McCulloch v. Hartford Life and Accident Insurance Company

Background

Kristin E. McCulloch challenged Hartford Life and Accident Insurance Company’s denial of her long-term disability benefits under a group plan governed by the Employee Retirement Income Security Act of 1974. McCulloch worked as an Employee Benefits Insurance Agent for BB&T Corporation until March 2018. She reported involuntary tremors and body jerking, fatigue, dizziness, headaches, and cognitive impairment. She applied for short-term disability benefits, which Hartford approved, and later applied for long-term disability benefits. Hartford denied the long-term claim and upheld that denial on appeal.

McCulloch sued under 29 U.S.C. § 1132(a)(1)(B) to recover benefits under the plan. The parties agreed that the court would review the claim independently, without deferring to Hartford’s decision. The court held a bench trial on December 4, 2020 and considered the parties’ cross-motions for judgment under Federal Rule of Civil Procedure 52.

Evidentiary Ruling

McCulloch submitted a Social Security Administration letter awarding her monthly disability benefits. The letter was not part of Hartford’s administrative record because it was issued after Hartford completed its final review. The court nevertheless found that the letter was necessary for an adequate independent review of Hartford’s benefits decision and denied Hartford’s objection to that extrinsic evidence.

Plan Terms and McCulloch’s Occupation

The long-term disability plan defined disability as a condition preventing a claimant from performing one or more essential duties of “Your Occupation.” The plan defined “Your Occupation” as the essential duties of the job the claimant performed for her employer. The court rejected Hartford’s position that McCulloch’s occupation should be treated as a generally defined “light” occupation requiring only limited lifting and other physical activity.

The court found that the plan required consideration of McCulloch’s actual work as an Employee Benefits Insurance Agent. Her duties included maintaining client relationships, meeting sales goals, negotiating renewals, solving problems, planning insurance designs, performing financial modeling, driving to clients, traveling by airplane, and using a keyboard. Hartford’s own physical-demands analysis described the position as requiring constant driving and airplane travel.

Disability Determination

The court found that McCulloch proved by a preponderance of the evidence that she was disabled under the plan. The court relied on medical and vocational evidence concerning her tremors, involuntary movements, fatigue, cognitive impairment, abnormal brain scan, cardiopulmonary exercise test, and neuropsychological testing. The court found that her condition prevented her from driving to meet clients and significantly interfered with the concentration and cognitive processing needed to negotiate renewals, solve problems, plan insurance designs, and perform financial modeling.

The court gave little weight to Hartford’s reviewing experts’ reports. It concluded that those reports did not adequately address McCulloch’s actual job duties, did not sufficiently explain their treatment of the testing, or did not account for medical observations of her involuntary movements. The court also rejected Hartford’s argument that McCulloch lacked objective evidence, noting the testing and medical observations in the record.

Disposition

The court found that McCulloch was disabled from performing her own occupation within the meaning of Hartford’s long-term disability plan. It granted McCulloch’s motion for judgment and denied Hartford’s motion for judgment. The court also denied Hartford’s objection to the Social Security Administration letter and scheduled a further case-management conference for January 22, 2021, to determine what additional proceedings were required.