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“Deborah Maher V. Massachusetts General Hospital Long-Term Disability Plan”

Deborah Maher v. Massachusetts General Hospital Long-Term Disability Plan”

665 F.3d 289 (1st Cir. 2011)

We represented Deborah Maher in her long-term disability claim against her employer, Massachusetts General Hospital. Ms. Maher worked as a Registered Nurse. She developed chronic abdominal pain and related symptoms which her physicians attributed to chronic pancreatitis, chronic pain syndrome, and fibromyalgia. She was prescribed large 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 to submit a second appeal on her behalf.

We filed the second appeal, which was also denied. We then filed suit in federal district court. We lost at trial.

We then appealed to the First Circuit Court of Appeals. The First Circuit ruled in Ms. Maher’s favor, remanded the case back to the district court with instructions that it reconsidered its decision on remand the case settled.

One of the key issues discussed by the Court in Ms. Maher’s case was the Liberty’s and its doctors’ mischaracterization of surveillance of Ms. Maher.

Liberty caused Ms. Maher to be routinely secretly surveilled. At every stage of Ms. Maher’s claim, Liberty and its reviewing doctors emphasized a claimed inconsistency between Ms. Maher’s self-reported limitations and her conduct as depicted in the surveillance. But the 1st Circuit explained, 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 Court explained that in over 90 hours of surveillance, The most damning evidence the Plan identified was 15 minutes in which Ms. Maher carried a bucket or flowerpot and 30 minutes she played with her three-year-old son in the park. On 10 of the 19 days of the surveillance videos available, Ms. Maher engaged no activities. On other days, she would sit or stand outside of her house with her husband for about 20 minutes. The Court reasoned that most of the surveillance far from contradicted Maher’s disability and seemed to confirm her lifestyle is generally housebound with occasional limited activities. The Court distinguished these facts from other cases in which the video showed activities that specifically contradicted claims made by the claimant on how she spent her time and what actions she could tolerate.

The second important factor relied upon by the plan was Ms. Maher failed to provide supporting evidence of disability from her pain clinics. But the Court noted that in her appeal, Ms. Maher explained her attempts to obtain documentation from those clinics and offer releases to allow Liberty access to the information. She also offered to be examined by the doctor of Liberty’s choosing. Since two of the three pain clinics were MGH affiliated, the information should have been available.

A partially dissenting judge argued that the Court should not merely remand the case to the district court for reconsideration, but that it remand the case with an order that it enter judgment in favor of Ms. Maher. That judge reasoned that the records of Ms. Maher’s chronic pain, nausea, vomiting and food intolerance was persuasive evidence that she was disabled from performing the duties of the jobs identified by the Plan and therefore Ms. Maher was entitled to her benefits.