United States District Court, N.D. California
ORDER DENYING DEFENDANT'S MOTION FOR SUMMARY
JUDGMENT, GRANTING PLAINTIFF'S MOTION FOR SUMMARY
JUDGMENT, AND DENYING MOTIONS TO STRIKE Re: ECF Nos. 21, 24,
TIGAR, United States District Judge
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.
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.
Meiri's Work History and Alleged
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.
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.
Meiri's Benefits Plan
Short Term Disability
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.
Long Term Disability
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.
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
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
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
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
6) The extent of Your Disability, including restrictions and
limitations which are preventing You from performing Your
7) Appropriate documentation of Your Monthly Earnings. If
applicable, regular monthly documentation of Your Disability
8) If You were contributing to the premium cost, Your
Employer must supply proof of Your appropriate payroll
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.
parties dispute whether Meiri has presented sufficient
evidence to establish by a preponderance of the evidence that
she qualified for long term benefits.
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.
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.”
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 ...