United States District Court, D. Columbia.
THIA J. BROWN, Plaintiff,
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant
Decided: January 27, 2014.
For THIA J. BROWN, Plaintiff: Kenneth Hanson Rosenau, LEAD ATTORNEY, ROSENAU & ROSENAU, Washington, DC.
For HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant: Brian Patrick Downey, LEAD ATTORNEY, PEPPER HAMILTON LLP, Harrisburg, PA; Matthew D. Foster, LEAD ATTORNEY, PEPPER HAMILTON LLP, Washington, DC.
For HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Counter Claimant: Brian Patrick Downey, LEAD ATTORNEY, PEPPER HAMILTON LLP, Harrisburg, PA; Matthew D. Foster, LEAD ATTORNEY, PEPPER HAMILTON LLP, Washington, DC.
For THIA J. BROWN, Counter Defendant: Kenneth Hanson Rosenau, LEAD ATTORNEY, ROSENAU & ROSENAU, Washington, DC.
RICHARD J. LEON, United States District Judge.
(January 27th, 2014) [Dkt. ##27, 29]
Plaintiff Thia Jai Brown (" plaintiff" or " Brown" ) brings this case against Hartford Life and Accident Insurance Company (" defendant" or " Hartford" ), challenging the termination of her benefits under a Long Term Disability (" LTD" ) insurance policy. See Compl. [Dkt. #1]. Hartford filed a counterclaim alleging that Brown was in fact over paid and therefore owes Hartford more than $36,000. See Answer with Affirmative Defenses and Countercl. (" Answer" ) ¶ ¶ 51-74 [Dkt. #15]; Def. Hartford Life and Accident Ins. Co.'s Mem. of Law in Supp. of Its Mot. for Summ. J. (" Def.'s Mem." ) at 25-26 [Dkt.
#28]. Both parties have moved for summary judgment. See Def. Hartford Life and Accident Ins. Co.'s Mot. for Summ. J. [Dkt. #27]; Mot. for Summ. J. as to Pl.'s Compl. and Def.'s Countercl. [Dkt. #29]. Upon consideration of the parties' pleadings, relevant law, and the entire record therein, the plaintiff's motion is DENIED and the defendant's motion is GRANTED.
Brown is a 38-year-old histotechnologist, who worked for Universal Health Services, Inc. (" Universal" ) from March 11, 2002 through July 12, 2008, see Compl. ¶ 9; HLI00594, and was covered by Universal's ERISA-qualified Group Benefit Plan, HLI0020-63. Plaintiff stopped working on July 12, 2008 and applied for LTD benefits two months later, citing " chronic swelling and pain" in her feet and legs. HLI0531-33. Her physician, Dr. Andrew Lee, diagnosed her with synovitis of unclear etiology  and sarcoidosis. HLI0369. On January 27, 2009, Hartford approved plaintiff's application and awarded her monthly benefits of $2,331.68, retroactive to January 11. HLI0210-14.
From October 2008 through March 2011, plaintiff's rheumatologist was Dr. Thomas Grader-Beck. HLI0516-18; HLI0296-99. In that time, Dr. Grader-Beck treated plaintiff's sarcoidosis and an array of other medical conditions not now at issue.
In September 2009, however, Hartford became suspicious that Brown was engaged in physical activities that she had not reported to the insurance company or to her doctor. On September 22, plaintiff sent Hartford a facsimile that indicated it came from " Sweet Jai's Catering" (Jai being plaintiff's middle name). HLI0405. Three weeks later, on October 14, 2009, a Hartford Ability Analyst spoke with Brown on the phone. HLI0010. During the call, the analyst " could hear a baby in the background," id., and it " [s]ounded like [Brown] was holding [the] baby as it was very close to phone and could be heard making noises throughout entire phone call," HLI0404. When asked about the baby, Brown claimed " someone was visiting her." HLI0010. At the time, she claimed she was " unable to do any part of her job and she does nothing at home; only takes a bath and sometimes reads and watches TV" and that " she [was] not receiv[ing] any other income." Id. Unpersuaded, Hartford referred plaintiff's case to its Special Investigation Unit. HLI0404.
Hartford hired two firms to surveil Brown for four days in November and December 2009. HLICIU0651-60. On all four days, investigators observed an unidentified female drive up to plaintiff's home between 7:25 and 7:55 AM and leave a small child inside. HLICIU0654-60. The child remained with plaintiff until at least 4:00 PM when the surveillance ended. Id. In addition, on November 3, the investigators observed a neighbor enter Brown's residence at about 11:30 AM, at which time Brown walked to her car, drove to a Safeway supermarket, walked around the store, went into a CVS pharmacy next door, purchased baby-related items, drove back to her residence, and walked back inside while carrying a shopping bag in one hand and her cell phone in the other. HLICIU0655-56. About an hour later, two unidentified males visited Brown and left carrying Styrofoam food trays and a beverage cup. HLICIU0656. As the men were leaving, Brown was " holding a child near the front door," then placed the child down, " exited the residence and began to run towards the vehicle the two males were occupying." Id. The investigator concluded that although " [t]here was no evidence of the subject working at a catering company or at any company[,] . . . it appeared as if the subject may be possibl[y] selling food out of the residence." HLICIU0657.
On January 4, 2010, the Social Security Administration (" SSA" ) denied Brown's application for disability benefits because " [t]he medical evidence show[ed] that [she was] responding to treatment and . . . able to carry out [her] activities of daily living without assistance." HLI0465. According to the SSA, plaintiff " should be capable of work which is not physically demanding," and her " condition [was] not severe enough to keep [her] from working." Id. Hartford arranged for Brown to have legal ...