Chretien v. Sedgwick Claims Management Services, Inc.

Filing 37

OPINION AND ORDER adopting 30 Report and Recommendations; granting 15 Motion for Summary Judgment filed by Sedgwick Claims Management Services, Inc.; denying 19 Motion for Summary Judgment filed by Darlene Chretien. So Ordered by Judge William E. Smith on 9/30/13. (Jackson, Ryan)

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF RHODE ISLAND
______________________________
)
)
)
)
v.
)
)
SEDGWICK CLAIMS MANAGEMENT
)
SERVICES, INC.,
)
Defendant.
)
______________________________)
DARLENE CHRETIEN,
Plaintiff,

C.A. No. 12-348 S

OPINION AND ORDER
WILLIAM E. SMITH, United States District Judge.
Plaintiff

Darlene

Chretien

brought

this

suit

under

the

Employee Retirement Income Security Act of 1974 (“ERISA”), 29
U.S.C. §§ 1132(a), (e), (f) and (g), following the denial of her
claim for long-term disability benefits by Defendant, Sedgwick
Claims

Management

Sedgwick

serves

Protection

Plan

Services,
as
for

Inc.

third-party
Store

(“Defendant”
administrator

Managers

(the

or
for

“Plan”)

“Sedgwick”).
the

Income

offered

by

Plaintiff’s former employer, Walgreen Company. 1

1

Before the Court is a Summary Plan Description (“SPD”),
outlining in detail the terms of the Plan.
(Ex. D to Def.’s
Statement of Undisputed Facts (“Def.’s SUF”), ECF No. 16-4.)
The SPD should not, however, be confused with the Plan itself,
which is not in the record.
The Supreme Court has stated that
an SPD “is not itself part of the plan.” CIGNA Corp. v. Amara,
131 S. Ct. 1866, 1877 (2011) (emphasis omitted). The Court has
drawn a distinction between the enforceability of a summary
description and the language of the plan itself.
Id. at 187778.
Here, while the Plan is not in the record, neither party
contends that it materially differs from the SPD.

On July 25, 2013, United States Magistrate Judge Lincoln D.
Almond issued a Report and Recommendation (“R&R”) with respect
to

cross

motions

(ECF No. 30.)

for

summary

judgment

filed

by

the

parties.

Judge Almond recommended that this Court grant

Defendant’s motion, and deny Plaintiff’s motion.
Plaintiff

objects

to

the

R&R

on

three

grounds,

arguing

that: (1) Judge Almond improperly relied solely on Defendant’s
statement of undisputed facts (“Def.’s SUF”); (2) Judge Almond
misinterpreted
(“SPD”);

and

supported

by

the
(3)

terms

the

of

denial

substantial

the
of

Summary

Plan

Plaintiff’s

evidence.

(Mem.

Objections to the R&R, ECF No. 35.)

Description

benefits
in

was

Supp.

of

not

Pl.’s

For the reasons set forth

below, this Court adopts the R&R and overrules the objections.
I.

Facts
Although

the

R&R

contains

a

thorough

recitation

of

the

factual history, it is worthwhile to highlight several portions
in order to properly address Plaintiff’s objections.

Under the

terms of the Plan, as described in the SPD, an employee is
“disabled” if he or she satisfies a two-prong test.
Def.’s SUF, ECF No. 16-4.)
employee

is]

prevented

(Ex. D to

First, “due to sickness . . . [the

from

performing

one

or

more

of

the

essential duties of [the employee’s] own occupation and [the
employee is] receiving appropriate care and treatment from a
doctor on a continuing basis.”

(Id.)

2

Second, “for the first 18

months of long-term benefits, [the employee is] unable to earn
more than 80% of [the employee’s] pre-disability earnings or
indexed

pre-disability

earnings

at

[the

employee’s]

own

occupation from any employer in [the employee’s] local economy”
or “following that 18 month period, [the employee is] unable to
earn more than 60% of [the employee’s] indexed pre-disability
earnings from any employer in [the employee’s] local economy at
any gainful occupation for which [the employee is] reasonably
qualified,

taking

into

account

[the

employee’s]

education, experience, and pre-disability earnings.”
Two

further

objections.

provisions

First,

the

are

SPD

relevant

provides

that

to

training,
(Id.)
Plaintiff’s

“[b]enefits

are

limited to a total of 24 months during [an employee’s] lifetime
if [the employee is] disabled due to mental or nervous disorders
or diseases . . . .”
that

Plaintiff

period

of

September

(Id.)

received

twenty-four
2010,

based

This provision is significant in

shortmonths

in

part

and

long-term

between
on

a

benefits

September

diagnosis

of

for

2008

a

and

depression,

before being informed that she was no longer eligible to do so
because Sedgwick’s reviewing physicians had determined that she
was not disabled. 2

(Pl.’s Statement of Undisputed Facts (“Pl.’s

SUF”) ¶¶ 11, 16 and 24, ECF No. 20.)

2

Plaintiff alleges that, in addition to depression, she
suffers from fibromyalgia, migraines, a colloid cyst, restless
3

Second,

relevant

to

Plaintiff’s

objection

as

to

the

sufficiency of the evidence underlying Sedgwick’s denial of her
claim for benefits, the SPD provides that “[Sedgwick] and [an
officer of Walgreen Company] will apply their judgment to claims
and appeals in a manner that they deem to be consistent with the
Plan and any rules, regulations or prior interpretations of the
Plan.” 3

(Ex. E to Def.’s SUF, ECF No. 16-5.)

As it is relevant to Plaintiff’s first objection, it should
be noted that Judge Almond states at the outset of his R&R that
his recitation of the factual history derived from Def.’s SUF.
(See R&R 1.)

However, Judge Almond further states in a footnote

that he also reviewed and considered Pl.’s SUF.
II.

(Id.)

Discussion
This Court reviews de novo those portions of the R&R to

which Plaintiff objects.

28 U.S.C. § 636(b)(1)(C).

Plaintiff’s

first argument, regarding Judge Almond’s reliance on Def.’s SUF,
is without merit.

As an initial matter, Plaintiff was obliged

to raise any factual inaccuracies contained in Def.’s SUF in the
form of a statement of disputed facts.

(See LR Cv 56(a)(3).)

leg syndrome, blindness in one eye, and back and neck problems.
(Pl.’s Mot. for Summ. J. 5, ECF No. 19.)
3

Although the SPD reserves discretion to both Sedgwick and
a Walgreen Company officer, in this case, the Walgreen Company
officer was uninvolved in the resolution of Plaintiff’s claim.
(Def.’s SUF ¶ 19, ECF No. 16.)

4

Plaintiff did file such a statement (“Pl.’s SDF”), but raised
just one minor distinction, effectively admitting the remainder
of Def.’s SUF.
Even

(Pl.’s SDF, ECF No. 25.)

setting

aside

cannot be sustained.

this

admission,

Plaintiff’s

Judge Almond’s footnote clearly indicates

that he also reviewed and considered Pl.’s SUF.
principal

reliance

consequence.

on

This

objection

Pl.’s

Court

SUF

or

reviewed

Def.’s

the

Judge Almond’s
SUF

relevant

is

of

no

documents

in

detail and found that they present a remarkably similar version
of events.

Any differences are ultimately immaterial.

Plaintiff
the

SPD’s

next

language

“disabled.”

In

disputes
with

Judge

respect

effect,

to

Plaintiff

Almond’s
the

interpretation

meaning

argues

that

of

the

of

term

because

she

received twenty-four months of coverage based on her diagnosis
of depression, she should automatically satisfy the first prong
of the definition of “disabled,” and Judge Almond improperly
declined to conduct an earnings analysis under the second prong.
Upon review of the relevant provisions described in the
SPD,

this

Sedgwick

Court

concurs

appropriately

Plaintiff’s claim.
489

U.S.

101,

111,

with

Judge

interpreted

Almond’s

and

applied

finding
the

that

SPD

to

See Firestone Tire & Rubber Co. v. Bruch,
115

(1989)

(holding

that

where

an

ERISA

benefit plan gives the administrator discretionary authority to

5

construe terms of the plan, the administrator’s construction of
disputed terms should not be disturbed if reasonable).
It would be an incorrect reading of the SPD to conclude
that because an employee was eligible to receive benefits based
on a diagnosis of depression, the employee could then rely on
that same disorder to get around the twenty-four month cap on
coverage

for

twenty-four

mental
months

disorders.

By

related

her

to

collecting

benefits

depression,

for

Plaintiff

exhausted her eligibility for coverage for mental disorders, and
would

have

had

to

separately

meet

the

SPD’s

definition

of

“disabled” based on her alleged physical ailments.
Finally, Plaintiff argues that the denial of her benefits
was not supported by substantial evidence in the record.
in

ERISA

cases

such

as

this

one,

the

Plan

gives

Where,

the

claim

administrator discretion to determine eligibility for benefits,
courts

must

uphold

the

decision

unless

capricious, or an abuse of discretion.” 4

it

is

“arbitrary,

Cusson v. Liberty Life

Assurance Co., 592 F.3d 215, 224 (1st Cir. 2010) (quoting Gannon
v. Metro Life Ins. Co., 360 F.3d 211, 213 (1st Cir. 2004)).

4

The

As discussed previously, the Court reviewed only the SPD,
as the Plan itself is not in the record. Neither party suggests
that the SPD differs from the Plan, and both parties concur that
because Sedgwick has discretion to administer the Plan, the
arbitrary and capricious standard applies.
The Court considers
waived any contention that (1) the SPD improperly describes
Sedgwick’s discretion to administer the Plan and (2) a standard
other than the arbitrary and capricious standard applies.
6

standard asks “whether a factfinder’s decision is plausible in
light of the record as a whole, or, put another way, whether the
decision is supported by substantial evidence in the record.”
Leahy v. Raytheon Co., 315 F.3d 11, 17 (1st Cir. 2002) (internal
citations

omitted).

“Evidence

is

substantial

if

it

is

reasonably sufficient to support a conclusion, and the existence
of

contrary

evidence

does

not,

administrator’s decision arbitrary.”
The
medical

R&R

thoroughly

evidence

and

explores

summarizes

in

itself,

make

the

Gannon, 360 F.3d at 213.
the
the

hundreds
various,

of
and

pages
at

of

times

differing, opinions of Plaintiff’s doctors and those hired by
Defendant to evaluate her case.

(See R&R 1-13.)

Upon careful

review, this Court is satisfied that Sedgwick’s determination as
to Plaintiff’s eligibility was thorough, reasoned, and based on
substantial medical evidence.
III. Conclusion
Because this Court agrees with Judge Almond’s findings, it
adopts

his

Plaintiff’s

R&R
motion

pursuant
for

to

summary

28

U.S.C.
judgment

§
is

Defendant’s motion for summary judgment is GRANTED.
IT IS SO ORDERED.

/s/ William E. Smith
William E. Smith
United States District Judge
Date: September 30, 2013

7

636(b)(1)(C).
DENIED,

and