Donald Godmar v. Hewlett-Packard Company

631 F. App'x 397
CourtCourt of Appeals for the Sixth Circuit
DecidedDecember 9, 2015
Docket15-1480
StatusUnpublished
Cited by16 cases

This text of 631 F. App'x 397 (Donald Godmar v. Hewlett-Packard Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Donald Godmar v. Hewlett-Packard Company, 631 F. App'x 397 (6th Cir. 2015).

Opinion

HELENE N. WHITE, Circuit Judge.

Donald Godmar appeals the district court’s grant of judgment on the administrative record to Hewlett-Packard Company (HP), the Hewlett-Packard Disability Plan (the Plan), and Sedgwick Claims Management Services, Inc. (Sedgwick), in this action to recover disability benefits under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a)(1)(B). Godmar argues the denial of his disability claim was arbitrary and capricious. We VACATE the district court’s judgment and REMAND for further proceedings.

I.

Godmar worked as a customer-project manager at HP. In this role, Godmar managed HP programs at General Motors and led a team of eighteen to forty persons. He drove from HP to General Motors on a daily basis and spent eight to ten hours at the General Motors site. . His position also required more extensive travel approximately' every six weeks. Aside from driving, Godmar’s position required five to six hours of sitting per day and less than one hour of standing and walking.

On September 20, 2009, Godmar sustained traumatic injuries to his left leg in a water-skiing accident, including dislocation of his tibia and fibula, a tibia plateau fracture, a torn meniscus, a torn medial collateral ligament, a ruptured plantar fascia, a damaged Achilles tendon, a damaged thigh muscle, damaged ligaments in his ankle, and damaged peroneal, femoral, and sciatic nerves. Over the next three years, God-mar underwent nine surgeries to repair the damage, culminating in a knee-replacement arthroplasty in October 2011. Because of his numerous surgeries, Godmar *399 was prescribed pain medication for more than two years. Godmar took intermittent leaves of absence from HP during treatment for his injuries, including the 2011 knee-replacement surgery. He apparently received disability benefits from HP for at least some of these leaves of absence, including a period in February 2010 and from October 5, 2011 until at least December 31, 2011. 1 Godmar’s orthopedic surgeon approved his return to work in early 2012.

HP provides disability benefits through the Plan, which is administered by Sedg-wick. In the first twenty-six weeks following the onset of an injury or sickness, an employee is eligible for short-term disability benefits if “totally disabled.” An employee qualifies as totally disabled if “unable to perform the material and essential functions” of the employee’s “usual occupation,” defined as “the customary work assigned” to the employee on the employee’s “customary schedule.” HP delegated to Sedgwick its “discretionary authority” to determine whether an employee is totally disabled. This determination is made “on the basis of objective medical evidence,” defined as “evidence establishing facts or conditions as perceived without distortion by personal feelings, prejudices, or interpretations.”

On June 1, 2012, Godmar visited his primary-care physician, Dr. David Schwarz, to address chronic pain from the water-skiing accident. Godmar also reported to Dr. Schwarz that his medications were “out of control,” leading to addiction, depression, and anxiety. Dr. Schwarz’s clinical impressions included left greát-toe pain, pain-management' issues, and left foot and ankle pain. Dr. Schwarz told Godmar not to return to work until July 15, 2012. Godmar took a leave of absence from HP and applied for short-term disability benefits. On June 4, Dr. Schwarz sent Sedgwick a certification that Godmar was disabled. The certification detailed a diagnosis of left leg, foot, and ankle pain arising from the knee-replacement surgery and stated that Godmar was “[ujnable to work” from June 1 to July 15 because of “pain/meds.”

In the following weeks, Sedgwick contacted Godmar to discuss his claim and ordered records from his medical providers. Sedgwick’s claim examiner requested an internal review by a registered nurse on June 20 to “determine if medical information presented substantiates initial benefits.” A nurse then reviewed the disability certification and concluded that “[mjedical information substantiate^] disability from 6/1 to 6/15.” The nurse observed that Dr. Schwarz had referred Godmar to the orthopedic surgeon who performed the knee arthroplasty, Dr. Bruce Lawrence, and asked the examiner to request his notes for further review. The examiner then approved “initial benefits” for June 1 through June 30. Sedg-wick contacted Godmar by phone o.n June 21 to inform him that he was approved for disability through the end of the month.

The nurse reevaluated the available records on July 6 and determined there was no objective evidence to substantiate God-mar’s total-disability claim after June. On July 12, while Godmar’s claim was still pending, Dr. Schwarz submitted a form to extend Godmar’s disability through September 15, 2012. By the end of July, Sedgwick obtained medical records from Dr. Lawrence, the orthopedic surgeon; Dr. Angel Rigueras, a physiatrist; Dr. *400 John Kohn, a pain-management specialist; and Dr. Schwarz, the family physician. A second nurse reviewed the records on July 20 and found there was still no objective medical evidence to support Godmar’s claim. The second nurse reevaluated the claim on July 26, after receipt of additional records from Dr. Schwarz, but came to the same conclusion.

Sedgwick issued its decision on July 30, 2012. In a letter to Godmar, Sedgwick informed him that short-term disability benefits had been terminated effective July 1. The letter explained that Sedgwick had reviewed the records from Godmar’s physicians, including Drs. Lawrence, Kohn, Rigueras, and Schwarz, and concluded that “[t]he medical documentation ... [did] not contain objective findings to support [Godmar’s] inability to perform [his] usual and customary job duties.” The letter acknowledged that “a medical condition may exist” but stated that “there must be objective medical information to support disability benefits” under the Plan. Lastly, Sedgwick informed Godmar that he would need to “submit a written appeal and objective medical evidence” to perfect his claim.

Godmar submitted an appeal on August 8, 2012. In a six-page letter, Godmar addressed the findings Sedgwick cited in its decision and elaborated on the circumstances of his treatment in June and July. He explained that he was on morphine twenty-four hours per day, could no longer drive, and slept more than twenty hours per day several times per week. He also described his plan to seek professional help to address his opiate addiction. He attached a detailed spreadsheet that he and his wife used to track his medications. On August 15, the day after Sedgwick received the appeal, Godmar checked himself into the Brighton Center for Recovery to treat his addiction; he was successfully discharged on August 28. On August 27, Dr. Schwarz sent Sedgwick a letter reiterating his support for Godmar’s disability claim and explaining that Godmar could not perform the core functions of his HP position because of his chronic pain and medication.

Sedgwick sent Godmar’s records to two board-certified physicians to conduct outside reviews. Dr.

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631 F. App'x 397, Counsel Stack Legal Research, https://law.counselstack.com/opinion/donald-godmar-v-hewlett-packard-company-ca6-2015.