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Teresa Duncan v. the Hartford Life and Accident Insurance

February 7, 2013

TERESA DUNCAN,
PLAINTIFF,
v.
THE HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, A CORPORATION; LORILLARD TOBACCO INSURANCE COMPANY,
DEFENDANTS.



The opinion of the court was delivered by: Garland E. Burrell, Jr. Senior United States District Judge

FINDINGS OF FACT AND CONCLUSIONS OF LAW; ORDER REMANDING MATTER TO THE HARTFORD LIFE & ACCIDENT COMPANY

AND RELATED COUNTERCLAIM

A bench trial was scheduled to commence on February 6, 2013, in this Employment Retirement Income Security Act ("ERISA") action, which concerns the termination of Plaintiff's long term disability ("LTD") benefits. The parties agreed that no witnesses were to be called at trial "since this case is governed by ERISA." (Joint Pretrial Statement 6:18-23, ECF No. 73.)

Upon reviewing the parties' trial briefs and the Administrative Record ("AR"), the Court determined that argument was unnecessary for decision on this matter. See Matter of Generes, 69 F.3d 821, 825 (7th Cir. 1995) (affirming bankruptcy court's decision to preclude closing argument in adversary proceeding, stating: "[Appellant] has supplied no authority for the proposition that closing arguments are a constitutional right in civil cases . . . nor have we been able to find any"). Therefore, the Court vacated the bench trial by minute order on February 1, 2013. (ECF No. 114.) The February 1, 2013 minute order stated that a "formal order providing the [C]court's reasoning . . . w[ould] follow." (Id.)

Accordingly, the following findings of fact and conclusions of law are made under Federal Rule of Civil Procedure 52. For the reasons stated below, Defendant Lorillard Tobacco Company ("Lorillard") does not prevail on its affirmative defense that Plaintiff expressly released her ERISA claim against it. Further, the matter will be remanded to Defendant the Hartford Life and Accident Insurance Company ("Hartford") to complete its administrative review of Plaintiff's claim.

I. FINDINGS OF FACT

A. Plaintiff's Long Term Disability Claim

1. Effective January 1, 2005, CNA Group Life Assurance Company issued Lorillard group policy number 83099921 ("Policy"), providing LTD insurance benefits to eligible employees. (AR 1864-1902.)

2. Pursuant to a policy endorsement, Hartford Life Group Insurance Company replaced the name CNA Group Life Assurance Company wherever it appears in the Policy. (AR 1888.)

3. Hartford Life Group Insurance Company later merged into Hartford Life and Accident Insurance Company. At the time the benefit decision on Plaintiff's claim was reached, Hartford Life and Accident Insurance Company had assumed the rights and liabilities under the Policy. (Joint Pretrial Statement, Undisputed Fact B, 3:9-10.)

4. In November 2005, Plaintiff, a former sales representative for Lorillard, submitted a claim for LTD benefits, claiming to be unable to work as of April 29, 2005, due to pain in her lower back, hips, legs, and feet. (AR 1586.)

5. Hartford paid Plaintiff LTD benefits under the Policy from October 27, 2005, through July 28, 2010. (Joint Pretrial Statement, Undisputed Fact D, 3:13-14.)

6. On July 28, 2010, Hartford notified Plaintiff that her LTD claim was terminated effective July 28, 2010. (AR 296-303.) The July 28, 2010 letter contains the following language:

After review of the information gathered in the course of our investigation, we have determined that you no longer satisfy the definition of Disability as stated in the [P]olicy, and we have been prevented from having you examined as established in the [P]olicy. Therefore, your claim is hereby terminated effective 07/28/10 and is no longer payable.

(AR 296.)

7. On August 4, 2010, Plaintiff's former counsel, Kantor & Kantor, LLP ("Kantor"), "advised [Hartford] that [Plaintiff] is requesting a review of Hartford's July 28, 2010 denial of her claim for ongoing benefits." (AR 291.)

8. The August 4, 2010 correspondence contains the following language:

[W]e request that Hartford not complete its review of her denial until we have been afforded the opportunity to receive and review the claim file in order to determine what additional documentation is needed to supplement the record. Please advise us of the last date which Hartford will accept additional materials prior to commencing its review of her claim. While we fully intend to supplement her record on appeal, if you have not received additional materials by such date, please proceed to complete your review. (AR 291.)

9. On September 10, 2010, Hartford sent Kantor a copy of Plaintiff's claim file. (AR 117.)

10. On December 9, 2010, Plaintiff requested a ninety day extension for her appeal to "obtain an attorney." (AR 288.) Plaintiff indicated in the December 9, 2010 correspondence that she was notified by her former attorneys in November that "they would not be handling [her] appeal process . . . ." (AR 288.)

11. On December 14, 2010, Hartford granted Plaintiff an extension until April 4, 2011, to submit her "complete appeal." (AR 113.) The December 14, 2010 correspondence contains the following language:

[Y]our complete appeal must be filed with The Hartford by April 4, 2011 in order to be considered timely. Any appeal received beyond April 4, 2011 will not be considered timely and will not be reviewed. . . . . At this time your file remains closed and any appeal that you intend to file must be received by the Hartford by April 4, 2011. (AR 113.)

12. On February 8, 2011, one of Plaintiff's current attorneys, Charles J. Fleishman ("Fleishman") sent Hartford a letter, indicating that he was "retained by [Plaintiff] with regard to her claim for disability benefits from The Hartford." (AR 285-286.)

13. The February 8, 2011 letter contains the following language:

[Plaintiff] appeals the denial of disability benefits. In order to present a meaningful appeal and to help you fulfill your obligation to give her a "full and fair" review, please send me the following:

1. All medical records, reports, treatises, etc, regardless of the author, that were submitted to The Hartford for consideration with regard to this claim.

2. All other reports offered to you for consideration regarding this claim including, but not limited to, vocational ...


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