United States District Court, District of New Hampshire
William D. Pandolph, Esq. Shawn J. Sullivan, Esq.
Joseph A. DiClerico, Jr. United States District Judge
Wendy Goodwin brought suit under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq., seeking to overturn the decision of Liberty Life Assurance Co. of Boston ("Liberty") to terminate her long term disability ("LTD") benefits. The parties have both moved for judgment on the administrative record. See L.R. 9.4(c).
Standard of Review
The standard of review in an ERISA case differs from that in an ordinary civil case, where summary judgment is designed to screen out cases that raise no trialworthy issues. See, e.g., Orndorf v. Paul Revere Life Ins. Co., 404 F.3d 510, 517 (1st Cir. 2005). "In the ERISA context, summary judgment is merely a vehicle for deciding the case, " in lieu of a trial. Bard v. Boston Shipping Ass'n, 471 F.3d 229, 235 (1st Cir. 2006). Rather than consider affidavits and other evidence submitted by the parties, the court reviews the denial of ERISA benefits based "solely on the administrative record, " and neither party is entitled to factual inferences in its favor. Id. Thus, "in a very real sense, the district court sits more as an appellate tribunal than as a trial court" in deciding whether to uphold the administrative decision. Leahy v. Raytheon Co., 315 F.3d 11, 18 (1st Cir. 2002) .
Wendy Goodwin was employed by The Timberland Company ("Timberland") as a customer fulfillment database administrator, a sedentary job, since 1987. As a Timberland employee, Goodwin was eligible for and participated in the company's long-term disability insurance plan ("Plan"), offered through Liberty.
To receive benefits under the Plan, an employee must be certified as disabled by Liberty. The Plan defines a disabled employee as one who "as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of . . . [the employee's] occupation that [she] was performing when [her] Disability . . . began."
On January 23, 2006, Goodwin had a CT scan of her abdomen and pelvis because of stomach pain. Following the scan, Goodwin was examined by Dr. Peter Carter on two occasions in early February of 2006. On or about February 15, 2006, Dr. Carter performed surgery on Goodwin to repair a ventral incisional hernia. At a follow-up appointment on March 8, 2006, Dr. Carter prescribed Ciprofloxacin, an antibiotic, because Goodwin appeared to have a possible infection at the incision site. He also prescribed pain medication.
Goodwin saw Dr. Carter on March 24 and April 7, 2006. During the March 24 appointment, Dr. Carter noted that the antibiotic was helping to treat the infection. During the April 7 appointment, Dr. Carter noted that the incision had healed adequately, but that Goodwin had a "mild keloid formation" and a "moderate amount of discomfort." Dr. Carter advised Goodwin to return to work but to remain on "light duty for this next month. "
Goodwin saw Dr. Carter again on May 3, 2006. Dr. Carter noted that Goodwin continued to have discomfort, mostly while sitting, in the area of the incision. He ordered an ultrasound of Goodwin's stomach and a pain consultation.
Goodwin saw Dr. Christopher Delorie for the pain consultation on May 10, 2006. Dr. Delorie noted that the "area along the scar seems boggy and inflammed [sic]." He prescribed Tramadol for Goodwin's pain. Dr. Delorie also noted that the "next option would be . . . infiltration of the scar and deeper tissues with local and steroid."
Goodwin saw Dr. Carter on May 17, 2006, to discuss the results of the ultrasound. According to Dr. Carter, the ultrasound showed a "collection of fluid" in Goodwin's abdomen. Dr. Carter prescribed codeine for Goodwin, and referred her back to Dr. Delorie for "some injections to soften up the scar tissue." Goodwin saw Dr. Delorie on May 23, 2006, and received a nerve block injection to ease her pain.
On May 31, 2006, Goodwin saw Dr. William Gilbert of Kittery Family Practice. Dr. Goodwin wrote Goodwin prescriptions for two pain medications: Gabapentin and Darvocet (also known as propoxyphene napsylate). Over the next several months, Goodwin received and filled renewed prescriptions for these medications from Dr. Gilbert.
Goodwin saw Dr. Carter on July 18, 2006. Dr. Carter did not think that Goodwin's pain was being caused by the collection of fluid shown on the ultrasound. He thought Goodwin may be having a reaction to the suture used to close the incision from her previous operation. On August 8, 2006, Goodwin underwent a "[d]ebridement of scar tissue, excision of Prolene suture, evacuation of seroma .... [and] repair of small incisional hernia."
Goodwin saw Dr. Carter on August 24, 2006, to examine her for a "possible wound infection" after her August 8 procedure. Dr. Carter thought that Goodwin was having a "superficial reaction to the suture material" and noted that he was "at a loss as to why [Goodwin] has so much discomfort." Dr. Carter prescribed Darvocet for Goodwin's pain.
Goodwin saw Dr. Carter again on September 7, 2006. Dr. Carter noted that he had never had a "patient with this much chronic pain for the entire duration of my career, so I am perplexed regarding what could be contributing to her discomfort." Dr. Carter also expressed concern "about the amount of Darvocet and Tylenol [Goodwin] has been taking." Dr. Carter wrote Goodwin a prescription for Tramadol.
Goodwin next saw Dr. Carter on September 28, 2006. Dr. Carter encouraged Goodwin to return to work. He directed her to see him again in one month, at which point "the inflammation should subside, and she should feel better." He also wrote her a prescription for Hydrocodone, a pain medication. It does not appear that Goodwin saw Dr. Carter the following month or at any point after the September 28 appointment.
Goodwin returned to work in early October 2006. Around this time, Dr. Gilbert wrote Goodwin prescriptions for two pain medications: Cymbalta (also known as Duloxetine) and Lidoderm patches. Goodwin also requested, and apparently received, a new prescription for Darvocet from Dr. Frederick Thaler of Kittery ...