, it's my opinion that this surgery is medically necessary in order to allow her to have sufficient mobility to perform activities of daily living, as well as employment activities.

Id. at 365.

On April 23, 2013, Cammack performed the surgery, removing hardware from Weske's left ankle and administering a corticosteroid injection into her right subtalar joint. Id. at 311. Under the same anaesthesia, Fischer removed hardware from her left wrist. Id. at 312-13. Two weeks later, Weske reported that her right foot was "great, " she was without pain, and she felt as though she was walking for a normal gait. Id. at ...


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