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Miller v. Hartford Life & Accident Insurance Co.

United States Court of Appeals, Eighth Circuit

December 16, 2019

Diane Miller Plaintiff- Appellant
v.
Hartford Life & Accident Insurance Company, also known as Hartford Defendant-Appellee

          Submitted: September 26, 2019

          Appeal from United States District Court for the Eastern District of Arkansas - Little Rock

          Before GRUENDER, BENTON, and SHEPHERD, Circuit Judges.

          SHEPHERD, Circuit Judge.

         Following the termination of disability benefits under a long-term disability plan governed by the Employee Retirement Income Security Act (ERISA), plaintiff Diane Miller initiated this action against plan administrator Hartford Life & Accident Insurance Company. The district court[1] dismissed Miller's complaint with prejudice, concluding that substantial evidence supported Hartford's decision to terminate benefits based on exhaustion of mental illness benefits and the lack of a disabling physical condition. Having jurisdiction under 28 U.S.C. § 1291, we affirm.

         I.

         Miller was an employee of Integris Health, where she worked as a Medical Billing Specialist. Through her employment, Miller was covered by a long-term disability benefits plan, which was funded by a Hartford-issued group insurance policy for Integris. On April 30, 2012, Miller ceased working and initiated claims for long-term disability benefits under the plan and Social Security disability benefits based on depression and non-specific psychosis. In October 2012, the Social Security Administration approved Miller's claim, and in November 2013, Hartford approved Miller's claim, effective as of November 11, 2012. Hartford's approval of benefits was based on evidence of Miller's mental illness; Hartford did not find any support for a disability due to a physical impairment at that time. Under the plan, benefits based on mental illness were limited to a maximum of 12 months. Hartford determined that Miller had received the 12-month benefit maximum as of November 10, 2013, and terminated Miller's benefits as of that date.

         In May 2014, Miller appealed Hartford's decision, asserting that her mental illness was secondary to a physical impairment and that she was thus entitled to benefits for a physical disability. After an additional review of medical records, including independent medical reviews, Hartford determined that Miller suffered from a disabling physical condition. Hartford's determination was primarily based on the physical restrictions identified by one reviewing physician, who concluded that

          Miller did not have the capacity to do sedentary work. Hartford reminded Miller that she was obligated to continue to submit evidence of her disabling physical condition to continue to receive benefits.

         Nearly a year later, Hartford learned that the only treatment Miller was receiving was from a psychiatrist. Hartford requested that Miller submit information about her claimed physical disability, reminding her that she had received all of the available mental illness benefits. The information Miller provided from her treating psychiatrist stated that Miller had little to no ability to work because of her mental illness and noted that it was not known whether Miller's limitations were the result of a psychiatric or physical condition. Hartford then scheduled an independent medical evaluation. After examining Miller, the independent examining physician concluded that Miller suffered from Major Depressive Disorder with psychosis and noted that Miller's treating psychiatrist had previously indicated that Miller's mental illness was secondary to or exacerbated by a thyroid condition. The examining physician determined that Miller had no physical impairment that precluded her from engaging in full-time work, but could not opine as to whether her mental illness was due to a physical or psychological condition. He did acknowledge, however, that a possible link existed between thyroid disorders and psychotic episodes.

         Based on the lack of clarity regarding Miller's mental illness, a case manager recommended an independent psychiatric review. Dr. Taral R. Sharma, a board-certified psychiatrist, reviewed the records and spoke with Miller's treating psychiatrist, who noted improvement in Miller's mental illness. Dr. Sharma concluded that Miller suffered from no mental illness that required restrictions or limitations or prevented her from maintaining full-time work. A vocational manager later opined that, based on the functional capabilities identified by the independent examining physician, there were numerous jobs that Miller could perform.

         On October 1, 2016, Hartford notified Miller that her benefits were being terminated as of that date because she no longer satisfied the policy definition of disabled. Hartford again noted that Miller's only potential basis for receiving benefits was physical disability because she had exhausted the mental illness benefits. Despite the exhaustion of these benefits, Hartford also determined that Miller's mental illness no longer precluded her from working, noting that Miller's own treating psychiatrist opined that she should consider returning to work.

         Miller then initiated an internal appeal to Hartford, arguing that Hartford erroneously denied benefits, specifically noting that her anti-psychotic medications cause her to suffer from side effects such as blurred vision, tremors, muscle stiffness, and fatigue. Miller also asserted that when her psychotic episodes occurred, she could not work for a period of two to three weeks. Miller did not raise any challenge to Hartford's discussion of the lack of evidence of a disabling physical impairment. Based on Miller's argument regarding the side effects of her medications, Hartford obtained an additional review from Dr. Sharma. Dr. Sharma again communicated with Miller's treating psychiatrist who offered additional information about Miller's psychotic episodes and the effects of medications Miller took during these periods. Dr. Sharma ultimately concluded that the medical records did not support Miller's inability to work during her psychotic episodes and that the evidence did not show that Miller suffered from an impairing mental illness that precluded her from working after September 29, 2016. Hartford notified Miller that it was denying her appeal and upholding the termination of benefits. Miller then initiated this action, seeking reinstatement of her benefits. Hartford ...


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