Rossignol v. Liberty Life Assurance

2010 DNH 021
CourtDistrict Court, D. New Hampshire
DecidedFebruary 9, 2010
Docket09-CV-110-JD
StatusPublished
Cited by1 cases

This text of 2010 DNH 021 (Rossignol v. Liberty Life Assurance) is published on Counsel Stack Legal Research, covering District Court, D. New Hampshire primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rossignol v. Liberty Life Assurance, 2010 DNH 021 (D.N.H. 2010).

Opinion

Rossignol v . Liberty Life Assurance 09-CV-110-JD 02/09/10 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE

Mark Rossignol

v. Civil N o . 09-cv-110-JD Opinion N o . 2010 DNH 021 Liberty Life Assurance Company of Boston

O R D E R

Mark Rossignol brings an Employee Retirement Income Security

Act (“ERISA”) action to recover benefits under a long-term

disability policy provided by his former employer, Wingfoot

Commercial Tire Systems, LLC (“Wingfoot”) through Liberty Mutual

Assurance Company (“Liberty”). See 29 U.S.C. § 1132(a)(1)(B).

The parties have filed their joint statement of material facts.

Both Rossignol and Liberty move for judgment on the

administrative record.

Background1

Mark Rossignol worked as a sales representative for

Wingfoot, beginning in 1985. As a Wingfoot employee, Rossignol

1 The factual background information is presented in detail in the parties’ joint statement of material facts (document n o . 12) and is summarized here. participated in its long-term group disability plan, which was

insured by and issued through Liberty. On October 1 0 , 2003,

while working, Rossignol lifted a 125-pound truck tire and felt a

pop in the left side of his low back and then pain in his back,

radiating down his leg.

Rossignol was first seen for the back injury on October 3 0 , 2003, when Dr. Ashraf Guirgues noted that Rossignol probably had

a recurrence of disc herniation, planned to obtain an MRI, and

restricted Rossignol from lifting, bending, and squatting. In

December, Guirgues noted that the MRI results showed degenerative

disc disease, scar formation, swelling at the L5 and S1 nerve

roots, but no new herniation. Dr. Guirgues did not recommend

surgery but instead suggested limited activity and exercises to

strengthen his back.

Because he continued to have back pain, Rossignol saw Dr. Sanchez in February of 2004, who also found only degenerative

changes in the lumbar spine. Dr. Sanchez completed two New

Hampshire Workers’ Compensation Medical Forms for Rossignol in

February of 2004, with a diagnosis of sacroiliac arthropathy.

Dr. Sanchez indicated that Rossignol was unable to work.

Rossignol then saw Dr. Asi Hacobian in late February of 2004, who

also completed a Workers’ Compensation Medical Form for Rossignol

in which she referred to her office notes instead of completing

2 part of the form and indicated that Rossignol was then working,

although she provided no detail about his work. Rossignol

continued to treat with Dr. Sanchez, Dr. Hacobian, and Dr.

Guirgues through 2004. In January of 2005, Rossignol was seen

by Dr. Kelly Ly and Dr. David Janfaza. Their notes document

Rossignol’s back injuries and continued pain. During 2005, Rossignol underwent several blocking procedures without long-term

beneficial effect. In August of 2005, Rossignol was awarded

Social Security disability benefits.

Dr. Albert Fullerton completed an independent medical

examination of Rossignol at Liberty’s request in March of 2006.

Dr. Fullerton reported Rossignol’s history of his back problem

and Rossignol’s belief that he could not work because of pain.

He concluded, however, that although Rossignol remained disabled

as to his former work at Wingfoot, he should be able to work as an “inside sales person” with some restrictions on his

activities. Dr. Fullerton completed a Physical Capabilities

form, which indicated that Rossignol was capable of sedentary

work.

A Labor Market Survey, completed in April of 2006,

identified several occupations that were compatible with

Rossignol’s education and physical capabilities, including work

as an inside sales representative, in automotive sales, and in

3 other sales positions. In August of 2006, a private investigator

hired by Liberty reported that Rossignol held a New Hampshire

real estate license and was employed by a real estate agency in

Portsmouth, New Hampshire, as an independent contractor.

For purposes of Rossignol’s workers’ compensation claim, Dr.

Edgar Robertson examined Rossignol and reviewed Rossignol’s medical records on November 2 2 , 2006. Dr. Robertson diagnosed

degenerative lumbar disc disease with scarring of nerve roots due

to prior surgeries. He stated that no further treatment would be

helpful. Dr. Robertson also stated: “I do not believe he will

be gainfully employed as I believe he is completely disabled from

his former occupation. He would not be able to be employed in

any type of capacity that requires continuous sitting or standing

for prolonged periods of time.” Rossignol settled his workers’

compensation claim in May of 2007. On June 1 1 , 2007, Rossignol’s counsel wrote to Wingfoot,

requesting an application for long-term disability benefits, and

Wingfoot forwarded the letter to Liberty. Wingfoot informed

Liberty that Rossignol had received workers’ compensation

benefits from October 1 3 , 2003, through August 2 0 , 2006, that he

had received partial benefits after that time, and that his

workers’ compensation claim was settled on May 2 2 , 2007. In a

letter dated June 2 5 , 2007, Liberty notified Rossignol that he

4 had failed to follow the contractual requirements for notice and

proof of his claim and asked for an explanation and other

information by August 2 , 2007. When the requested information

was not provided by the deadline, Liberty denied Rossignol’s

claim and notified Rossignol of its decision on August 1 0 , 2007.

Liberty received a letter, which is dated August 7 , 2007, from Rossignol’s counsel on August 1 7 , 2007, with a questionnaire

signed by Rossignol on August 1 , 2007, and many medical records

and other information pertaining to Rossignol’s disability claim.

Liberty then received information about Rossignol’s workers’

compensation claim. Liberty approved Rossignol’s claim for a

twenty-four month period on October 1 5 , 2007, with a date of

disability determined to be October 1 3 , 2003, and an “elimination

period” of twenty-six weeks, making him eligible to begin to

receive benefits as of April 1 2 , 2004. Benefits were to be paid until April 1 1 , 2006, for the period that Rossignol could not

return to his former work at Wingfoot.

Liberty then reviewed the records to determine whether

Rossignol was eligible to receive benefits after the end of the

twenty-four month period. To be eligible for extended benefits,

Rossignol would have to show that he was disabled from any

occupation, not just his own former work. On December 2 7 , 2007,

Liberty denied Rossignol’s claim for benefits extending after the

5 “own occupation period” because, based on Liberty’s review of the

records, after April 1 1 , 2006, Rossignol could work as a sales

representative at an outbound call center, an automotive sales

person, or an automotive leasing sales representative.

Through counsel, Rossignol appealed Liberty’s decision and

sent additional medical records, covering the period between April of 2006 to August of 2008, to support his claim. As part

of the appeal process, Liberty referred Rossignol’s file to

Milton Klein, D O , for peer review. Dr. Klein reviewed the file,

including Rossignol’s medical records, communicated with Dr.

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