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Bacquie v. Liberty Mutual Insurance Co.

June 21, 2006

ENA MAE BACQUIE, PLAINTIFF,
v.
LIBERTY MUTUAL INSURANCE CO. AND LIBERTY LIFE ASSURANCE CO. OF BOSTON, DEFENDANTS.



The opinion of the court was delivered by: Conner, Senior D.J.

ECF CASE

OPINION AND ORDER

Plaintiff Ena Mae Bacquie brings this action pursuant to the Employees' Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq., against her former employer, Liberty Mutual Insurance Company ("Liberty"), and the sponsor of its Group Disability Income Policy (the "Plan"), Liberty Life Assurance Company of Boston (collectively, "defendants"). Plaintiff seeks a determination that defendants acted arbitrarily and capriciously in offsetting her long term disability ("LTD") benefits by the amount of plaintiff's Social Security Disability Income ("SSDI"). She also seeks payment of those offset sums. Resolution of this dispute requires this Court to determine the meaning of the phrase "same Disability" in the context of multiple disabling medical conditions in order to assess the validity of Liberty's LTD benefit reduction.

Presently before the Court are the parties' cross-motions for summary judgment. For the reasons contained herein, defendants' motion for summary judgment is granted, and plaintiff's motion for summary judgment is denied.

BACKGROUND

In January 2000, Bacquie began working as a senior case manager at Liberty. (Pl. Rule 56.1 Stmt. ¶ 1; Defs. Rule 56.1 Stmt. ¶ 37.) Approximately three months later, Bacquie reported a disability claim after her physician "took her off work" as a result of fainting spells and seizures. (AR 149-50, 1375-76, 1377.)*fn1 During this period, Liberty provided plaintiff with short term disability ("STD") benefits in accordance with the terms of its STD plan. (AR 1375.) However, after she returned to work on May 2, 2000, Bacquie's physician "took her back out of work" on May 31, 2000 in order to investigate the cause of her continued fainting spells (AR 148), at which point Liberty opened a new STD claim. (AR 145; 1296-99.)

On June 20, 2000, Niels H. Lauersen, M.D. completed a disability claim form on behalf of plaintiff citing complaints of pelvic pain, abdominal pain and bleeding. (AR 285.) The form notes that Dr. Lauersen performed dilation and curetage with a laparoscopy on June 7, 2000.*fn2 (AR 148, 285; see also AR 1321-23.) Another of Bacquie's doctors, C. Goldberg, M.D., found that plaintiff suffered from a seizure disorder (AR 147); he completed a restriction form in early June 2000 indicating plaintiff would not return to work until July 15, 2000.*fn3 (AR 1316.) However, Stephen L. Sowinski, M.D., who replaced Dr. Goldberg as plaintiff's internist, completed a restriction form on August 9, 2000 diagnosing Bacquie with Addison's Disease (an endocrinological disorder), Sjogren's Syndrome (an autoimmune disorder), orthostatic hypotension and syncope (fainting) and stating that, as a consequence, she could not return to work. (AR 1235; see also AR 139.) Dr. Sowinski noted that Bacquie's disability was compounded by depression, for which Bacquie received medical care. (AR 134-37, 1203, 1212, 1219.) Although Sowinski repeatedly pushed back plaintiff's expected date of return to work (AR 135-37, 1196-97, 1201-04), he indicated on October 27, 2000 that she was permitted to return to "light duty" on October 30, 2000. (AR 1187.) Martin A. Hurwitz, M.D., Bacquie's psychiatrist, who found Bacquie suffered from a "Major Depressive Order," further restricted plaintiff's work ability to no more than six hours per day. (AR 1186; see also AR 134.) Liberty paid plaintiff STD benefits for this period of disability as well. (AR 1192-93.)

After returning to work at the end of October, Bacquie left work again on November 6, 2000 because, according to plaintiff, Liberty failed to comply with the medically mandated work restrictions. (AR 1182-83. But see AR 131-33 (providing Liberty's account of its accommodations).) Drs. Hurwitz and Sowinski subsequently filled out restriction forms indicating that Bacquie's depression had rendered her totally disabled. (AR 1175-76; see also 130-32.) In accordance with the terms of its STD plan, Liberty informed plaintiff that since she had not returned to work for more than six months following her last disability period, her STD benefits were "successive," and therefore did not constitute a new claim.*fn4 (AR 130-32, 1173-74; see also 19.) Accordingly, Liberty reopened plaintiff's previous STD claim and began to pay her benefits on November 6, 2000. (AR 1167-68, 1171-74.)

Given the 180-day STD benefit limit, plaintiff's STD benefits were set to expire on December 5, 2000. (AR 1167.) Liberty informed plaintiff of her eligibility for LTD benefits, which she applied for and received on December 14, 2000. (AR 1152-54.) Bacquie's LTD benefits were authorized subject to the Plan's 18-month limitation for a mental illness because Liberty concluded that her primary diagnosis was a mental disorder.*fn5 (AR 1152-53.) In addition, the letter instructed that Bacquie was "expected to apply for Social Security Disability Income ("SSDI") benefits" where a disability is expected to last beyond twelve months. (AR 1154.) It also noted that plaintiff's failure to apply for SSDI benefits would result in an automatic reduction in LTD benefits "by an amount equal to your anticipated SSDI benefit." (Id.)

On January 2, 2001, Peter M. Mirkin, M.D. conducted a peer review of plaintiff's file at Liberty's request. Dr. Mirkin opined that plaintiff suffers from Systemic Lupus Erythematosus, but his report was ultimately unable to conclude whether "her psychiatric condition is a primary impairing condition or whether it is secondary to one of her medical conditions." (AR 1144.)

Plaintiff was examined on January 17, 2001 by neurologist Morton Finkel, M.D., who diagnosed major motor epilepsy and panic attacks in addition to Sjogren's Syndrome and Addison's Disease; he prescribed Dilantin. (AR 1127.) This diagnosis was communicated to Liberty by Dr. Finkel at Liberty's request. (AR 1128-31; 1135-36.) Liberty requested responses to specific questions regarding plaintiff's condition from Dr. Finkel on March 16, 2001. (AR 1113-14.) In addition, Liberty sought medical records, test results and answers to specific questions on multiple occasions from plaintiff's rheumatologist, Stelios Viennas, M.D., and endocrinologist, Vincent Yen, M.D. (AR 1109, 1116-21.) The record shows that Liberty was provided with all this information. (AR 1101-05.) Both plaintiff's neurologist and rheumatologist independently indicated that plaintiff was permanently and totally disabled. (AR 1101, 1104.)

In an email dated January 11, 2001, Claims Case Manager Deneen DeCost contacted Managed Disability Nurse Barbara Desjardins, RN and informed her that, due to the complexity of plaintiff's case, Liberty would "like to aggressively manage" her claim. (AR 1138.) In a May 8, 2001 email, DeCost informed Liberty Team Manager Michael Bisson that Desjardins was "leaning more toward a physical disability of Sjogren's Disease with a resultant complication of Addison's Disease as the primary diagnosis," and that plaintiff's depression was caused by "the high levels of steroids she is taking for pain[,] and is really a secondary diagnosis." (AR 1097; see also AR 81, 97, 100, 104.)

On May 11, 2001, Bacquie was awarded SSDI benefits retroactive to April 23, 2000. (AR 1084-87.) As a result of this award, Liberty determined that it had overpaid LTD benefits to plaintiff, and requested and received reimbursement in those amounts from her. (AR 82, 93.)

Liberty again conducted a peer review of plaintiff's case in June 2001. Laura K. O'Malley, M.D. submitted a report that was inconclusive regarding the disabling effects of Bacquie's various conditions. (AR 1068-70; see also AR 81.) Liberty then requested and received Claimant's Supplementary Statement, in which Bacquie stated that her multiple conditions left her with "inconsistent health" resulting in permanent disability. (AR 1058-62.) This conclusion was supported by reports filed by Drs. Finkel, Hurwitz and Viennas. (AR 924, 939-40, 1040, 1042.) The findings of Jill P. Buyon, M.D., who conducted an ...


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