United States District Court, D. Utah
BRENNA L. MAWA, Plaintiff,
HARTFORD LIFE & ACCIDENT INSURANCE COMPANY, Defendant.
MEMORANDUM DECISION AND ORDER
A. Kimball, District Judge
the court are cross motions for summary judgment in an ERISA
case. Plaintiff Brenna Mawa claims to be disabled primarily
due to fatigue, dizziness, and shortness of breath. Mawa
asserts a claim for long term disability benefits under the
Group Long Term Disability Plan for Employees of LHC Group,
Inc. (“Plan”). The motions will be decided based
on the administrative record.
is the claim administrator responsible for the determination
of Long-Term Disability (“LTD”) claims under the
Plan. The plan has delegated to Hartford the
“discretion to determine eligibility for benefits and
to interpret the terms of the benefit plan.
Plan requires a claimant to submit proof of loss showing that
the claimant is disabled under the Plan's terms and
conditions. The proof of loss “must be
satisfactory” to Hartford. The payment of LTD benefits
will end on “the date [a claimant is] no longer
Disabled” under the Plan's terms.
Plan's definition of disability focuses on whether a
claimant can perform the duties of her own occupation. After
a claimant receives 24 months of LTD benefits, the test for
disability changes to whether the claimant is able to perform
any occupation. The Plan defines “Any Occupation”
as “any occupation for which you are qualified by
education, training or experience…” Rec. 34.
Brenna Mawa was a nurse and worked as a Branch Director and
Clinical Director of LHC Group, Inc. (“LHC”).
Mawa stopped working for LHC due to symptoms related to
peripartum cardiomyopathy and subsequently applied for LTD
benefits. On June 5, 2015, Hartford approved Mawa's claim
for LTD. In the approval letter, Hartford advised Mawa that
the test for disability would change to the Any Occupation
Definition effective February 8, 2017.
20, 2016, Roxann Koelln, an on-staff Hartford Nurse,
interviewed Mawa by telephone about her status. Mawa reported
that she had worsening symptoms of extreme fatigue/tired,
feeling like she is going to black out upon standing which
can last for prolonged period of times, shortness of breath
with exertion, dizziness with bending and slight edema in
legs and feet as the day goes on. She also reported that she
cared for her four-year-old child who she can lift, but not
carry around. Mawa further noted that she had lost 101 pounds
since lap band placement in January 2016 and did light
Koelln asked Mawa whether she could return to work in a
sedentary capacity. Mawa did not believe she could sit for
more than a couple of hours due to her taking of coumadin.
Nurse Koelln told Mawa that individuals work while on
coumadin therapy and that seated work generally allows for
the ability to stand and stretch, and to walk around when
needed. Mawa said she would think about returning to work in
some capacity once her symptoms were better controlled.
27, 2016, Nurse Koelln called Mawa for an update. Mawa said
that she had an echocardiogram on June 15, 2016. Mawa
reported continued issues with blood pressure and dizziness.
On June 28, 2016, Nurse Koelln sent a letter to Dr. Kristin
Scott-Tillery, Mawa's attending physician, asking Dr.
Scott-Tillery to comment on Mawa's work capacity. On July
12, 2016, Assistant Nurse Practitioner Terri Hancock
responded on behalf of Dr. Scott-Tillery. Hancock indicated
that Mawa was capable of part time sedentary work. Hancock
noted that Mawa had pre-syncope episodes and hypertension,
and that she had “significant limitations at this
September 7, 2016, Dr. Stehlik examined Mawa. At the
examination, Mawa reported less near syncope, but she still
had some lightheadedness. Mawa told Dr. Stehlik that she
tries to walk, and does some exercise videos for activity,
and is thinking about purchasing a stationary bike.
Stehlik's review of symptoms during the examination was
negative for malaise/fatigue, claudication, dyspnea on
exertion, near-syncope, orthopnea, shortness of breath, and
muscle weakness. Rec. 281. Mawa tested positive for
light-headedness based on her self-report. Mawa had a normal
heart rate, regular rhythm, normal heart sounds, and intact
distal pulses. Mawa exhibited normal psychiatric conditions
with normal cognition and memory.
September 28, 2016, Nurse Koelln sent a letter to Dr.
Scott-Tillery asking whether Mawa was able to perform
sedentary work on a full-time basis, and requested
information supporting Dr. Scott-Tillery's opinion. On
October 4, 2016, Hartford learned that Dr. Scott-Tillery had
left the medical practice and moved to Montana. Mawa's
new primary treating physician was Dr. Joseph Stehlik.
October 6, 2016, Hartford referred the medical records for an
independent physician peer review. Hartford provided 342
pages of medical records with the referral. Dr. Mark Eaton
summarized some of the medical records that he had reviewed.
Dr. Eaton pointed out the inconsistency between a
provider's statement regarding Mawa's inability to