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Meiri v. Hartford Life & Accident Insurance Co.

United States District Court, N.D. California

July 24, 2017

HADAR MEIRI, Plaintiff,


          JON S. TIGAR, United States District Judge

         Before the Court are Plaintiff's and Defendant's cross-motions for Summary Judgment, as well as Defendant's and Plaintiff's motions to strike. ECF Nos. 21, 24, 25. The Court will grant Plaintiff's motion for summary judgment, deny Defendant's motion for summary judgment, and deny both motions to strike.

         I. BACKGROUND

         Plaintiff Hadar Meiri (“Meiri”) brought this action under section 502(a)(1)(B) of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), seeking to recover long-term disability benefits under her Plan administered by Hartford Life and Accident Insurance Company (“Hartford”). ECF No. 1.

         A. Meiri's Work History and Alleged Disability[1]

         At the end of July 2014, Ms. Meiri was diagnosed with thyroid cancer. She was then the Vice President, Human Experience Strategy Director for MediaVest USA (“MediaVest”), where she earned $165, 000 annually. ECF No. 20-2 at 24-25. She has an M.B.A. and had worked until her cancer surgery. Id. at 25. Ms. Meiri also has a history of Hashimoto's Thyroiditis and hypothyroidism. ECF No. 20-3 at 97-98. Meiri's job at MediaVest required a “minimu[m] ¶ 3 years of managing professional level employees[, ] strong and proven strategic skills and the ability to apply them in the development of marketing/communications solutions[, and a] strong understanding of and ability to work w/ both qualitative and quantitate[v]e data.” Id. at 24. On September 10, 2014 Meiri underwent a total thyroidectomy to address her thyroid cancer and her secondary diagnosis of Hashimoto Thyroiditis. ECF No. 24-2 at 34. She experienced fatigue and weakness after surgery. Id.

         Meiri filed a claim for Short Term Disability (STD) benefits while recovering from the surgery. A December 4, 2014 medical review indicated she was “unable to work due to her reported brain fog, poor memory, fatigue, poor focus for 2-3 months until meds adjusted.” It concluded it was “reasonable that her cognitive difficulty (typical for hypothyroid) would preclude job performance.” ECF No. 20-2 at 49. Meiri's short term benefits were thus approved during her post-surgery recovery until February 15, 2015. ECF No. 35 at 6.

         B. Meiri's Benefits Plan

         1. Short Term Disability

         Meiri received short-term disability benefits while she recovered from surgery, paid from September 17, 2014 until February 15, 2015, and her entitlement to those benefits is not in dispute. ECF No. 20-1 at 20, 27. Hartford informed Meiri on February 12, 2015 that it would begin investigating her eligibility for Long Term Disability benefits, and that “receipt of Short Term Disability benefits does not necessarily mean that you will be eligible to receive Long Term Disability benefits.” Id. at 20.

         2. Long Term Disability

         Meiri's Long Term Disability (“LTD”) Policy requires her to prove that throughout the 180-day Elimination Period (‘EP”), from September 10, 2014 through March 10, 2015 and thereafter, her condition was so severe that she was precluded from performing the material and substantial duties of her occupation. See ECF No. 35 at 6; ECF No. 20-4 at 12-13. Meiri's Policy pays core benefits at 40% of an employee's prior monthly earnings, minus other income offsets, after a claimant has satisfied the 180-day Elimination Period (“EP”). ECF No. 20-4 at 6. “The Elimination Period begins on the day You become Disabled. It is a period of continuous Disability which must be satisfied before You are eligible to receive benefits from Us. You must be continuously Disabled through Your Elimination Period.” Id. at 13. “Disability or Disabled means that You satisfy the Occupation Qualifier or the Earnings Qualifier as defined below.” Id. at 12.

         Occupation Qualifier

Disability means that during the Elimination Period and the following 36 months, Injury or Sickness causes physical or mental impairment to such a degree of severity that You are:
1) continuously unable to perform the Material and Substantial Duties of Your Regular Occupation; and 2) not Gainfully Employed.
After the LTD Monthly Benefit has been payable for 36 months, Disability means that Injury or Sickness causes physical or mental impairment to such a degree of severity that You are:
1) continuously unable to engage in any occupation for which You are or become qualified by education, training or experience; and
2) not Gainfully Employed.

ECF No. 20-4 at 12. The Policy also limits benefits to 36 months for disability from a Mental Disorder of any type or a condition primarily manifested through Self-Reported Symptoms. Id. at 18. To prove disability, the claimant must provide the following:

1) The date Your Disability began;
2) The cause of Your Disability;
3) The prognosis of Your Disability;
4) Proof that You are receiving Appropriate and Regular Care for Your condition from a Doctor, who is someone other than You or a member of Your immediate family, whose speciality or expertise is the most appropriate for Your disabling condition(s) according to Generally Accepted Medical Practice.
5) Objective medical findings which support Your Disability. Objective medical findings include but are not limited to tests, procedures, or clinical examinations standardly accepted in the practice of medicine, for Your disabling condition(s).
6) The extent of Your Disability, including restrictions and limitations which are preventing You from performing Your Regular Occupation.
7) Appropriate documentation of Your Monthly Earnings. If applicable, regular monthly documentation of Your Disability Earnings.
8) If You were contributing to the premium cost, Your Employer must supply proof of Your appropriate payroll deductions.
9) The name and address of any Hospital or Health Care Facility where You have been treated for Your Disability.
10) If applicable, proof of incurred costs covered under other benefits included in the Policy.

ECF No. 20-4 at 24. The employee must provide a signed authorization to obtain necessary medical, financial, or other non-medical information to support the claim. Id.

         The parties dispute whether Meiri has presented sufficient evidence to establish by a preponderance of the evidence that she qualified for long term benefits.

         C. Medical Evidence

         1. Dr. Mielke

         Dr. Lynne Mielke, a board-certified psychiatrist and neurologist, began treating Meiri on June 12, 2014 and saw her every 2-4 weeks. ECF No. 20-3 at 271. Meiri notes that “Dr. Mielke is certified by the American Board of Psychiatry and Neurology and is an expert in hormone optimization.” ECF No. 29 at 8.

         On December 22, 2014, Dr. Mielke noted that Meiri's “[e]nergy level has improved since just after surgery, ” and that she could “now walk 25 minutes without . . . causing exhaustion, ” but that she continued to have “poor memory.” ECF No. 21-1 at 9. Hartford recorded in a report on January 27, 2016 that Dr. Mielke had noted in an Attending Physician Report that observations on January 7, 2015 and February 9, 2015 had shown “poor memory, fatigue, feelings of weakness and being overwhelmed, crying spells . . . psychomotor retardation and poor recall.” ECF No. 20-2 at 49. On November 10, 2014, Dr. Mielke documented Meiri's self-reports of being fatigued, overwhelmed, and unable to keep up in conversations. ECF No. 20-3 at 277. In a report Hartford received January 28, 2015, Dr. Mielke stated “depression” as a secondary diagnosis, and wrote that there were “no physical restrictions ‒ the issues are currently mental.” ECF No. 20-1 at 29. Under “physical exam findings, ” Dr. Mielke wrote that Meiri had “psychomotor retardation poor recall.” Id. Dr. Mielke noted that the treatment plan was “treat underlying infections and hormone deficiencies, ” and that Meiri “calls and emails several times daily.” Id.

         In an Attending Physician's Statement of Functionality from February 16, 2015, Dr. Mielke stated that Meiri had no physical restrictions and could sit for 8 hours at a time, stand for 2 hours at a time, and walk for 2 hours at a time. ECF No. 20-3 at 272. In response to the prompt “[e]xpected duration of any restriction(s) or limitation(s), ” Dr. Mielke wrote “Unknown - this patient has not responded to any intervention so far.” ECF No. 20-3 at 272. In response to the question “[d]oes the patient have a psychiatric/cognitive impairment, ” Dr. Mielke marked ...

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