United States District Court, D. South Carolina, Greenville Division
Ralph J. Tortora, Plaintiff,
Hartford Life and Accident Insurance Company, Defendant.
OPINION & ORDER
M. HERLONG, Jr., Senior District Judge.
matter is before the court for review of the claim
administrator's decision to deny long-term disability
("LTD") benefits to Ralph J. Tortora
("Tortora") under an LTD insurance policy
("Policy") governed by ERISA. The Policy is
insured and administered by Hartford Life and Accident
Insurance Company ("Hartford"). Tortora seeks LTD
benefits pursuant to 29 U.S.C. § 1132(a)(1)(B) and
attorneys' fees and costs pursuant to 29 U.S.C. §
1132(g). (Joint Stipulation ("J.S.") ¶ 1, ECF No.
23.) The parties have filed a joint stipulation and memoranda
in support of judgment pursuant to the court's
Specialized Case Management Order for ERISA benefits cases.
The parties agree that the court may dispose of this matter
consistent with the joint stipulation and memoranda. (Id. ¶
8, ECF No. 23.) The parties further agree that the court
should resolve the following issues: (1) whether
Hartford's claim decision was proper under the applicable
standard of review and factors made relevant by Champion
v. Black & Decker (U.S.) Inc., 550 F.3d 353 (4th Cir.
2008); (2) if the claim decision was improper, whether
benefits should be awarded pursuant to 29 U.S.C. §
1132(a)(1)(B), or whether the case should be remanded to
Hartford for further evaluation of Tortora's claim; and
(3) if remand is necessary, whether resolution of the issue
of retroactive benefits and attorneys' fees should be
deferred until after further evaluation is conducted. (J.S. ¶
7, ECF No. 23.) For the reasons set forth below, the court
remands the case to Hartford for further consideration.
FACTUAL AND PROCEDURAL HISTORY
claim arises under a group disability policy that was issued
by Hartford to Tortora's former employer, Macro Plastic,
Incorporated ("MPI"). (Compl. ¶ 4, ECF No. 1.)
Tortora was employed by MPI as a sales and marketing manager
until January 4, 2006, when he ceased working due to a back
injury caused by a fall at home, which required a spinal
fusion of T-10 to L-3. (Def. Mem. Supp. J. 4, ECF No. 27.) As
an employee of MPI, Tortora was covered by the Policy as a
participant in the employee benefits plan. (Id. at 1, ECF No.
27.) Under the employee benefits plan and the Policy, MPI
vested Hartford with discretionary authority to interpret
Policy terms and make benefit determinations. ( Id.,
ECF No. 27.)
applied for LTD benefits on February 18, 2006. (J.S. Exs.,
ECF No. 24-15, AR 1117-22.) Hartford approved LTD benefits
under the Policy and notified Tortora by letter dated March
21, 2006. (Id. Exs., ECF No. 24-16, AR 1266-68.) Between 2007
and 2014, Tortora completed several Claimant Questionnaire
forms upon Hartford's request, in which he reported
working as a part-time realtor fluctuating between ten to
twelve or ten to fifteen hours per week. (Id. Exs., ECF No.
24-13, AR 898-900; Id . Exs., ECF No. 24-13, AR
879-81; Id . Exs., ECF No. 24-10, AR 532-34.) On
October 2, 2014, Hartford denied Tortora continuing LTD
benefits, finding that Tortora no longer had a
"Disability" as that term is defined under the
Policy. (Id. Exs., ECF No. 24-16, AR 1145-50.) The decision
was upheld on appeal and became final on June 10, 2015. (Id.
Exs., ECF No. 24-16, AR 1129-32.) Tortora alleges that he is
disabled and that Hartford abused its discretion in
terminating his LTD benefits.
Policy provides in pertinent part as follows:
When do benefits become payable?
You will be paid a monthly benefit if:
1. you become Disabled while insured under this plan;
2. you are Disabled throughout the Elimination Period;
3. you remain Disabled beyond the Elimination Period;
4. you are, and have been during the Elimination Period,
under the Regular Care of a Physician; and
5. you submit Proof of Loss satisfactory to us.
* * *
When will benefit payments terminate?
We will terminate benefit payment on the first to occur of:
1. the date you are no longer Disabled as defined;
* * *
Any Occupation means an occupation for which you are
qualified by education, training or experience, and that has
an earnings potential greater than an amount equal to the
lesser of the product of your Indexed Pre-disability Earnings
and the Benefit Percentage and the Maximum Monthly Benefit
shown in the Schedule of Insurance.
* * *
Disability or Disabled means that during the Elimination