This case involves James Ampe (\u201cAmpe\u201d), a Senior Development and Test Engineer employed by MIT Lincoln Laboratories (\u201cMIT\u201d). Ampe\u2019s job duties included not only traditional electrical engineer work, but also regular client interactions. He was employed by the company from 2008 to January 26, 2015.<\/p>\n
Around August 2011, Ampe injured himself when he fell and hit his head in his home bathroom. Subsequent to this injury, he began to experience issues with focusing in loud environments, inability to concentrate, and cognitive fatigue. Ampe consulted Dr. Sheba Khumbani, a neurologist, and she found that Ampe was \u201cfunctioning in the average range for verbal abilities and in the very superior range for visual-spatial skills\u201d and that he \u201cexperienced a significant decline since the possible concussion and his residual symptoms, including physical, cognitive, and emotional\/behavioral changes, are consistent with what is often seen in post-concussive syndrome<\/a>.\u201d<\/p>\n Regardless of Dr. Khumbani\u2019s diagnosis, Ampe remained at work and occasionally took FMLA leave. Over the next few years, Ampe\u2019s performance reviews decreased in quality. After a particularly poor review in 2014, the company stated that it would no longer offer accommodations to Ampe and suggested that he seek\u00a0long-term disability (LTD)<\/a>\u00a0benefits with\u00a0The Prudential Insurance Company of America\u00a0(\u201cPrudential\u201d)<\/a>. Ampe sought LTD benefits on February 14, 2015. MIT\u2019s Plan defined disability as follows:<\/p>\n \u201cYou will be considered totally disabled if you are prevented by bodily injury, sickness, disease, or mental disorder from engaging in your\u00a0own\u00a0<\/em>occupation. After the first 24 months, you will be considered totally disabled\u00a0only if<\/em>\u00a0you are prevented by bodily injury, sickness, disease, or mental disorder from engaging in\u00a0any<\/em>\u00a0occupation<\/a> for which you are reasonably fitted by education, training, or experience.\u201d<\/p><\/blockquote>\n When Ampe began to gather information for his LTD claim, he reached out to his treating physician, Dr. Seth Hermann. Dr. Hermann stated that Ampe \u201ccontinues to be limited by post brain injury symptoms, especially dizziness, fatigue, headache, nausea,\u00a0confusion, [sic<\/em>] irritability. He is not able to tolerate work and 32 hours or more of work is not medically feasible.\u201d He further stated that<\/p>\n \u201cMr. Ampe\u2019s\u00a0post-concussion syndrome\u00a0symptoms and condition are causally related to his fall on 8\/29\/2011 . . . . Some patients never return to [sic<\/em>] prior level of functioning. What we do know is that up to 5 to 15% continue to suffer persistent post concussions symptoms.\u201d<\/p><\/blockquote>\n Later, on April 27, 2015, Prudential\u2019s Vice President and Medical Director, Dr. Rajesh Wadhwa, rejected Ampe\u2019s LTD claim. His reasoning stemmed from a belief that Dr. Khumbani failed to perform \u201cvalidity testing\u201d for her diagnosis and that Dr. Hermann\u2019s report and other physical therapy records were \u201cnot relevant and current.\u201d Dr. Wadhwa, however, asked that Prudential \u201cplease consider [a] fresh neuropsychiatric IME.\u201d MIT did not wish to pay for this exam, and Ampe offered to assist with the cost; his offer was declined. On May 11, 2015, Ampe\u2019s claim was formally denied for the reasons that Dr. Wadhwa gave.<\/p>\n