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12-cv-10512-DJC

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Case Summary: Gregory Cannon v. Aetna Life Insurance Company, et al, 12-cv-10512-DJC, (D. Mass.)

Plaintiff Gregory Cannon brought this action against Defendants, the PharMerica Temporary Disability Income Plan and the plan’s claims fiduciary, Aetna Life Insurance Company, under the Employee Retirement Income Security Act (ERISA).  Plaintiff’s complaint argued that the Defendants improperly denied him short-term disability benefits.

In August 2010, Plaintiff sought medical treatment for a litany of symptoms.  The examining doctor attributed the symptoms to Lyme’s Disease and noted Plaintiff was not in acute distress.  At that time, Plaintiff was employed by PharMerica and enrolled in its Temporary Disability Income Plan, an ERISA-governed welfare benefits plan administered by Aetna.  Plaintiff then filed a claim with Defendants for short-term disability.  Aetna initially approved the claim but, after peer review by another doctor, terminated his benefits soon thereafter. 

Plaintiff appealed the termination after spending three nights in an emergency room in December 2010.  Aetna submitted Plaintiff’s file to another independent physician specializing in internal medicine, but this file did not include records from his primary care physician.  This physician responded with a report to Aetna but noted the absence of the primary care physician’s records and its adverse effect on her findings.  Aetna granted short-term disability for the three nights spent in the emergency room but otherwise reaffirmed its original termination of benefits.  Plaintiff filed suit on March 21, 2012, in the District of Massachusetts, alleging that he is entitled to short-term and long-term benefits.

Plaintiff and Defendants each moved for summary judgment.  This video shows the July 19, 2013 hearing on the cross motions.  The court denied Defendants’ motion and granted Plaintiff’s motion in part.  The Court remanded the matter to Aetna to allow the independent, reviewing physicians to update their reports after the Plaintiff’s file is supplemented with the additional medical records from Plaintiff’s primary care physician.

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Case Highlights

  • Complaint filed 3/21/2012 (Doc #1)
  • Answer filed 5/14/2012 (Doc #7)
  • Defendant filed Motion for Summary Judgment 2/26/2013 (Doc #36)
  • Plaintiff filed Motion for Summary Judgment 2/26/2013 (Doc #39)
  • Hearing held on cross motions 7/19/2013 (Doc #51)
  • Order entered granting in part Plaintiff’s motion 9/17/2013 (Doc #52)

 

Case-related documents, including those referenced above, are available via the Public Access to Court Electronic Records (PACER) service. For more information, visit Pacer.gov.