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Rose v. Hartford Life and Accident Insurance Co.

United States District Court, D. Colorado

June 11, 2014

BARBARA ROSE, Plaintiff,
v.
THE HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, and JOHN AND JANE DOES NUMBER 1-10 Defendant.

ORDER AFFIRMING DEFENDANT'S DENIAL OF LONG TERM DISABILITY BENEFITS

WILLIAM J. MARTÍNEZ, District Judge.

This case arises under the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001, et seq. ("ERISA"). Plaintiff Barbara Rose claims that Defendant Hartford Life and Accident Insurance Company ("Hartford" or "Defendant") violated ERISA when it issued its final determination letter dated October 13, 2010, upholding its earlier decision to deny long-term disability benefits to Plaintiff. (ECF No. 2.)

For the reasons set forth below, Defendant's denial of benefits is affirmed and Plaintiff's claim for disability benefits is denied.

I. FACTUAL AND PROCEDURAL BACKGROUND

Plaintiff began working as a psychiatrist for Colorado Permanente Medical Group, P.C. on December 15, 2008. (Record ("R.") (ECF No. 15) at 76.) In conjunction with her employment, Plaintiff was a participant in an employee welfare benefit plan, which included a long-term disability policy through Defendant Hartford. (R. 1-40.) The Hartford Policy Number for Colorado Permanente Medical Group, P.C. is GVL-16008 (the "Policy"). (R. 1.) The relevant portions of the Policy are as follows:

Pre-existing Conditions Limitation: Are benefits limited for Pre-existing Conditions?
We will not pay any benefit, or any increase in benefits, under The Policy for any Disability[1] that results from, or is caused by or contributed to by, a Pre-existing Condition, unless, at the time You become Disabled:
1) You have not received Medical Care for the condition for 3 consecutive month(s) while insured under The Policy; or
2) You have been continuously insured under The Policy for 12 consecutive month(s).
Pre-existing Conditions means:
1) any Injury, Sickness, Mental Illness, pregnancy, or episode of Substance Abuse; or
2) any manifestations, symptorms, findings, or aggravations relating to or resulting from such accidental bodily injury, sickness, Mental Illness, pregnancy, or Substance Abuse;
for which You received Medical Care during the 3 month(s) period that ends the day before:
1) Your effective date of coverage; or
2) the effective date of a Change in Coverage.
Medical Care is received when a physician or other health care provider:
1) is consulted or gives medical advice; or
2) recommends, prescribes or provides Treatment.
Treatment includes, but is not limited to:
1) medical examinations, tests, attendance, or ...

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