Boardman v. The Prudential Insurance Company of America, 337 F.3d 9 (1st Cir. 2003)

Former participant sues administrator under ERISA challenging termination of long-term disability benefits. U.S. District Court for District of Mass. Judge Judy Dein found summary judgment for defendant. Participant appealed. Court of Appeals First Circuit Judge Lipez affirmed. The Court held that plaintiff’s claim of Epstein Barr viral disease and paratitis when examined under an IME (independent medical examination) by Dr. Hurbert Caplan a rheumatologist,  was instead rheumatoid arthritis and secondary psychogenic disorder. The IME by Dr. Caplan indicated there was not enough evidence to show there was a limitation on plaintiff’s ability to perform her former job. The court looked at the patient’s history, objective findings, medications and activities she could perform. The Court therefore held, that plaintiff was not totally disabled. The court also held that benefits eligibility determined by SSA was not binding upon the disability insurance carrier.