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    Maher v. Massachusetts General Hospital Long Term Disability Plan | 665 F.3d 289 (1st Cir. 2011)

    In Maher v. Massachusetts General Hospital Long Term Disability Plan, we represented Ms. Maher in her long term disability claim against the plan established by her employer, Massachusetts General Hospital. Ms. Maher had worked as a Registered Nurse. She developed chronic abdominal pain and related symptoms which her physicians attributed to chronic pancreatitis, a pain syndrome, and fibromyalgia. She was prescribed substantial amounts of narcotic pain medications to control the pain. After receiving long term disability benefits for several years the plan administrator, Liberty Life Insurance Company of Boston, terminated her benefits. After Ms. Maher=s first appeal was denied by Liberty, she hired us. We submitted the second appeal, which was also denied. We then filed suit in district court. We lost at trial. We appealed. The First Circuit Court of Appeals ruled in Ms. Maher=s favor, remanded the case back to the district court with instructions to reconsider the claim. On remand the case settled. One of the key issues in our successful appeal of Ms. Maher’s case was Liberty’s and the plan’s misuse and mischaracterization of surveillance evidence. At every stage of Ms. Maher=s administrative appeal Liberty, the Plan and their reviewing doctors emphasized a claimed inconsistency between Ms. Maher=s self-reported limitations and her conduct depicted in surveillance videos, arguing that conduct was inconsistent with her disability status. But the First Circuit concluded, Ait is not apparent to us that any such inconsistency exists.@ Ms. Maher reported that her activities varied based on the extent of her pain, nausea, and opportunity to pre-medicate for activities, but she generally spent most of her days in bed. The First Circuit explained that in over 90 hours of surveillance, Athe most damming evidence@ the Plan identified was 15 minutes in which Ms. Maher carried a bucket or flowerpot and 30 minutes in which she played with her 3-year-old son in a park. On 10 of the 19 days of surveillance, Ms. Maher engaged in no activities. On other days she would sit or stand outside of her house with her husband for about 20 minutes. The Court reasoned: AThus, most of the surveillance, far from contradicting Maher=s disability, seems to confirm her lifestyle is generally housebound with occasional limited activities.@ The Court distinguished these facts from other cases in which videos showed activities that specifically contradicted claims made by the claimants on how they spent their time and what actions they could tolerate.

    ERISA Law Center

    Maher v. Massachusetts General Hospital Long Term Disability Plan | 665 F.3d 289 (1st Cir. 2011)

    In Maher v. Massachusetts General Hospital Long Term Disability Plan, we represented Ms. Maher in her long term disability claim against the plan established by her employer, Massachusetts General Hospital. Ms. Maher had worked as a Registered Nurse. She developed chronic abdominal pain and related symptoms which her physicians attributed to chronic pancreatitis, a pain syndrome, and fibromyalgia. She was prescribed substantial amounts of narcotic pain medications to control the pain. After receiving long term disability benefits for several years the plan administrator, Liberty Life Insurance Company of Boston, terminated her benefits. After Ms. Maher=s first appeal was denied by Liberty, she hired us. We submitted the second appeal, which was also denied. We then filed suit in district court. We lost at trial. We appealed. The First Circuit Court of Appeals ruled in Ms. Maher=s favor, remanded the case back to the district court with instructions to reconsider the claim. On remand the case settled. One of the key issues in our successful appeal of Ms. Maher’s case was Liberty’s and the plan’s misuse and mischaracterization of surveillance evidence. At every stage of Ms. Maher=s administrative appeal Liberty, the Plan and their reviewing doctors emphasized a claimed inconsistency between Ms. Maher=s self-reported limitations and her conduct depicted in surveillance videos, arguing that conduct was inconsistent with her disability status. But the First Circuit concluded, Ait is not apparent to us that any such inconsistency exists.@ Ms. Maher reported that her activities varied based on the extent of her pain, nausea, and opportunity to pre-medicate for activities, but she generally spent most of her days in bed. The First Circuit explained that in over 90 hours of surveillance, Athe most damming evidence@ the Plan identified was 15 minutes in which Ms. Maher carried a bucket or flowerpot and 30 minutes in which she played with her 3-year-old son in a park. On 10 of the 19 days of surveillance, Ms. Maher engaged in no activities. On other days she would sit or stand outside of her house with her husband for about 20 minutes. The Court reasoned: AThus, most of the surveillance, far from contradicting Maher=s disability, seems to confirm her lifestyle is generally housebound with occasional limited activities.@ The Court distinguished these facts from other cases in which videos showed activities that specifically contradicted claims made by the claimants on how they spent their time and what actions they could tolerate.

    ERISA Law Center

    Murphy v. Deloitte Touche | 619 F.3d 1151 (10th Cir. 2010)

    In Murphy v. Deloitte Touche, we represented Ms. Murphy in her long term disability claim against MetLife. Ms. Murphy had worked for Deloitte & Touche in a position which required travel, significant interaction and coordination with others, negotiations with the IRS, and advising clients on complex tax matters. She became disabled by co-morbid psychiatric and pain conditions as a result of severe back problem. The combination of her conditions together with her medications caused fatigue, balance and vision problems, memory and cognitive problems, as well as chronic pain. MetLife denied her claim for long term disability benefits; she submitted her own appeal, which was also denied. We filed suit on her behalf and sought discovery from MetLife regarding how its conflict of interest effected its decision. The district court prevented us from conducting any discovery and then ruled against Ms. Murphy. We appealed. The Tenth Circuit Court of Appeals held that the district court should have allowed us to conduct discovery regarding MetLife=s conflict of interest and ordered that we be permitted to do so to allow us to present evidence on the seriousness of MetLife=s conflict of interest and the likelihood it influenced MetLife=s decision-making process in Ms. Murphy’s case. On remand from the Tenth Circuit we conducted discovery and then the case settled. As a result of the Tenth Circuit’s opinion in Murphy v. Deloitte & Touche, other jurisdictions have adopted similar rules regarding ERISA discovery, enabling ERISA claimants throughout the United States to more effectively explore biased decision-making by insurance companies.

    ERISA Law Center

    Gardner v. Ameritech Sickness & Accident Disability Plan 2009 U.S. Dist. LEXIS 96065 | (C.D. Ill. Sept. 29, 2009)

    In Gardner v. Ameritech Sickness & Accident Disability Plan, we represented Ms. Gardner, who had been an employee of an AT&T subsidiary, working as a Marketing Support Specialist. Her job consisted primarily of communicating with customers via telephone and coordinating the provision of various user- related services. She began experiencing aching-type back pain, sought medical treatment, and was diagnosed with degenerative disc disease at L3-L4, L4-L5, L5-S1 and central and annular tears at L3-L4, L5-S1 discs. Ultimately, her doctors recommend surgery, but her medical carrier would not approve it, claiming that the surgery was experimental. In the meantime, Ms. Gardner=s claim for disability benefits was denied by AT&T=s third party administrator, Sedgwick Claims Management Services. We appealed the denial of Ms. Gardner=s short term and long term disability claims. Sedgwick CMS denied both appeals. We then filed suit. The only issue litigated in the lawsuit (which ultimately settled) was the standard of review. In ERISA litigation, there are two possible standards of review: de novo or abuse of discretion. When review is for abuse of discretion, the court defers to the plan=s decision as long as it is reasonable. Under abuse of discretion review, it is common for courts to sustain the plan=s decision, whether it is right or wrong, so long as it is reasonably based on substantial evidence. When review is de novo, the court disregards the plan=s decision, evaluates the claim on its own, and decides whether or not the claimant is entitled to benefits. Although de novo review does not guarantee that the claimant will prevail and abuse of discretion review does not guarantee that the plan will prevail, it is certainly easier for the claimant to prevail if review is de novo. In Ms. Gardner=s case, AT&T=s plan granted discretion to an internal benefits committee. The Plan claimed the benefits committee delegated discretion to Sedgwick CMS. We argued that since the delegation was not properly documented, review should be de novo. The Court agreed. Since review was de novo, the Court also authorized us to take depositions of the four doctors who evaluated Ms. Gardner=s records for Sedgwick with those depositions we demonstrated that the doctors= opinions were not well founded or consistent with established medical standards. The case then settled.

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