Hulbert v. Hartford Life and Accident Insurance Company

Background

Christian Hulbert brought an action under the Employee Retirement Income Security Act (ERISA) against Hartford Life and Accident Insurance Company. Hartford insured a group long-term disability policy issued to Hulbert’s former employer, Infinera Corporation. Infinera was the plan administrator, and Hartford was the insurer.

The policy defined total disability, for the first two years, as being unable to perform the essential duties of the policyholder’s own occupation with reasonable continuity. After two years, the policy required proof that the policyholder could not engage with reasonable continuity in any occupation meeting the policy’s earnings requirements.

Hulbert worked as a Senior Support Technician. His work was primarily sedentary but required him to analyze, troubleshoot, and evaluate computer-network problems. He stopped working after tripping down stairs and hitting his head, which resulted in a concussion. Hartford paid short-term disability benefits but denied his application for long-term benefits in April 2019. Hartford also denied his appeal in December 2019.

Hulbert and Hartford filed cross-motions for judgment under Federal Rule of Civil Procedure 52. Under that rule, the court decides the facts and legal issues based on the record rather than deciding only whether disputed facts exist.

Standard of Review

The parties agreed that California Insurance Code section 10110.6 applied. The court therefore independently reviewed the administrative record without deferring to Hartford’s denial. Hulbert had the burden of proving by a preponderance of the evidence—meaning that it was more likely than not—that he was disabled under the plan.

Medical and Other Evidence

Hulbert reported headaches, memory problems, difficulty reading, attention problems, vision issues, anxiety, depression, and auditory hallucinations. Medical records also documented brain cavernomas. The court reviewed opinions from neurologists, mental-health professionals, a psychologist, a neuropsychologist, an optometrist, a rehabilitation counselor, and Hartford’s reviewing physicians.

The court found that most medical professionals did not conclude that the cavernomas caused Hulbert’s reported symptoms. Dr. Marcella Wozniak concluded that the cavernomas were stable, were not the primary cause of his symptoms, and caused only mild difficulties that did not reach the policy’s disability level. Dr. Enslin Aldrich similarly found that the cavernomas were unlikely to cause Hulbert’s reading problems and advised against surgery or radiation. Dr. J. Marc Simard also concluded that treating the cavernomas would not address Hulbert’s reading difficulties.

Dr. Ben Jones was the only treating professional the court identified as finding that the cavernomas might be causing Hulbert’s symptoms. The court gave his opinions less weight because his testing did not use embedded validity testing, earlier testing had shown response inconsistency, and the record raised concerns about possible symptom exaggeration and substance use.

The court also found that Hulbert’s other reported symptoms were not proven disabling by reliable objective evidence. The court relied particularly on Laura Hanes’s statement that there was no impairment affecting Hulbert’s ability to work and that his reading difficulty was subjective, and on Dr. Wozniak’s bedside examination, during which Hulbert performed well on reading-related testing. The court also considered evidence that some symptoms—including headaches, bradycardia, and auditory hallucinations—had improved or resolved.

The court found the vocational report by Walter Stanfill unpersuasive because it incorrectly attributed Hulbert’s leave from work to Dr. Wozniak and mischaracterized Dr. Wozniak’s findings. The court also concluded that Hartford’s file-review physicians, Dr. David Lang and Dr. Scott Sautter, reached the same general conclusion as Hulbert’s most frequent treating professionals and therefore found their opinions more credible than those of Dr. Jones and Stanfill.

Court’s Conclusions

The court rejected Hulbert’s argument that Hartford’s payment of short-term benefits should make its denial of long-term benefits more suspect. The court explained that the short-term benefits related to cardiac symptoms and auditory hallucinations that had resolved, rather than establishing entitlement to long-term benefits for a separate neurological condition.

The court also rejected Hulbert’s argument that Hartford’s failure to conduct an in-person examination made its decision unreliable. The court held that a file-based review can be an acceptable basis for a benefits determination, particularly where the reviewing physicians’ conclusions were consistent with the treating professionals’ conclusions.

The court concluded that Hulbert had not proved by a preponderance of the evidence that he was disabled under the plan or entitled to long-term disability benefits. At the hearing, Hulbert sought 24 months of benefits based on inability to perform his own occupation and a remand to Hartford to consider benefits beyond that period. His counsel also stated that Hulbert was not pursuing a claim based on substance abuse.

Disposition

The court denied Hulbert’s Rule 52 motion for judgment and granted Hartford’s Rule 52 motion for judgment.