Maureen Keough v. Liberty Life Assur.

2005 DNH 032
District Court, D. New Hampshire·Decided February 24, 2005·No. CV-03-266-PB·Published

Opinion

Maureen Keough v . Liberty Life Assur. CV-03-266-PB 02/24/05

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE

Maurene Keough

v. Civil N o . 03-266-PB Opinion N o . 2005 DNH 032 Liberty Life Assurance Company of Boston

MEMORANDUM AND ORDER

Maurene Keough brings this claim for disability benefits pursuant to the Employee Retirement Income Security Act of 1974, (“ERISA”) as amended, 29 U.S.C. § 1132(a)(1)(B), to recover benefits allegedly due her under the terms of the Liberty Mutual Insurance Company’s Long-Term Disability Plan (“Plan”). The Plan is administered by defendant Liberty Life Assurance Company of Boston (“Liberty Life”). In the single count of the complaint, Keough alleges that defendant Liberty Life’s decision to terminate her long term disability benefits was improper and contrary to the weight of the evidence. Before me are Liberty Life’s motion for summary judgment (Doc. N o . 9 ) and Keough’s cross motion for summary judgment (Doc. N o . 1 4 ) . For the reasons set forth below, I grant Liberty Life’s motion and deny Keough’s

motion.

BACKGROUND1

Maurene Keough worked for the Liberty Mutual Insurance Company (“Liberty Mutual”) as a business analyst for 32 years until she was hospitalized with a serious heart condition in October 2000. Compl. at ¶ 5 . As a regular employee of Liberty Mutual, she was eligible to participate in the Plan. Admin R. 30, 33. A. The Plan The Plan provides, among other benefits, long-term disability (“LTD”) coverage to eligible employees through a group insurance policy sponsored by Liberty Mutual and issued by Liberty Life. Admin. R. 1 . In particular, the Plan provides for the payment of LTD benefits to eligible employees who are determined by Plan Administrator Liberty Life to be “[d]isabled.” Id. at 1 3 . The Plan divides eligibility for long-term disability benefits into two phases. During the first phase of up to 18

1 The background facts set forth herein are taken from the Administrative Record (“Admin. R.”) filed by Liberty Life as an appendix in support of its motion for summary judgment. Where appropriate, additional facts are taken from the pleadings.

months, an employee will be considered “disabled” i f , “due to Injury or Sickness,” she is “unable to perform all of the material and substantial duties of [her] own occupation.” Id. at 6, 3 1 . In the second phase, after collecting benefit payments for 18 months, an employee will continue to be considered “disabled” only if she is “unable to perform, with reasonable continuity, all of the material and substantial duties of [her] own occupation or any other occupation for which [she] is or becomes reasonably fitted by training, education, experience, age and physical and mental capacity.”2 Id.

The burden is on the employee to submit to Liberty Life proof that she is disabled and requires the regular attendance of a physician. Id. at 1 3 . The Plan also provides that long-term disability benefits will be paid for the “period of Disability if the [employee] gives to Liberty proof of continued” disability and the need for continued regular attendance of a physician. Id. (Emphasis added). Furthermore, the Plan specifies that long- term disability benefits will cease if the employee is no longer

2 The two phases of disability under the Plan are frequently referred to as the “own occupation” period (first 18 months) and the “any occupation” period (after 18 months).

disabled. Id. at 1 7 . The Plan expressly invests Liberty Life, the Plan Administrator, with

the authority, in its sole discretion, to construe the terms of this Plan and decide all questions of eligibility, determine the amount, time and manner of payments of any benefits and decide any other matters relating to the administration or operation of the Plan.

Id. at 3 9 . Finally, the Plan specifies that any “interpretations or decisions of the Plan Administrator shall be conclusive and binding.” Id. B. Keough’s Claim for Short Term Disability Benefits On October 1 8 , 2000, Keough went to the emergency room at the Wentworth-Douglass Hospital in Dover, New Hampshire, complaining of chest pain and shortness of breath. Admin. R. 8 8 , 100. She was seen by Michael Jacuch, M.D., of Seacoast Cardiology Associates and later diagnosed with unstable angina, severe coronary artery disease, hypothyroidism, and hyperlipidemia with fasting cholesterol. Id. at 96-99.

On October 2 6 , 2000, Keough was transferred to Portsmouth Regional Hospital for coronary artery bypass surgery. Id. at 100. Keough underwent quadruple bypass surgery on November 1 , 2000; the surgery was performed by Donato Sisto, M.D. of Coastal

Cardiothoracic Associates. Id. at 103. According to her November 7 , 2000 discharge summary, “postoperatively [Keough] has done very well. She has had an uncomplicated course without dysrhythmia or complications.” Id. at 105-06.

While she was still hospitalized, Keough applied for short-

term disability benefits (“STD”) for the period from October 2 5 , 2000, through December 7 , 2000. Id. at 109. Liberty Life’s case manager, Deneen DeCost, requested medical records from D r . Sisto and D r . Jacuch and asked them each to complete a Restrictions form and a Physical Capacities form. Id. at 7 6 , 8 0 . In response to this request, D r . Jacuch forwarded Keough’s medical records, but did not complete the forms, explaining that he had not yet seen Keough in his office “post-hospitalization.” Id. at 85-87. Dr. Jacuch indicated, however, that Keough had an appointment for an office visit on December 7 , 2000. Id. at 8 7 . Nevertheless, by letter dated November 8 , 2000, Liberty Life approved Keough’s claim for STD benefits through December 7 , 2000. Id. at 109.

Unlike D r . Jacuch, D r . Sisto returned completed Restrictions and Physical Capacities forms to Liberty Life. Id. at 112-13. On the Restrictions form he estimated that Keough would be able to return to work in January 2001. Id. at 112. D r . Sisto

indicated that Keough should engage in “no driving, no lifting 5 lbs or more” and he instructed her “not to walk or sit for a long period of time” through December 2 6 , 2000. Id. On the Physical Capacities form, D r . Sisto noted that Keough could sit or walk for up to four hours and stand for up to three hours of an eight- hour workday, but that she should not do any pushing or pulling and should limit reaching above the shoulder level to one hour per workday. Id. at 113. Finally, D r . Sisto indicated that although Keough could start work as early as December 8 , 2000, she could not perform any “heavy lifting” until after December 2 6 , 2000.3 Id. On December 7 , 2000, however, a physician’s assistant from D r . Sisto’s office reported to Liberty Life that he would like Keough to “hold off on [her return to work] until 1/1/01.” Id. at 4 7 .

Keough in fact saw D r . Jacuch in his office on December 7 , 2000, as planned. Id. at 145. In his progress notes from this visit, he indicated that although she was experiencing “some

3 Keough apparently told Liberty Life that she had seen Robert Helm. M.D., of Coastal Cardiothoracic Associates on November 2 1 , 2000 who reportedly thought that a return to work date of December 8 , 2000 “might be right on target.” Admin R.

chestwall tenderness” and “some fatigability,” she was nevertheless “recuperating nicely.” Id. D r . Jacuch’s notes make no mention of a return to work date. On December 6, 2000, however, based on “updated medical information” suggesting that Keough would be able to return to work on January 8 , 2001, Liberty Life notified her that it had extended her STD benefits through January 7 , 2001. Id. at 116.

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