DiGregorio v. Hartford Comprehensive Employee Benefit Service Co.

423 F.3d 6, 35 Employee Benefits Cas. (BNA) 2222, 2005 U.S. App. LEXIS 19380, 2005 WL 2170350
CourtCourt of Appeals for the First Circuit
DecidedSeptember 8, 2005
Docket04-2219, 04-2252
StatusPublished
Cited by42 cases

This text of 423 F.3d 6 (DiGregorio v. Hartford Comprehensive Employee Benefit Service Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
DiGregorio v. Hartford Comprehensive Employee Benefit Service Co., 423 F.3d 6, 35 Employee Benefits Cas. (BNA) 2222, 2005 U.S. App. LEXIS 19380, 2005 WL 2170350 (1st Cir. 2005).

Opinion

LIPEZ, Circuit Judge.

Plaintiff-appellant Angela DiGregorio appeals the district court’s judgment in favor of defendants-appellees Hartford Comprehensive Employee Benefit Service Company (“Hartford”) and Pricewaterhou-seCoopers Long Term Disability Plan (“the Plan”) on her claim of entitlement to long-term disability (“LTD”) benefits under the Employee Retirement Income Security Act of 1974, 29 U.S.C § 1001-1461, as amended (“ERISA”). DiGregorio challenges only the district court’s denial of her alternate prayer for relief requesting a remand to Hartford, the Plan administrator, for supplementation of the administrative record, on the ground that Hartford and the Plan failed to provide a reasonable opportunity for full and fair review of her benefits claim in violation of ERISA § 503, 29 U.S.C. § 1133, and its implementing regulations. Because the district court did not err in determining that a remand was unwarranted on the facts of this case, we affirm the district court’s judgment. 1

I.

The facts of this case are set forth in detail in the district court’s opinion. See DiGregorio v. Pricewaterhouse Coopers Long Term, Disability Plan, No. 03-11191, 2004 WL 1774566 2004 U.S. Dist. LEXIS 15485 (D.Mass. Aug. 9, 2004). We relate only those facts, undisputed unless otherwise noted, that are relevant to this appeal.

A. DiGregorio’s Claim for LTD Benefits

DiGregorio worked as a secretary for Coopers & Lybrand (now Pricewaterhou-seCoopers) from September 1988 through early February 1995, when she began receiving worker’s compensation. In July 1995, DiGregorio applied for LTD benefits under the Coopers & Lybrand Employee Long Term Disability and Income Plan, now the PricewaterhouseCoopers Long Term Disability Plan. In support of her claim, she submitted a statement by her attending physician, Dr. Walsh, diagnosing DiGregorio with bilateral carpal tunnel syndrome that totally disabled her from performing her job as a secretary. The Plan administrator, then the Pacific Mutual Life Insurance Company, approved Di-Gregorio’s claim in September 1995, and DiGregorio began receiving LTD benefits for the period beginning August 1, 1995.

Under the terms of the Plan, DiGregorio was entitled to LTD benefits for “Total Disability” for a period of up to two years so long as she could “perform no duty *9 pertaining to [her] occupation” as a secretary. DiGregorio was entitled to continue receiving benefits beyond the two-year period only so long as she could “perform no duty pertaining not only to [her] occupation but to any occupation ... for which [she] is, or may be, qualified by education, training or expertise” (emphasis added). DiGregorio continued to receive LTD benefits beyond the initial two-year period.

B. Hartford’s Termination of DiGrego-rio’s LTD Benefits

In July 1999, PricewaterhouseCoopers retained Hartford to administer claims for benefits under the Plan. In August 1999, at Hartford’s request, DiGregorio completed an “Authorization to Obtain and Release Information” permitting Hartford to periodically obtain DiGregorio’s updated medical information so that Hartford could verify her disability status and eligibility for benefits.

On April 18, 2001, Hartford notified Di-Gregorio by letter that “the evidence submitted in support of your claim does not establish that you meet the Plan definition of Total Disability on or after April 16, 2001.” Hartford stated that it had based its “decision to deny your claim for benefits upon Plan language and all documents contained in your claim file, viewed as a whole.”

Hartford then identified four specific pieces of information that it had considered: (1) “Medical records received from [an orthopedic surgeon,] Douglas Howard, M.D.[,] regarding your April 11, 2000 evaluation,” (2) “Employability Analysis Report completed ... on March 22, 2001,” (3) “Telephone conversation with you on November 28, 2000,” and (4) “Telephone conversation with you on February 5, 2001.”

Hartford explained:

The medical record completed by Dr. Howard on April 11, 2000 indicates that you are capable of working full time in an occupation that does not require repetitive use of your hands. Dr. Howard states that he does not find you totally disabled but only partially disabled. He indicates that you would be capable of performing a sedentary job on a full time basis that did not require repetitive use of your hands.

Hartford noted that although DiGregorio had indicated in the telephone conversations that she “would have [a different physician,] Dr. Jupiter[,] send medical information [to Hartford] concerning [her] eondition[,][t]o date, this information has not been received. We do not have sufficient medical documentation to verify continued disability.”

Finally, Hartford stated: “We have identified the following positions that you could perform based on your abilities as identified by Dr. Howard. These positions are both sedentary and do not require repetitive use of the hands.” The positions were: “Customer-Complaint Clerk,” “Insurance Clerk,” “Information Clerk,” and “Counter Clerk.” Hartford determined that because DiGregorio could perform duties pertaining to these occupations, “for which [she was], or may be, qualified by education, training or expertise,” she did not meet the Plan definition of Total Disability and was not entitled to LTD benefits.

Hartford then reiterated: “In reviewing your claim, [Hartford] considered your claim file as a whole for purposes of determining your eligibility [for] benefits under the Policy.” Hartford concluded the denial letter by describing DiGregorio’s rights “to appeal our decision and review pertinent documents in your claim file,” as well as to submit

additional information not previously submitted which you believe will assist *10 us in evaluating your claim for Long Term Disability benefits, .... [specifically, medical documentation that you are unable to perform any occupation or work due to your abilities, training, education and experience, or documentation that you have a Disability which prevents you from performing other occupations.

C. DiGregorio’s Requests for Her Entire Claim File

In a letter dated September 25, 2001, DiGregorio informed Hartford, through counsel, of her intent to appeal Hartford’s decision to terminate her benefits and requested copies of “all documents upon which [Hartford] ha[d] relied ... in making [its] unfavorable determination,” namely, her “entire claim file,” including “[a]ny reports or other documents relating to or connected with a review of Ms. Di[G]rego-rio’s medical records by a member of your medical department, or outside consultant.”

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Bluebook (online)
423 F.3d 6, 35 Employee Benefits Cas. (BNA) 2222, 2005 U.S. App. LEXIS 19380, 2005 WL 2170350, Counsel Stack Legal Research, https://law.counselstack.com/opinion/digregorio-v-hartford-comprehensive-employee-benefit-service-co-ca1-2005.