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Bruce v. Hartford Life and Accident Insurance Co.

United States District Court, E.D. California

November 20, 2019

LORETTA BRUCE, Plaintiff,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

          MEMORANDUM AND ORDER

          MORRISON C. ENGLAND, JR. UNITED STATES DISTRICT JUDGE

         In this action, Plaintiff Loretta Bruce (“Plaintiff”) seeks redress under various California laws from Defendant Hartford Life and Accident Insurance Company (“Defendant”) arising from Defendant's termination of Plaintiff's long-term disability (“LTD”) benefits.[1] Presently before the Court are Defendant's Motion for Summary Adjudication and Plaintiff's Motion for Partial Summary Judgment pursuant to Federal Rule of Civil Procedure 56, as well as Defendant's Motion to File Sur-reply and Motion to Strike. The matter is fully briefed, and for the reasons outlined below Defendant's Motion for Summary Adjudication (ECF No. 47) is GRANTED, Plaintiff's Motion for Partial Summary Judgment (ECF No. 48) is DENIED, and Defendant's Motion to File Sur-reply (ECF No. 82) and Motion to Strike (ECF No. 63) are DENIED as moot.[2]

         BACKGROUND

         Defendant issued Group Contract Number GLT-677969 (the “Policy”) to Los Rios Community College District (“Los Rios”), effective July 1, 2010, for Los Rios employees. Pl.'s Compl., ECF No. 1 ¶ 7. Plaintiff, as a Los Rios employee, was a beneficiary of the Policy. Id. ¶¶ 6-8. On February 11, 2016, Plaintiff sustained an injury after falling at work. She subsequently underwent surgery for a meniscus tear, and she still experiences continuous pain and swelling in her knee. Id. ¶ 13. As a result, according to Plaintiff, she became disabled from her job as a Center Lead Pre-School Teacher.

         In relevant part, the applicable Policy provides coverage for injuries in the event of disability, as follows:

[D]uring the Elimination Period and for the next 24 month(s), as a result of injury or sickness, You are unable to perform with reasonable continuity the Essential Duties necessary to pursue Your occupation in the usual and customary way. After that, as a result of injury or sickness You are unable to engage with reasonable continuity in Any Occupation.

Id. ¶ 9 (emphasis added).

         Accordingly, Plaintiff applied for LTD benefits (“Your Occupation” benefits) from Defendant in March 2016 after her employer determined she could no longer perform her occupation and could not be accommodated to do so. Id. ¶ 15. On April 27, 2016, Defendant granted Plaintiff's claim for Your Occupation benefits, effective for a two-year period retroactive to January 11, 2016, but also referred Plaintiff's claim to Defendant's special investigation unit (“SIU”) for further investigation. Id. ¶ 16; Def.'s Mem. Supp. Summ. Adj., ECF No. 47 at 5:9-11.

         Defendant thereafter conducted surveillance of Plaintiff, during which she was observed driving, pumping gas, running errands, carrying items weighing less than approximately twenty pounds, and standing and walking for about twenty to thirty minutes at a time, with sit-down breaks and/or driving in between. Pl.'s Compl. ¶ 19. Plaintiff was also seen performing activities such as ascending and descending two or three steps, adjusting a hose, and sweeping. Id. ¶ 19.

         One of Defendant's field investigators interviewed Plaintiff, and again her claim was referred to the SIU to clarify [Plaintiff's] current restrictions/limitations and her ability to perform her occupation. Id. ¶¶ 22-23. Defendant also conducted an occupational analysis and arranged for Plaintiff to attend an Independent Medical Evaluation (“IME”), which she did. Id. ¶¶ 24, 27-28. The attending doctor, Dr. Bernhard, concluded that Plaintiff was able to walk forty minutes at a time for a total of three hours per day, lift twenty pounds for five minutes continuously per hour, carry fifteen pounds up to five minutes per hour for a total of eight hours per day, and push and pull fifty pounds for ten minutes per hour for a total of eight hours per day. Id. ¶ 28.

         On November 21, 2016, Defendant terminated Plaintiff's Your Occupation benefits by letter. Id. ¶ 31; Def.'s UMF, ECF No. 70-2 at 47:15-23. The letter set out Dr. Bernhard's conclusions from the IME and noted that, although Plaintiff's treating doctor, Dr. Coward, somewhat disagreed with Dr. Bernhard's conclusions, Dr. Coward did not believe they had any major differences of opinion. Def.'s UMF at 47:15-23. Therefore, Defendant concluded Plaintiff was able to perform the Essential Duties of her occupation. Id. Approximately six months later, with the assistance of counsel, Plaintiff appealed the termination of those benefits. Pl.'s Compl. ¶¶ 36, 38; Def.'s UMF at 47:24-27.

         After receiving Plaintiff's appeal, Defendant requested an independent peer review of Plaintiff's medical file by Dr. Pietro Seni. Def.'s UMF at 50:16-18. Because Dr. Seni ultimately agreed with Dr. Coward on Plaintiff's restrictions and limitations, Defendant reversed its initial termination and reinstated Plaintiff's Your Occupation benefits. Id. at 50:18-51:6.

         Thereafter, Defendant conducted an Employability Analysis Report (“EAR”) using the restrictions and limitations determined by Dr. Seni and other relevant information. Id. at 51:28-52:3. Based on those results, by letter dated August 29, 2017, Defendant prospectively terminated Plaintiff's future LTD benefits effective January 10, 2018, at which point Plaintiff had to meet the Policy's Any Occupation standard (“Any Occupation” benefits). Id. at 71:21-72:5. Defendant notified Plaintiff of the opportunity to appeal; however, Plaintiff, determining an appeal would be futile, initiated this action instead. Id. at 71:21-72:5; Pl.'s Compl. ¶ 42.

         STANDARD

         The Federal Rules of Civil Procedure provide for summary judgment when “the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a); see also Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). One of the principal purposes of Rule 56 is to dispose of factually unsupported claims or defenses. Celotex, 477 U.S. at 325.

         Rule 56 also allows a court to grant summary judgment on part of a claim or defense, known as partial summary judgment. See Fed.R.Civ.P. 56(a) (“A party may move for summary judgment, identifying each claim or defense-or the part of each claim or defense-on which summary judgment is sought.”); see also Allstate Ins. Co. v. Madan, 889 F.Supp. 374, 378-79 (C.D. Cal. 1995). The standard that applies to a motion for partial summary judgment is the same as that which applies to a motion for summary judgment. See Fed.R.Civ.P. 56(a); State of Cal. ex rel. Cal. Dep't of Toxic Substances Control v. Campbell, 138 F.3d 772, 780 (9th Cir. 1998) (applying summary judgment standard to motion for summary adjudication).

         In a summary judgment motion, the moving party always bears the initial responsibility of informing the court of the basis for the motion and identifying the portions in the record “which it believes demonstrate the absence of a genuine issue of material fact.” Celotex, 477 U.S. at 323. If the moving party meets its initial responsibility, the burden then shifts to the opposing party to establish that a genuine issue as to any material fact actually does exist. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986); First Nat'l Bank v. Cities Serv. Co., 391 U.S. 253, 288-89 (1968).

         In attempting to establish the existence or non-existence of a genuine factual dispute, the party must support its assertion by “citing to particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits[, ] or declarations . . . or other materials; or showing that the materials cited do not establish the absence or presence of a genuine dispute, or that an adverse party cannot produce admissible evidence to support the fact.” Fed.R.Civ.P. 56(c)(1). The opposing party must demonstrate that the fact in contention is material, i.e., a fact that might affect the outcome of the suit under the governing law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 251-52 (1986); Owens v. Local No. 169, Assoc. of W. Pulp and Paper Workers, 971 F.2d 347, 355 (9th Cir. 1987). The opposing party must also demonstrate that the dispute about a material fact “is ‘genuine,' that is, if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson, 477 U.S. at 248. In other words, the judge needs to answer the preliminary question before the evidence is left to the jury of “not whether there is literally no evidence, but whether there is any upon which a jury could properly proceed to find a verdict for the party producing it, upon whom the onus of proof is imposed.” Anderson, 477 U.S. at 251 (quoting Improvement Co. v. Munson, 81 U.S. 442, 448 (1871)) (emphasis in original). As the Supreme Court explained, ...


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