Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-5_04-cv-05163/USCOURTS-arwd-5_04-cv-05163-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1132 E.R.I.S.A.-Employee Benefits

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Plaintiff initially submitted a record of documents he had in his possession 1

(document #4). By Order dated December 9, 2004, the Court directed plaintiff to advise

whether the Court needed to give any further consideration to those documents.

Plaintiff has not so advised the Court, and it is the Court’s understanding that

document #8 contains all those records included by plaintiff in document #4. The Court

will, therefore, give no further consideration to document #4.

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

FAYETTEVILLE DIVISION

LEROY SANDERS PLAINTIFF

v. Civil No. 04-5163

HARTFORD LIFE AND ACCIDENT

INSURANCE COMPANY DEFENDANT

O R D E R

Now on this 28th day of March, 2006, comes on for

consideration the captioned matter, the parties having submitted

a Stipulated Administrative Record (document #8) , and briefs in 1

support of their respective positions. From those submissions,

the Court finds and orders as follows:

1. Plaintiff, while employed as a truck driver by Wal-Mart

Stores, Inc., was insured under group policy GLT 024544 (the

“Plan”) issued by defendant to Wal-Mart Stores, Inc. The Plan

provided benefits for long-term disability. Plaintiff was found

eligible for such benefits as of July 21, 1998.

2. The Plan made the following provisions regarding total

disability:

Total Disability or Totally Disabled means that:

(1) during the Elimination Period; and

(2) for the next 12 months, you are prevented by:

 (a) accidental bodily injury;

 (b) sickness;

 (c) Mental Illness;

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 (d) substance abuse; or

 (e) pregnancy,

from performing the essential duties of your occupation,

and are under the continuous care of a Physician and as

a result you are earning less than 20% of your Predisability Earnings, unless engaged in a program of

Rehabilitative Employment approved by us.

After that, you must be so prevented from performing the

essential duties of any occupation for which you are

qualified by education, training or experience.

3. On May 12, 1999, plaintiff was notified that effective

July 21, 1999, he had to meet the second portion of this

definition in order to continue to be eligible for benefits.

Translating the second portion into the terms of plaintiff’s case,

plaintiff would have to show that he was prevented, by accidental

bodily injury or sickness, from performing the essential duties of

any occupation for which he is qualified by his education,

training, or experience.

An investigation was begun by defendant to determine if

plaintiff met these criteria.

4. Following its investigation, defendant informed

plaintiff on February 19, 2002, that his benefits would cease as

of February 20, 2002. The reasons given were:

* that there were no objective findings to support

plaintiff’s subjective complaints of disability; 

* that video surveillance revealed plaintiff engaging in

activities which would be impossible for him if he had the

subjective limitations he claimed; and 

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Defined in Steadman’s Medical Dictionary, 26th Edition, as an infection or 2

inflammation of an epicondyle, the part of a long bone near the joint. A classic

example is “tennis elbow.” All medical definitions in this Order are taken from

Steadman’s.

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* that plaintiff had “a relative lack of orthopedic

evaluation and treatment given his subjectively high level of

disability.”

5. At plaintiff’s request, the decision to terminate his

benefits was administratively reviewed in conjunction with

additional medical information submitted by plaintiff. On January

1, 2003, defendant again informed plaintiff that he was no longer

considered totally disabled under the Plan, and that his file

would remain closed. The letter informing plaintiff of that

decision gave the following reasons:

* A Physical Capacity Exam in July, 2001, showed that

plaintiff could sit for up to four hours, stand for up

to two hours, and walk for up to two hours in an eighthour day.

* Plaintiff’s treating orthopedic physician, Alice

Martinson, told a reviewing physician that there were no

“truly objective findings” of lateral epicondylitis ,

2

plaintiff’s initial disabling condition, and that he

could have surgery for that condition which, if

successful, would allow him to return to truck driving,

but that plaintiff had not elected to have the surgery.

* Plaintiff’s subjective complaints of disability were

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inconsistent with video surveillance of his actual

activities.

* Defendant’s reviewing orthopedic physician opined that

plaintiff could drive a truck on a full-time basis.

* Defendant’s reviewing vascular physician found that

plaintiff had had no evaluation or treatment for his

alleged vascular problems, and thus there was no

evidence to support a disabling vascular condition.

This decision exhausted plaintiff’s administrative remedies,

and the decision now comes on for judicial review.

6. The parties agree that this claim falls within the

purview of the Employee Retirement Income Security Act, 29 U.S. C.

§1001 et seq. (“ERISA”). Where an ERISA plan gives the plan

administrator discretion to determine eligibility for benefits, as

the Plan herein does, judicial review proceeds on an abuse of

discretion standard, and the administrator’s decision will be

reversed only if it is arbitrary and capricious. Groves v.

Metropolitan Life Insurance Co., 438 F.3d 872 (8th Cir. 2006).

The contours of such review are by now well settled:

In applying an abuse of discretion standard, we must

affirm if a reasonable person could have reached a

similar decision, given the evidence before him, not

that a reasonable person would have reached that

decision. A reasonable decision is fact based and

supported by substantial evidence. We may consider both

the quantity and quality of evidence before a plan

administrator. And we should be hesitant to interfere

with the administration of an ERISA plan.

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Steadman’s defines “exquisite” as “[e]xtremely intense, keen, sharp; said of pain 3

or tenderness in a part.”

Steadman’s defines RSD as “diffuse persistent pain usually in an extremity often 4

associated with vasomotor disturbances, trophic changes, and limitation or immobility

of joints; frequently follows some local injury.”

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Groves, 438 at 875 (internal citations and quotation marks

omitted; emphasis in original).

Substantial evidence is more than a scintilla, but less than

a preponderance, of the evidence. Woo v. Deluxe Corp., 144 F.3d

1157 (8th Cir. 1998). It is “such relevant evidence as a

reasonable mind might accept as adequate to support a conclusion.”

Shipley v. Arkansas Blue Cross and Blue Shield, 333 F.3d 898 (8th

Cir. 2003) (quotation marks omitted).

Given this standard, the Court turns to the record to see if

there is substantial evidence to support defendant’s decision that

plaintiff had ceased to be eligible for long-term benefits as of

February 20, 2002.

7. The Stipulated Administrative Record contains the

following medical information relevant to plaintiff’s claim:

05/13/98 Clinic Note of Scott Cooper, M.D., an orthopedic

surgeon, describing plaintiff’s injury (his hand slipped

while cranking a crank at work and he slammed his elbow

into a trailer). Dr. Cooper found plaintiff to be

“exquisitely tender over the lateral epicondyle,” and 3

referred him to William Ackerman, M.D., to evaluate him

for reflex sympathetic dystrophy (“RSD”) .

4

06/03/98 Clinic Note of Dr. Cooper, noting exquisite tenderness

over the lateral epicondyle, as well as other symptoms,

and pointing out that while “there’s no question he has

a component of lateral epicondylitis,” that “does not

explain all of his symptoms.” RSD had been ruled out by

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Dr. Ackerman, and Dr. Cooper was comfortable treating

plaintiff with injections.

06/17/98 Clinic Note of Dr. Cooper, noting “I think this has all

settled down to lateral epicondylitis,” and that

plaintiff was in physical therapy.

07/01/98 Clinic Note of Dr. Cooper, noting plaintiff was still

having pain and tenderness in the lateral epicondyle

region.

07/29/98 Clinic Note of Dr. Cooper, noting plaintiff was

“exquisitely tender over the lateral epicondyle” and

“diffusely tender in the forearm and on the medial

side.” Dr. Cooper explained to plaintiff that his

condition usually gets well “on its own,” and surgery is

seldom required, but that healing often takes “a good

while.”

08/26/98 Clinic Note of Dr. Cooper, noting exquisite tenderness

over the lateral epicondyle and mild tenderness over the

flexor origin at the medial epicondyle. Dr. Cooper

notes “Mr. Sanders presents a difficult problem. He

doesn’t give much evidence in the way of neuropathy,

however, it’s hard to explain all of his symptoms just

from his lateral epicondyle. On the other hand, when we

inject his lateral epicondyle, he gets much better.”

09/14/98 Clinic Note of Dr. Cooper, noting that he had checked

out plaintiff’s complaints in a number of ways, that his

symptoms “have not all been focused over the lateral

epicondyle and I’m not very confident at this point that

we could help him with surgery.”

10/12/98 Clinic Note of Dr. Cooper, noting that plaintiff does

well in physical therapy, but then when he returns to

work, he has pain. Dr. Cooper’s approach to plaintiff’s

care was to “keep him working.”

11/18/98 Clinic Note of Dr. Cooper, regarding plaintiff’s lateral

epicondylitis, reporting that valid testing showed

plaintiff had “some limitations with grip and pinch,

etc.” Dr. Cooper explains in this note why he is not

comfortable recommending surgery for plaintiff: He’s

worried that he’s going to make things worse by waiting

and I’ve explained to him that’s absolutely not the

case. If indeed he has lateral epicondylitis, then

surgery 6 months from now isn’t any different from

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surgery now and I don’t think it affects his result.

I’ve explained to him that in lateral epicondylitis,

we’re treating a subjectively painful entity rather than

something objective that we can measure and it’s

something that he needs to hold off on as long as

possible as far as considering surgery. . . . I’m not

saying that I won’t operate on him, but I am saying that

it may be absolutely a last resort. The fact remains

that he’s been doing quite well up until the last 2 or

3 days and if we can get him to the point where he just

has a flare up every now and then, he would probably be

better off tolerating that than considering surgery.

He’s not the usual picture with lateral epicondylitis.

01/27/99 Clinic Note of Dr. Cooper, in which he states his

conclusion that he has done all he can do for plaintiff.

“I finally have come to the conclusion that I really

don’t think I can help him surgically. I’ve explained

to them in all honesty that they might find another

orthopedic surgeon who operates on his lateral

epicondylitis and gets him well in which case I will be

sorry that I did not do the operation. . . . I can only

tell them truthfully that I don’t have confidence in my

heart and in my gut that I can make him well with an

operation and in all honesty, if he’s going to hurt, I

would rather him hurt without an operation than hurt

with an operation. Again, I cannot say for sure that he

would not get well with an operation, I just don’t have

confidence in my abilities. I did not know this, but

after I said that, Wendy showed me a letter from Dr.

Martinson and her feeling was much the same. Her

feeling was that it was not unreasonable to consider

surgery but that she did not have any great confidence

that he would continue to do well in the occupation that

he’s in.”

02/04/99 Dr. Cooper completed an Attending Physician’s Statement

of Disability, noting a diagnosis of right lateral

epicondylitis, and stating that it was not safe for

plaintiff to drive because he “misses gears,” that he

cannot lift more than ten pounds with his right arm once

an hour, and that he cannot use his right arm

repetitively.

06/29/99 Dr. Cooper completed an Attending Physician’s Statement

of Disability, noting a diagnosis of right lateral

epicondylitis, which totally disabled plaintiff from

driving and from heavy or repetitive use of his right

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Steadman’s defines “articular crepitus” as “the grating of a joint.” 5

“Inflammation of a vein.” 6

“Inflammation of a synovial membrane, especially that of a joint; in general, 7

when unqualified, the same as arthritis.”

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arm, but that he was capable of light work if those

restrictions were observed.

10/04/99 Clinic Note of Dr. Cooper, noting diffuse tenderness of

plaintiff’s arm and forearm, and describing that “with

a great deal of encouragement and a little help,” he has

flexed the arm fully, and gotten to within a few degrees

of full extension.

11/07/00 Office note of Dan Bell, M.D., reporting plaintiff’s

complaints of “extreme ankle pain and lower leg pain

that appears to be a combination of his joints and his

varicose veins.” Dr. Bell observed that plaintiff “has

rather prominent varicosities with multiple small,

tender varicose veins in his instep and ankle, larger

varicose veins above,” “trace edema,” and “clearly

arthritic ankles, left greater than right, with

crepitus and reduced motion.” His assessment was 5

chronic phlebitis with varicosities, and osteoarthritis 6

of both ankles.

01/04/01 Office note of Dr. Bell, noting “mild varicosities, none

inflamed” in the legs, and a “[d]isabling posttraumatic

arm condition, stable.”

01/24/01 Office note of Dr. Bell, noting plaintiff “is

exquisitely tender in his right lateral epicondyle. His

grip is only about 1/3rd of normal.” Dr. Bell’s

assessment is “[r]ight lateral epicondylitis, disabling

as he is a truck driver” and “OA [osteoarthritis] of the

right shoulder and both ankles.”

07/11/01 Office note of Dr. Bell, noting “obvious exquisitely

tender right lateral epicondylitis,” and “synovitis and 7

crepitus in his ankles with tenderness in his

metatarsals. He has bulky varicose veins in his upper

leg and along his feet.” Dr. Bell also completed an

Attending Physician’s Statement of Continued Disability

this date. He noted a primary diagnosis of

osteoarthritis of the right shoulder, feet and ankles,

and a secondary diagnosis of lateral epicondylitis of

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“[C]ongestion and slowing of circulation in veins due to blockage by either 8

obstruction or high pressure in the venous system, usually best seen in the feet and

legs.” 

Turn the foot upward. 9

“Walking with the entire sole and heel of the foot on the ground, a do man and 10

bears.”

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the right elbow. He opined that plaintiff could sit for

four hours, stand or walk for two hours, and drive for

one to two hours in an eight-hour day, but could “never”

do any climbing, balancing, stooping, kneeling,

crouching, crawling, or reaching, and had no capacity

for repetitive use of the right or left foot or the

right hand. He stated that plaintiff “continues to be

completely disabled,” but could return to work if

sedentary part-time work was available.

09/05/01 Office note of Dr. Bell, noting tenderness in the

epicondyles and shoulders, and visible synovitis in the

feet.

12/18/01 Clinic notes of Alice Martinson, M.D., a board certified

orthopedic surgeon, noting the continuing problems with

plaintiff’s right elbow, along with “rather significant

hypertrophic osteoarthritis of both feet and ankles and

severe venous stasis changes in both lower 8

extremities.” Dr. Martinson was “unable to passively

dorsiflex either ankle to within ten degrees of the 9

plantigrade position when the knees are extended, and 10

he can only achieve neutral in dorsiflexion with the

knees flexed.” X-rays of plaintiff’s ankles showed

large bone spurs on the anterior tibial margins and the

talar necks. Dr. Martinson thought that surgery on

plaintiff’s elbow would be helpful, but that he should

not have surgery on his ankles. Her report notes that

“[g]iven the severe chronic stasis changes which he has,

I have advised him that surgical intervention to remove

the large spurs should probably be avoided. I would be

concerned about wound healing. He asked me about the

advisability of his returning to over-the-road truck

driving. Assuming that his elbow surgery is successful

- which I think is a reasonable assumption - there would

be no reason why he could not return to driving a truck

from an upper extremity point of view. His severe

chronic venous stasis, however, makes it most unwise for

him to return to over-the-road trucking because of the

long hours of sitting which that particular job

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Osteoarthritis. 11

A “clinically detectable increase in extracellular fluid volume localized in a 12

dependent area, as of a limb, characterized by swelling or pitting.” 

Stasis dermatitis is “erythema and scaling of the lower extremities due to 13

impaired venous circulation.” Erythema is “redness of the skin due to capillary

dilatation.”

While “augmentation” is not defined therein, Steadman’s defines “compression” as 14

“[a] squeezing together; the exertion of pressure on a body in such a way as to tend to

increase its density; the decrease in a dimension of a body under the action of two

external forces directed toward one another in the same straight line.”

“[C]lotting within a blood vessel which may cause infarction of tissues supplied 15

by the vessel.”

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requires.”

07/25/02 Radiology report from William Hicks, M.D., noting minor

degenerative changes of the left shoulder, and

osteoarthritis of the right elbow with spurs at several

locations, including the medial and lateral humeral

epicondyles.

08/02/02 Bone Scan report from Denny Krout, D.O., reporting an

impression of “degenerative disease .” 11

08/20/02 Report of Dr. Krout, noting that both of plaintiff’s

feet showed vascular insufficiency, and stating that

plaintiff is “unable to drive truck or work in that

field.”

08/27/02 History and physical of Dennis McClary, D.O., noting

that plaintiff has “dependent edema that appears 12

chronic with some venous stasis dermatitis .” 13

08/28/02 Report of doppler ultrasound from Jeffrey Smith, D.O.,

with findings of “augmentation and compression ”

14

throughout the area, and an impression of “no evidence

of bilateral deep venous thrombosis .” 15

10/09/02 Letter from Robert Koch, D.O., stating that he is

treating plaintiff for hypertension, degenerative

disease of the left shoulder, osteoarthritis of both

ankles, and chronic venous stasis of both lower

extremities; that the ankles are inoperable due to the

venous stasis; and that “it would not be feasible for

this individual to resume his long haul truck driving

career due to the long hours of sitting.”

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8. The Stipulated Administrative Record also contains a

description of the job responsibilities of a Wal-Mart truck

driver. Those responsibilities include driving seventy hours in

a seven-day week, climbing in and out of trucks and trailers, and

stooping and bending while dollying trailers down or hooking

trailers up.

9. The Stipulated Administrative Record also contains the

video footage of surveillance conducted by defendant on

plaintiff’s activities.

One portion of the video is of someone who clearly is not

plaintiff, driving a tractor. 

One portion shows plaintiff walking slowly from the front to

the side of a house, where he bends down to cut something with a

pair of hedge clippers. This footage lasts about a minute. 

One portion shows plaintiff and a woman going into a store.

Plaintiff walks slowly. He comes back about an hour later with

the woman and a cart filled with small plastic bags of items. He

helps the woman put these bags into the back of a vehicle, then

they go get a hot dog.

10. The Stipulated Administrative Record also contains the

report of Barry Turner, M.D., who was retained by defendant to

review plaintiff’s file as of December 18, 2002, with reference to

plaintiff’s musculoskeletal orthopedic condition only. Dr. Turner

was to provide “recommended limits and restrictions associated

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with [plaintiff’s] orthopedic condition” based on plaintiff’s

medical records, conversations with plaintiff’s treating

physicians, and the surveillance videotape. Dr. Turner opined

that “from an orthopedic standpoint only, with consideration of

his ankle joints, and his right elbow and shoulders, I do not find

any reason why he should be incapable of performing his own

occupation as a truck driver, full-time from an orthopedic point

of view.” 

11. The Stipulated Administrative Record also contains the

report of Willard Johnson, M.D., who was retained by defendant to

review plaintiff’s file from the standpoint of his vascular

condition. Although Dr. Johnson found no vascular diagnostic

workup in the records he reviewed, and therefore was unable to

determine whether plaintiff’s venous stasis was caused by

medications, incompetent valves, cirrhosis of the liver, or

overweight, and noted that he would defer judgment until such a

workup was done, he then volunteered the prognosis that “with

proper treatment and compliance by Mr. Sanders I would except

[sic] that he could return to long distance truck driving.”

12. The Stipulated Administrative Record also contains the

report of George Kazda, M.D., defendant’s Associate Medical

Director, dated February 2, 2002. Dr. Kazda reviewed some of

plaintiff’s medical records and spoke by phone with Dr. Bell. He

opined that it is “more likely than not” that plaintiff “retains

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the ability to drive an 18-wheel truck but may require

accommodations, like the use of an automatic transmission and, and

taking appropriate rest.”

13. The Stipulated Administrative Record also contains a

section of medical records which were submitted by plaintiff but

are said to be challenged by defendant. The nature of this

challenge is not fleshed out, but the Court has elected not to

include these records in its review, except to the extent that the

same records appear in the unchallenged portion of the Stipulated

Administrative Record.

14. The Court has carefully reviewed all the foregoing

information and concludes that the decision of the Plan

administrator is not supported by substantial evidence. This

conclusion is based on the following:

(a) All of the evidence from plaintiff’s treating physicians

is to the effect that he is disabled from returning to his former

occupation of long-haul truck driving -- not one disputes this or

says otherwise. Their statements of disability relate not only to

plaintiff’s initial disabling condition, lateral epicondylitis,

but to the gradually-worsening condition of his lower extremities

due both to osteoarthritis of his ankles and venous insufficiency.

Their diagnoses of these conditions are supported not only by

plaintiff’s subjective complaints, but also by x-rays showing bone

spurs in his elbow and ankles, and varicose veins and skin changes

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associated with venous stasis that were observed by his treating

physicians.

(b) On the other hand, the Court believes the opinions of

the reviewing physicians are flawed - each in its own way - but

most particularly by failures to consider all of the medical

evidence supplied by plaintiff’s treating physicians. The

opinions of the reviewing physicians - and thus the decision based

on them - are undermined by these failures. While an ERISA

administrator is not required to credit the opinions of a

claimant’s treating physicians over other relevant evidence of his

medical condition, it cannot “arbitrarily refuse to credit a

claimant’s reliable evidence, including the opinions of a treating

physician.” Black & Decker Disability Plan v. Nord, 538 U.S. 822

(2003). In this case, the only medical evidence of plaintiff’s

condition is found in the records of his treating physicians. The

Court sees no evidence to suggest that these records are

incredible and not worthy of consideration by a reviewing

physician.

Thus, by relying on the opinions of reviewing physicians who

failed to credit (or even consider) the opinions of the treating

physicians, the Plan Administrator effectively refused to credit

plaintiff’s reliable evidence.

The fact that such failures are not harmless flaws in the

Plan Administrator’s decision-making process is demonstrated by

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the following:

* Dr. Turner, in forming his opinion that plaintiff could

return to his former job driving a truck for Wal-Mart, apparently

overlooked the fact that Dr. Bell limited plaintiff’s driving to

one to two hours in an eight hour day. Plaintiff’s work for WalMart required driving ten hours a day, seven days a week. 

* Dr. Turner relied on Dr. Kazda’s conclusion that

plaintiff could return to truck driving with some accommodations.

However, it is apparent that this conclusion was reached without

full consideration of plaintiff’s medical evidence, as noted

infra; 

* Dr. Turner further concluded that there is no credible

evidence of lateral epicondylitis -- a conclusion that could only

be reached by discrediting two orthopedic surgeons who treated

plaintiff for that condition; and 

* Dr. Turner also, in the Court’s view, overestimated the

level of activity reflected in the surveillance videotapes.

* Dr. Johnson’s report must be regarded as being flawed

because, before offering his opinion, he took pains to explain

that he really had no basis upon which to form an opinion.

* Dr. Kazda’s opinion must also be regarded flawed because

he did not consider (indeed, he may not even have been aware of)

Dr. Martinson’s clinic notes of December 18, 2001, stating that it

would be “most unwise” for plaintiff to return to driving because

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of his “severe chronic venous stasis”; 

* Dr. Kazda opines that “[t]he medical record shows no

evidence that Mr. Sanders’ shoulder and ankle, osteoarthritis, or

his varicose veins would preclude return to his own occupation.”

This assertion is clearly be at odds with the records of both Dr.

Cooper and Dr. Bell - which records were ostensibly reviewed by

Dr. Kazda.

(c) In the Court’s view, the value of the video surveillance

is questionable and cannot be properly regarded as substantial

evidence of anything. The hedge-trimming incident, of which so

much is made, lasted only about a minute. It shows plaintiff and

a woman walking to some shrubs at the side of a house, where

plaintiff bends down to trim something with a pair of hedge

clippers. Characterizing this activity as being evidence that the

plaintiff is “doing yard work” is an overstatement. 

The grocery-shopping incident shows plaintiff lifting a few

small plastic bags of items out of a shopping cart - bags which

could not have weighed more than a few pounds apiece. Again, its

import does not appear to carry the weight assigned to it by

defendant.

Defendant’s file reports this video footage as evidence that

plaintiff can “use his right arm” and “be[] on his feet for over

an hour,” and claims that it calls plaintiff’s credibility into

question because it is at odds with plaintiff’s own statements of

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his disabilities. Yet no physician has stated that plaintiff’s

right arm hangs limp and useless by his side, or that he must use

a wheelchair to get around, nor does plaintiff. That is not the

issue here. As Dr. Bell noted, the video footage proves plaintiff

can unload a few Wal-Mart bags and drive his personal vehicle for

short periods. It does not show he can drive an 18-wheeler for

ten hours a day, seven days a week.

(d) The Activity Log from defendant’s claim file reflects

that in early August, 2001, the defendant determined that it would

be appropriate to obtain an independent medical examination

(“IME”) to evaluate plaintiff’s vascular problems, and a

functional capacity exam to evaluate his arm and leg function. In

September, 2001, the Log again notes that “[w]e will have to order

an IME to address the varicose vein issue.” Yet neither report

was obtained.

15. When one considers the flaws in the reports upon which

defendant relied to reach its decision to terminate plaintiff’s

benefits, the conclusion is inescapable that there is no

substantial evidence to support the bases for termination stated

in defendant’s letter of February 19, 2002, or the expanded

reasons given when defendant had completed its administrative

review on January 1, 2003. That being the case, the decision

cannot stand.

16. The proper disposition of this matter has required the

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Court to consider the curious fact that defendant did not base its

decision to terminate plaintiff’s benefits on a claim that he is

able to perform the essential duties of any occupation for which

he is qualified, but only on a claim that he is able to return to

his occupation of truck driving. Perhaps, had defendant come at

the termination decision from this perspective, it would have been

possible to muster substantial evidence to support termination. 

Then again, perhaps it would not have not have been possible.

As of the date of the termination notice, plaintiff was 45 years

old. He had a ninth-grade education, and had difficulty reading.

His work history consisted entirely of manual labor and driving a

truck. He had significant impairments to his right arm and to

both legs and feet. The Social Security ALJ, relying on the

evidence of an impartial vocational expert, found that plaintiff

“cannot make an adjustment to any work that exists in significant

numbers in the national economy.” 

Be that as it may, the Court finds that the decision was made

entirely on the basis that defendant determined plaintiff could

return to driving a truck, which is not supported by substantial

evidence. The Court, therefore, concludes that plaintiff’s

benefits were not properly terminated, and that he is entitled to

benefits from February 20, 2002, until the date of this Order,

with interest thereon, same to continue from henceforth unless and

until a valid determination that he is no longer entitled to

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benefits is reached. The parties are directed to confer and

determine the appropriate amount of those back benefits, and so

advise the Court within thirty (30) days of the date of this

Order, so that judgment for the correct amount may be entered.

17. Plaintiff prayed in his Complaint for an award of

attorney’s fees. ERISA gives the Court discretion to award a

reasonable attorney’s fee, and costs, 29 U.S.C. §1132(g)(1), and

the Court finds that plaintiff is entitled to such. A petition

supporting the amount claimed should be filed no later than

fourteen (14) days from the date of this Order, with any objection

thereto filed within ten (10) days thereafter.

IT IS THEREFORE ORDERED that the decision of Hartford Life

and Accident Insurance Company to terminate the long-term

disability benefits payable to Leroy Sanders under group policy

GLT 024544 as of February 20, 2002, is hereby reversed.

IT IS FURTHER ORDERED that the parties are to confer and

determine the appropriate amount of back benefits due to

plaintiff, and so advise the Court within thirty (30) days of the

date of this Order, so that judgment for the correct amount may be

entered.

IT IS FURTHER ORDERED that defendant is to reinstate

plaintiff’s benefits under the Plan as of the date of this Order,

and continue paying them henceforth, unless and until a valid

determination that he is no longer entitled to benefits is

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reached.

IT IS FURTHER ORDERED that plaintiff is entitled to recover

his reasonable attorney’s fees and costs, predicated upon a timely

and specific application for same within fourteen (14) days of the

date of this Order.

IT IS SO ORDERED.

 /s/ Jimm Larry Hendren 

JIMM LARRY HENDREN

UNITED STATES DISTRICT JUDGE

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