Ingravallo v. Hartford Life & Acc. Ins. Co., 2014 WL 1622798 (2d Cir. Apr. 24, 2014), doesn’t break any new legal ground, but it is nonetheless noteworthy for several reasons. It is rare that the Circuit reverses a District Court’s determination; here, it reversed and directed entry of judgment for Hartford. Second, it contains excellent findings regarding the adequacy of a claim administrator’s evaluation of a SSDI award, surveillance, and medical evidence.
There was no dispute that Ms. Ingravallo suffered from relapsing-remitting MS for many years. After working with the disease for a long time, she suffered an exacerbation that left her unable to perform the duties of her sedentary occupation. Hartford approved her claim in 2005. She received SSDI benefits in 2006. In 2008, “prompted by inconsistencies that it perceived between Ingravallo’s then-recent accounts of her condition and the accounts provided by her treating neurologist,” Hartford re-assessed her claim, which included surveillance of her performing chores outside her home, and medical reviews. After the reassessment, Hartford terminated benefits.
Ingravallo sued, and the district judge ruled that Hartford’s determination was arbitrary and capricious, citing three primary factors in support: “(1) that Hartford did not provide a cogent reason for its disagreement with the [SSA], … (2) that Hartford’s medical reviewers did not address an important detail: the presence of ‘black holes’ on Ingravallo’s most recent MRIs,… and (3) that, although the videos undoubtedly show Ingravallo doing things that she claimed not to be able to do, the videos did not constitute substantial evidence that she is able to work.”
Hartford appealed, and the Second Circuit reversed and directed the district court to enter judgment for Hartford.
First, the court found that “we cannot fault Hartford for failing to discuss the SSA’s position substantially in its decision.” The court noted that the SSA’s decision was made at a time when Hartford also was paying benefits, and there was no evidence that the SSA had ever re-evaluated her claim. The court also held that Ingravallo had not provided Hartford with any documents disclosing the basis for the SSA’s decision. Therefore, it was not an abuse of discretion for Hartford not to address the SSA decision.
Second, the court held that Hartford’s medical reviewers adequately addressed the medical evidence, particularly the “black holes” on an MRI, which, according to Ingravallo’s doctor, were lesions that “correlate well with the degree of a patient’s disability.” The court noted that the treating physician did not identify “any evidence suggesting that the lesions demonstrated Ingravallo lacked the capacity to work.” The court continued that “the significance of the treating physician’s statement about the lesions’ correlation with disability was unclear.” Further, “one of Hartford’s peer reviewers noted the lesions’ presence, but did not discuss them further.” After noting those factors, the court held: “[w]e cannot agree on this record that the failure of Hartford’s peer reviewers to account further for the lesions rendered Hartford’s decision arbitrary and capricious.”
Third, the court observed that there was sufficient medical evidence “inadequately rebutted by Ingravallo, to support Hartford’s decision.” It then noted that “Ingravallo bore the burden of establishing, through objective medical evidence, her continued inability to work.” And it held that “[t]he evidence cited by Ingravallo does not vitiate the contrary opinions offered by Hartford’s reviewers or render its decision arbitrary and capricious.”
Finally, the court held that Hartford had properly considered the surveillance. The court noted that the surveillance alone might not constitute substantial evidence supporting a termination of benefits, but held that “the record is persuasive that Hartford’s decision rested on far more than the surveillance videos,” including medical reviews and an investigator’s interview report.