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Rogozinski v. Hartford Life and Accident Insurance Co.

August 21, 2007

EDWARD J. ROGOZINSKI, PLAINTIFF,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: Judge Joan B. Gottschall

MEMORANDUM OPINION AND ORDER

When Hartford Life and Accident Insurance Company ("Hartford") terminated the long-term disability payments Edward J. Rogozinski ("Rogozinski") was receiving under his employer-sponsored benefit plan, Rogozinski sued Hartford, seeking to recover those benefits pursuant to section 502 of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132 (2006). Hartford counterclaimed, seeking reimbursement of a portion of the payments it made to Rogozinski because he also received benefits from the Social Security Administration ("SSA") and Prudential Insurance Company of America ("Prudential") during the relevant time period. Rogozinski moved for summary judgment on Hartford's counterclaim, and Hartford filed a cross-motion for summary judgment on both Rogozinski's ERISA claim and its counterclaim. For the reasons discussed below, Rogozinski's motion is denied, Hartford's motion is granted, and judgment is entered in Hartford's favor.

I.BACKGROUND

Before reciting the relevant facts, the court must briefly discuss the sources from which those facts are drawn. The court does not have a proper factual submission from Rogozinski before it because Rogozinski did not support his summary judgment motion with a statement of material facts, as required by Northern District of Illinois Local Rule 56.1(a)(3). While this failure alone is grounds for denying Rogozinski's motion, the court will excuse the gaffe because it appears to be the result of Rogozinski's attorney's poor health rather than mere oversight. See, e.g., FTC v. Bay Area Bus. Council, Inc., 423 F.3d 627, 633 (7th Cir. 2005) (district court has discretion to strictly apply or overlook transgressions of local rules). However, Rogozinski's response to Hartford's Local Rule 56.1(a)(3) statement likewise does not comply with the local rules. That document does not include record citations to support Rogozinski's position on the facts he disagrees with (although it bears mentioning that the vast majority of Hartford's facts are undisputed). See N.D. Ill. Local R. 56.1(b)(3)(B). It also contains no support for the eight additional facts Rogozinski wishes the court to take into account. See N.D. Ill. Local R. 56.1(b)(3)(C). The court cannot overlook these transgressions because Rogozinski's attorney was well aware of the requirements of the local rules by the time he filed his response to Hartford's material facts.*fn1 The court therefore accepts as true all of the facts set forth in Hartford's Local Rule 56.1(a)(3) statement and disregards the eight additional facts pleaded by Rogozinski.*fn2 See Raymond v. Ameritech Corp., 442 F.3d 600, 608 (7th Cir. 2006); N.D. Ill. Local R. 56.1(b)(3)(C). Accordingly, the following facts are taken from Hartford's Local Rule 56.1(a)(3) statement but recited in a light most favorable to Rogozinski. Raymond, 442 F.3d at 608.

Rogozinski was employed by R.R. Donnelly & Sons Company ("Donnelley") as Manager of Executive Compensation. While at Donnelley, Rogozinski participated in an ERISA-governed employee benefit plan sponsored by Donnelley that included a group disability insurance policy ("the Policy") with Hartford. Under the Policy, employees who are disabled are eligible to receive a monthly benefit payment. The amount of the payment is calculated by multiplying the person's monthly income by 60%, comparing the result with the maximum benefit for which the person is enrolled (here, $12,000), and deducting "Other Income Benefits" from the lesser of the two numbers. Def.'s Local R. 56.1(a)(3) Statement ¶ 8. The Policy defines "Other Income Benefits," in relevant part, as follows:

[T]he amount of any benefit for loss of income, provided to you or to your family, as the result of the period of Disability for which you are claiming benefits under this plan. This includes any such benefits for which you or your family are eligible or that are paid to you, to your family or to a third party on your behalf, pursuant to any: . . . .

2. governmental law or program that provides disability or unemployment benefits as a result of your job with the Employer;

3. plan or arrangement of coverage, whether insured or not, or as a result of employment by or association with the Employer as a result of membership in or association with any group, association, union, or organization . . . .

Id. ¶ 12. The Policy notes that overpayments can occur due to retroactive allocation of "Other Income Benefits" or failure to report "Other Income Benefits," and that Hartford is entitled to recover the amount of the overpayment in such instances.

Under the Policy, an employee is considered disabled if he, inter alia, is prevented from "performing one or more of the Essential Duties" of his occupation for the upcoming eighteen months due to "accidental bodily injury." Id. ¶ 9. After eighteen months have passed, the employee must be "prevented from performing one or more of the Essential Duties of Any Occupation." Id. "Any Occupation" means "an occupation for which you are qualified by education, training, and experience, and that has an earnings potential greater than an amount equal to the lesser of 60% of your Indexed Pre-disability earnings and the Maximum Monthly Benefit." Id. ¶ 11. "Essential Duties" are those that are "substantial, not incidental," "fundamental or inherent to the occupation," or "can not be reasonably omitted or changed." Id. ¶ 10. Working the number of hours in a regularly scheduled workweek is also considered an essential duty. Importantly, the Policy expressly grants Hartford "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the policy." Id. ¶ 7. Thus, Hartford is empowered to terminate benefit payments if it finds that an employee is "no longer Disabled as defined." Id. ¶ 14.

On March 30, 1999, Rogozinski underwent knee replacement surgery on both of his knees after being diagnosed with bilateral degenerative joint disease. Prior to his surgery, Rogozinski submitted a short-term disability claim to Hartford. Hartford approved the claim, and Rogozinski received short-term disability benefits from April 6, 1999, through October 4, 1999. In October of 1999, Rogozinski requested long-term disability. His surgeon submitted an "Attending Physician's Statement of Continued Disability" ("APS") to Hartford stating that Rogozinski was suffering complications in his left knee that might require an additional surgery and that he was "currently totally disabled." Id. ¶ 26. Hartford also interviewed Rogozinski regarding his medical condition. On October 20, 1999, Hartford approved Rogozinski's long-term disability claim retroactive to October 5, 1999, "finding that Rogozinski was limited in his ability to stand and sit for prolonged periods due to arthrofibrosis of the left knee following his knee replacement." Id. ¶ 29. In the approval letter it sent to Rogozinski, Hartford advised him that, under the Policy, he would receive 60% of his pre-disability income, subject to the "Other Income Benefits" provisions. Hartford also advised Rogozinski that, after eighteen months of disability (as of April 4, 2001), he would have to meet the "Any Occupation" provision of the Policy to continue receiving disability benefits. Finally, Hartford asked Rogozinski to apply for Social Security Disability ("SSD") benefits, which he soon did. Thereafter, Rogozinski began receiving monthly benefit payments of $4,950 from Hartford.

On October 22, 1999, Rogozinski signed a "Payment Options and Reimbursement Agreement" ("Reimbursement Agreement"), in which he elected not to have his benefit payments reduced by the amount he would likely receive each month if his SSD claim was approved. He acknowledged, however, that his benefit payments would be reduced by any "Other Income Benefits" he received, as defined in the Policy, and that his decision with regard to his SSD claim could result in an overpayment of benefits for which he would have to refund Hartford. He also agreed that, in the event of an overpayment, Hartford could reduce or eliminate his future disability payments in order to recover the discrepancy.

During the following months, Rogozinski continued to submit documentation to support his long-term disability claim. Specifically, his doctors sent Hartford several APS reports stating that Rogozinski remained disabled due to worsening conditions in his left knee. Rogozinski had a second surgery on his left knee on August 18, 2000, and shortly thereafter he contacted Hartford to inform it that his surgery had gone well. In October of 2000, Hartford initiated a review of Rogozinski's claim to determine whether he would remain eligible for disability benefits after April 4, 2001 (i.e., whether he could meet the "Any Occupation" provisions of the Policy); Rogozinski continued to claim that he was totally disabled. Hartford informed Rogozinski of its review in a letter dated October 5, 2000, which explained that Rogozinski's benefits would continue until Hartford's review was complete, but that any benefits paid after April 4, 2001, should not be interpreted as an admission of his claim's validity. Hartford also requested additional information regarding Rogozinski's SSD claim, again advising him that approval of his claim would result in a reduction of his payments pursuant to the "Other Income Benefits" provisions.

On December 19, 2000, Hartford received an APS from Rogozinski's surgeon advising it that Rogozinski continued to experience pain and stiffness that was being treated with physical therapy. The APS stated that Rogozinski could stand and walk for short periods but could not sit for an extended time or lift more than twenty pounds. The APS corroborated information Rogozinski relayed in a questionnaire dated December 15, 2000, wherein he noted that, due to severe pain and stiffness, he could not stand or sit for long periods and that he was attending physical therapy three times per week and also ...


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