In Creed v. Hartford Life & Acc. Ins. Co., 2020 U.S. Dist. LEXIS 17613, (S.D. Ohio February 4, 2020), the court applied a "reasoned explanation" approach to hold that the evidence supported an insurer's decision to deny an LTD claim.
The court's reliance on a "reasoned explanation" standard stemmed from Ohio case law's description of the arbitrary and capricious standard of review. Specifically, the court noted that under Ohio law, "[a]n outcome is not arbitrary and capricious where the evidence supports a reasoned explanation for that particular outcome." Citing Kirkham v. Prudential Ins. Co. of Am., 2011 U.S. Dist. LEXIS 53690, at *9 (S.D. Ohio March 11, 2011); Killian v. Healthsource Provident Administrators, Inc., 152 F. 3d 514 (6th Cir. 1998).
In Creed, the court found that Hartford's "reasoned explanation" for the denial was based on updated medical records and opinions, an interview with the claimant ("Creed"), video surveillance, and an employability study. In contrast, Creed failed to proffer any evidence of his own within the Administrative Record showing he was disabled from his occupation for which he was reasonably qualified by education, training, or experience. Instead, Creed simply argued that Hartford's evidence was irrelevant or insufficient.
The court analyzed each basis for Hartford's denial based on the "reasoned explanation" approach.
First, the court's review of the medical records found that while Creed disagreed with the opinions of three of his doctors and two independent non-treating physicians finding he was capable of working, albeit with restrictions, Creed did not provide any evidence to contradict their conclusions. The court found both the quality and the quantity of the medical opinions provided by Hartford—combined with the lack of conflicting evidence from Creed—formed a reasoned basis for Hartford's decision to terminate LTD benefits.
Second, the court dismissed Creed's argument that his interview established he was incapable of working absent any evidence supporting his statements. Moreover, according to the court, the interview could not be read in a vacuum because Hartford based its determination on medical evidence and surveillance.
Third, the court found that the video surveillance of Creed, which showed him moving in ways he claimed he could not, further supported Hartford's reasoned explanation for its decision to terminate benefits.
Finally, the court rejected Creed's argument that Hartford's employability analyses were flawed because they (1) were not authored by an outside vocational expert and (2) suggested job availability in locations too far from his residence. As to the first point, the court relied upon Sixth Circuit precedent which does not require plan administrators to obtain vocational expert reports when making disability determinations. Citing Judge v. Metro. Life Ins. Co., 710 F. 3d 651, 661-62 (6th Cir. 2013.). As to the second, the court noted that no doctor put driving restrictions on Creed and further found "a claimant's commute to a particular job is not a consideration for determining disability." Citing Nelson v. Unum Life Ins. Co. of Am., 421 F. Supp. 2d 558, 568 (E.D.N.Y. 2006), aff'd, 232 F. App'x 23 (2d Cir. 2007).
Because the evidence submitted by Hartford provided a reasoned explanation for each of the grounds it relied upon in denying Creed's LTD claim, the court concluded the denial was "well-taken" and granted Hartford's motion for judgment on the Administrative Record, and denied Creed's cross-motion.
