Petrone v. Long Term Disability Income Plan

935 F. Supp. 2d 278, 2013 WL 1282315, 2013 U.S. Dist. LEXIS 43593
CourtDistrict Court, D. Massachusetts
DecidedMarch 27, 2013
DocketCivil Action No. 11-10720-DPW
StatusPublished
Cited by17 cases

This text of 935 F. Supp. 2d 278 (Petrone v. Long Term Disability Income Plan) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Petrone v. Long Term Disability Income Plan, 935 F. Supp. 2d 278, 2013 WL 1282315, 2013 U.S. Dist. LEXIS 43593 (D. Mass. 2013).

Opinion

MEMORANDUM AND ORDER

DOUGLAS P. WOODLOCK, District Judge.

Cheryl Petrone challenges the decision by the Johnson & Johnson Corporate Benefits Department to deny her claim for continued benefits under the Long Term Disability Income Plan for Choices Eligible Employees of Johnson & Johnson and Affiliated Companies (the “Plan’.’), an ERISA employee benefit plan. The parties have filed cross-motions for summary judgment.

I. BACKGROUND

Cheryl Petrone worked at DePuy Orthopaedics, Inc., a subsidiary of Johnson & Johnson, as a Finish Operator, among other jobs, for approximately seven years, from March 13, 2000 until June 7, 2007.

Ms. Petrone developed back pain around April 2007, and an MRI revealed L5-S1 Disc Herniation. She underwent back surgery, a lumbar laminectomy, on July 2, 2007. In October 2007, she was diagnosed with radiculopathy and post-lumbar laminectomy syndrome, known as failed back syndrome.

She received short term disability benefits for 26 weeks beginning on her first day of absence from work due to her condition, June 9, 2007, and it continued through December 7, 2007. During this time, Ms. Petrone applied for long term disability (“LTD”) benefits. Reed Group, a third-party claims service organization to which the Pension Committee delegated the responsibilities of administering benefit claims, approved Ms. Petrone’s application on December 14, 2007, with benefits effective from December 8, 2007. Her benefits continued until Reed Group denied her claim for continued LTD benefits effective January 12, 2009.

A. The Long Term Benefits Plan

Ms. Petrone’s LTD Benefits are governed by the terms of the Long Term Disability Income Plan for Choices Eligible Employees of Johnson & Johnson and Affiliated Companies, in which Ms. Petrone has chosen to participate.

[282]*282In relevant part, the LTD plan states that Ms. Petrone remains eligible for LTD benefits until she retires, begins to receive a pension, turns 65 years old,. or dies, as long as she has “Total Disability.” Total Disability is defined as:

the complete inability of the Participant, due to Sickness or Injury, to perform any job for which the Participant is (or may reasonably become) with or without reasonable accommodation qualified by training, education or experience, (emphasis in original).

The LTD Plan also specifies that failure to do any of the following constitutes grounds for termination of benefits “at the sole discretion of the Plan Administrator”:

(1) ... [Cjooperate with any other procedures, evaluation, investigation or audit in connection with this Plan ..., (3) cooperate with respect to the evaluation of a Participant’s Total Disability or Continued Disability ....

The LTD1 Plan asserts that it was justified in denying Ms. Petrone’s claim for continued benefits both as a clinical matter because her medical examinations reveal that she does not meet the definition of “Total Disability” and as an administrative matter for violation of the cooperation requirement.

B. Clinical and Medical Examinations

Over the course of her treatment and review for her condition, numerous' doctors, therapists, and other professionals have either examined Ms. Petrone or her medical files. The administrative record reflects that more than 12 different medical professionals have weighed in on Ms. Petrone’s ability to return to work in any job. Six concluded that Ms. Petrone was totally disabled and unable to work in any job (Marcovici, Worthington, Dominguez, McClusky, Bledsoe, and Parker); six concluded that she was capable of some level of work (Saris, LeForce, Marion, Ferguson, DiTullio, and Trangle). The following is a summary of the impressions and conclusions of the medical professionals.

1. Dr. Marcovici

Ms. Petrone met with Dr. Marcovici, one of her attending physicians, on numerous occasions for examinations and surgeries. It was Dr. Marcovici who performed Ms. Petrone’s laminectamy on July 2, 2007. Dr. Marcovici also performed the surgery to insert Ms. Petrone’s spinal stimulator a year later.

In various follow-up examination reports, Dr. Marcovici continued to conclude that Ms. Petrone was completely disabled and incapable of performing sedentary work. For instance, on June 17, 2008, he wrote “her pain is severe and disabling. ... It is worse with activity and improved with rest. She has not had any significant relief since the onset of her symptoms over a year ago.” On September 2, 2008, Dr. Marcovici classified Ms. Petrone as “Class 5 — Severe limitation of functional capacity; incapable of minimal (sedentary) activity,” although he acknowledged that she had “improved (some).”

2. Dr. Jeremy Worthington

On November 13, 2007, Dr. Worthington conducted a neurological examination finding that Ms. Petrone “has intractable pain in any position but lying down, she’s able to stand and she’s able to walk” and that as a result, “the patient is unable to perform the responsibility for any job at this time.” Dr. Worthington also stated that “she has arachnoiditis which is a postoperative complication that may be associated with long-term pain and inability to work” and that “no definite timing can be established for the management of chronic pain of this type.”

[283]*283 S. Dr. Eric Dominguez

Dr. Eric Dominguez is another of Ms. Petrone’s attending physicians. During this period, he met with Ms. Petrone many times, and has consistently maintained that Ms. Petrone is incapable of any work. For instance, on the attending physician form he filled out for Reed Group,- he classified Ms. Petrone as “Class 5 — Severe limitation of functional capacity; incapable of minimal (sedentary) activity,” stating that she had “improved very little.” ;

On January 29, 2009, Dr. Dominguez wrote a “To Whom it May Concern” letter, indicating that Ms. Petrone “is unable to work at the current time and I believe this will be the case for the foreseeable future.” Dr. Dominguez reaffirmed this assessment on April 14, 2009, when he filled out a detailed attending physician form indicating that Ms. Petrone was “unable to concentrate or focus on activities for prolonged periods because [of] either intense paid or opioid related effects,” needs to be able to stand and sit at will, and has other restrictions consistent with work capacity below sedentary.

J. Catherine McClusky

Reed Group scheduled a Functional Capacity Evaluation (“FCE”) for Ms. Petrone on November 25, 2008 with Catherine McClusky, a Physical Therapist. McClusky noted that Ms. Petrone demonstrates

the ability to perform jobs requiring a work level of .78 METS. This energy equivalent falls below the Sedentary range of 1.5-2.1 METS. It is felt that Ms. Petrone did not demonstrate maximum effort on this test as she was observed to walk faster to the treadmill and during push/pulling trials than she demonstrated on the treadmill.

As to the grip and pinch testing, Ms. McClusky also stated that,

[n]o signs of maximum effort were noted during the grip and pinch dynamometry which decreases the test reliability.

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Cite This Page — Counsel Stack

Bluebook (online)
935 F. Supp. 2d 278, 2013 WL 1282315, 2013 U.S. Dist. LEXIS 43593, Counsel Stack Legal Research, https://law.counselstack.com/opinion/petrone-v-long-term-disability-income-plan-mad-2013.