Brigham v. Sun Life of Canada

183 F.Supp.2d 427

Bradley B. BRIGHAM, Plaintiff, v. SUN LIFE OF CANADA, Defendant.

No. Civ.A. 00-30182-MAP.

United States District Court, D. Massachusetts.

February 6, 2002.

Cristobal Bonifaz, Amherst, MA, for Plaintiff.

Joseph M. Hamilton, Jay P. Symonds, Mirick, O'Connell, DeMallie & Lougee, Worcester, MA, for Defendant.

MEMORANDUM REGARDING DEFENDANT'S AND PLAINTIFF'S MOTIONS FOR SUMMARY JUDGMENT (Docket Nos. 35 and 39)

PONSOR, District Judge.

I. INTRODUCTION

Plaintiff Bradley Brigham brought suit against Sun Life of Canada ("Sun Life") after Sun Life terminated his long term disability benefits. In his three-count complaint, Brigham alleged violations of Mass.Gen.Laws ch. 93A, breach of contract, and violations of 29 U.S.C. §§ 1001 et. seq. ("ERISA"). In April of 1999, this court granted summary judgment for the defendant on Counts one and two after finding that those counts were preempted by ERISA. Both parties now move for summary judgment on the third and final count of the complaint. For the reasons set forth below, this court will allow defendant's motion and deny plaintiff's.

II. FACTS

The facts are essentially undisputed. Bradley Brigham ("Brigham") is a 45-year-old male who resides in Colrain, Massachusetts. (Docket No. 1 at 2; Docket No. 41 at 1). At the age of 16, he was injured in a motorcycle accident that rendered him paraplegic. (Docket No. 41 at 1). Despite this devastating injury, Brigham diligently pursued a rehabilitation program, which enabled him to become self sufficient in the activities of daily life. (Docket No. 41 at 1). He also attended Williams College and Amherst College and now holds a Masters Degree. (Docket No. 37 at 1). From 1986 to 1990, Brigham worked for a social services organization as interim executive director. This job required him to supervise thirty employees and three offices. (Docket No. 22 at 109).

In Spring of 1990, Brigham began to work as a job placement specialist with Community Enterprises, Inc. ("Community Enterprises"), another social services organization. In this capacity, he served as an advisor regarding the employment of handicapped persons. (Docket No. 41 at 1). The job required him to visit various employers each day, resulting in frequent transfers from his car to his wheelchair and back. These car-to-wheelchair transfers required Brigham to lift his wheelchair out of and into his car. The regular strain of this task caused him to twist his upper torso in an awkward manner and use his arms both more frequently and more vigorously than he previously had. (Docket No. 41 at 1-2).

On September 1, 1992, Sun Life issued an Employee Group Benefit Plan to Community Enterprises, which provided Community employees with both short term and long term disability benefits. (Docket No. 22 at 1-26). The Plan provides long term disability benefits for the first sixty months of a totally disabling illness if it prevents the employee "from performing all the material duties of his regular occupation." (Docket No. 22 at 35) (emphasis supplied). To qualify for long term benefits after the sixty-month mark, the employee's illness must prevent him "from engaging in any occupation for which he is or becomes reasonably qualified by education, training, or experience." (Docket No. 22 at 35) (emphasis supplied). In order to qualify for benefits, proof of disability must be satisfactory to Sun Life.¹

In August of 1992, Brigham consulted his family doctor, Dr. Christopher French ("Dr.French") due to pain in his left side. He underwent a series of tests and evaluations, which revealed that the pain was the result of muscle strain, which was itself caused by the frequent car to wheelchair transfers. (Docket No. 41 at 2).

In June of 1993, Brigham developed a respiratory tract infection that caused him to have severe coughing spells. The combination of the left side pain and the coughing spells was so overwhelming that Brigham had to stop working. In July of 1993, Brigham applied for short term disability benefits under the contract between Community Enterprises and Sun Life. (Docket No. 22 at 79). He was thereafter placed on short term disability insurance for six months. (Docket No. 41 at 2). In December of 1993, a month before the short term benefits were scheduled to expire, Brigham applied for long term disability benefits under the provision covering disability from his "regular" occupation, citing pain and spasms due to severe back and side strain as the cause of his disability. (Docket No. 22 at 93).

In the Attending Physician Statement ("APS") that was submitted on December 21, 1993, Dr. French opined that Brigham was incapable of performing his own job because "the strain of frequent transfer from [his] car [is an] intolerable physical symptom." (Docket No. 22 at 98). However, Dr. French categorized Brigham's physical impairment as a "[m]oderate limitation of functional capacity; capable of clerical/administrative (sedentary) activity." This description put Brigham's disability in "Class 4" (out of 5) on the APS. (Docket No. 22 at 98). Even though he stated that Brigham was totally disabled, Dr. French believed that he was a "good candidate for more sedentary work but to do that he must get retraining." Id. at 98. Dr. French submitted no objective medical evidence in support of his conclusions. Id.

In January of 1994, the Social Security Administration ("SSA") approved Brigham's application for Long Term Disability payments. (Docket No. 41 at 2). Shortly afterwards, on February 16, 1994, Sun Life approved the payment of Long Term Disability Payments to Brigham under the "regular" occupation provision. After discounting the $529.00 that Brigham received each month from the SSA, Sun Life granted Brigham benefits in the amount of $777.07 per month. (Docket No. 41 at 3).

On February 28, 1994, Sun Life offered vocational rehabilitation services to Brigham. After conversing with Brigham via phone, the vocational training specialist noted Brigham's doubts concerning the availability of opportunities for someone with his experience and disability, and offered her opinion that Brigham's concerns were probably well founded. (Docket No. 41 at 3). In the record of their conversation dated March 11, 1994, the specialist also noted that Brigham had formally applied to law school and that it appeared that he was not in need of assistance. (Docket No. 41 at 3; Docket No. 22 at 126).

In March of 1994, Sun Life asked Dr. French for an update on Brigham's medical condition. In a letter dated March 31, 1994, Dr. French responded:

[Brigham] is a paraplegic who developed left side and hip pain secondary to [the] frequent car to chair transfer [that] his work requires. These symptoms have improved following several months of leave from work. I believe that he should avoid situations that require frequent car to chair transfers.

(Docket No. 22 at 129).

On May 16, 1994, Sun Life's medical consultant reviewed Brigham's file and noted that there was no objective evidence of any disability. (Docket No. 22 at 144). On the APS forms, it was clearly written that acceptable "objective findings" included "current x-rays, EKG's, laboratory dates and any clinical findings." (Docket No. 22 at 97). Nonetheless, Sun Life decided to continue paying benefits, pending confirmation of the number of car to chair transfers that was required for Brigham's job. (Docket No. 2 at 149).

On July 8, 1994, Sun Life carried out an extensive interview with Brigham for the purpose of assessing his condition. At that time, Brigham re-stated his belief, as well as that of Dr. French, that his disability was caused "by taking his wheelchair in and out of the back seat to his vehicle 15 to 20 times a day while calling on businesses, which was part of his duties at work." (Docket No. 22 at 159).

In October of 1994, Brigham submitted his third APS from Dr. French. Once again, Dr. French's diagnosis was low back strain, but he failed to give objective medical evidence to support his conclusion beyond his own opinion. (Docket No. 22 at 172). Furthermore, Dr. French reported that Brigham's condition remained unchanged, but nevertheless increased the level of Brigham's physical impairment to Class 5, a "[s]evere limitation of functional capacity; incapable of minimal (sedentary) activity." (Docket No. 22 at 173). In noting his prognosis, Dr. French found that Brigham was totally disabled. Again, however, under the section entitled "Rehabilitation," Dr. French indicated, somewhat inconsistently, that a job modification would enable Brigham to work despite his impairment. Specifically, he stated that Brigham would be able to work if his job did not involve getting into and out of his car. (Docket No. 22 at 173).

In a letter dated November 9, 1994, Dr. French stated that Brigham's back pain had improved since he stopped working. However, he opined that the problems would resurface if Brigham were to return to his current job; Dr. French recommended instead that he be placed in a job that did not require him to get in and out of his car all day. (Docket No. 22 at 197). On December 7, 1994, Dr. French stated in a conversation with a Sun Life representative that Brigham's condition had improved and that the muscle strain had resolved. (Docket No. 22 at 208). About two weeks later, Maureen Speed ("Speed"), Sun Life's medical consultant, contacted Dr. French to clarify his November 9, 1994 letter. At that time, Dr. French informed Speed that Brigham was indeed able to get in to and out of his car, but if he had to do it ten to twelve times a day he might have a recurrence of pain. (Docket No. 22 at 219).

On January 4, 1995, Sun Life cancelled Brigham's Long Term Disability benefits based on the medical evidence in his file and the conversation between Dr. French and Speed, which led it to conclude that he was no longer disabled from performing his regular occupation. (Docket No. 22 at 223). Brigham thereafter...