Opinion ID: 204137
Heading Depth: 2
Heading Rank: 4

Heading: Cusson's Appeal and Further Tests

Text: On June 1, 2005, Cusson notified Liberty that she was appealing its decision to terminate her benefits. Cusson submitted various documents, including her own sworn statement; affidavits from her friends, family, and former colleagues; and a chart comparing the surveillance reports with her own recollection of her activities on the days she was surveilled. Cusson's sworn statement and activity chart indicate that on some of the days she was seen outside of her home, she would hit a wall and return home crying in pain. However, Cusson's activity chart is completely silent as to what she was doing, or what symptoms she was experiencing, on many days when she was not observed outside of her home. Cusson also submitted medical reports from in-person examinations by Dr. Peter Schur (Schur), a rheumatologist, and Drs. Daniel Cohen (Cohen) and Jean Matheson (Matheson), who specialize in sleep disorders. Schur's examination was paid for by Cusson's health insurer as part of her treatment. Schur's examination indicated that Cusson had limited motion in her shoulders, hips, and back; had fair muscle tone at best; and was painfully sensitive to touch. Schur concluded that Cusson was disabled at present, and recommended treatment options. Cohen and Matheson indicated that Cusson had trouble sleeping because of her pain, but they did not render an opinion as to disability. Cusson also submitted a report from Paul Blatchford, Ed. M. (Blatchford), a vocational rehabilitation expert, who conducted an in-person evaluation on February 15, 2005. Blatchford's report detailed Cusson's impaired performance on a variety of standardized vocational tests approved by the United States Department of Labor (DOL). The report noted that Cusson appeared exhausted and distracted throughout the entire proceeding. Blatchford noted that under DOL guidelines, the occupations for which Cusson was qualified required sedentary to light exertion levels. Blatchford concluded that Cusson's functional capacity precluded her from performing and sustaining any work-related activities. Blatchford also disputed Liberty's interpretation of the surveillance videos. He argued that the videos failed to address Cusson's cognitive limitations. He also noted that although the video showed that Cusson was capable of short periods of activity, a fact that she herself had reported, it did not show Cusson engaged in sustained activity that would be necessary for any kind of employment. On July 26, 2005, Liberty informed Cusson that it had referred her file for two peer reviews. Both reviews were paid for by Liberty. One review was conducted by Dr. Walter Longo (Longo), an oncologist, who determined that there was no objective data supporting ongoing impairment due to prior therapy for breast cancer, but that it was possible that Cusson could have limitations due to fibromyalgia. The other was conducted by Dr. Jeffrey Liebermann (Liebermann), a rheumatologist, who concluded that Cusson should be able to perform the duties of light or sedentary occupations despite her fibromyalgia, and that Cusson's impairments were entirely subjective. Liebermann also claimed to have spoken on the phone with Figueroa. Liebermann reported that during his conversation with Figueroa, Figueroa said that he had told Cusson that he no longer wished to be consulted about the disability aspects of her case. On August 11, 2005, Liebermann sent Figueroa a letter purporting to summarize their conversation and requesting that Figueroa review and make comments or corrections to the letter and fax it back to him. Figueroa did not sign the letter or return it. On September 7, 2005, Cusson underwent an examination by Dr. Mitchell Abramson (Abramson). Abramson reported that Cusson had multiple trigger points for pain and was unable to bend forward more than forty degrees due to back pain. Abramson concluded that Cusson appear[ed] to be disabled due to her medical illness. On September 9, 2005, Blatchford wrote an addendum to his February 15, 2005 report, stating that Liberty's interpretation of the surveillance reports was inaccurate, and contradicted by the videotapes themselves. Blatchford noted that the video of Cusson running errands was consistent with [Cusson's] ability to perform activities for limited periods of time, but that Cusson's need for frequent rest and her tendency to `fade' after engaging in any task for a sustained period of time showed that she lack[ed] the ability to engage in sustained work, whether sedentary or otherwise. Cusson submitted Abramson's report, Blatchford's addendum, and other documentation to Liberty on September 15, 2005. In response, Liberty conducted a second round of peer reviews. Both of these additional reviews were conducted by MLS National Medical Evaluations, Inc. (MLS) and paid for by Liberty. The first review was conducted by Dr. Reynold Karr (Karr), a rheumatologist, who concluded that he did not identify any objective medical basis for impairment or need for physical restrictions based upon review of the accompanying medical record. The second MLS review was conducted by Dr. Matthew Kaufman (Kaufman), an oncologist. Kaufman indicated that, from his perspective as an oncologist, there was no identifiable or medically supported level of functional impairment that can be objectively verified. However, Kaufman noted that fibromyalgia fell outside his area of expertise, and conceded that Cusson may have a level of functional impairment due to ... fibromyalgia and/or psychological overlay. On November 1, 2005, Liberty upheld its decision to terminate Cusson's benefits. Liberty stated that based on the totality of clinical and objective medical documentation contained in Ms. Cusson's file, sedentary to light capacity has been established.