Colby v. Union Sec. Ins. Co.

In this 2013 ERISA case, the plaintiff claimant exhausted her administrative appeals and brought suit against defendant long term disability plan administrator. The parties cross-moved for judgment on the record and the United States District Court for the District of Massachusetts deemed the administrator’s termination of benefits unreasonable. The administrator appealed.

The central question was whether, in addiction context, a risk of relapse could be so significant as to constitute a current disability. Although its decision created a circuit split, the instant court answered the question affirmatively. A risk of relapse into substance dependence – like a risk of relapse into cardiac distress or a risk of relapse into orthopedic complications – could swell to so significant a level as to constitute a current disability. The holding was narrow. It pivoted on a fusion of the plain language of the plan and the administrator’s all-or-nothing approach to its benefits determination. The administrator could have written into the plan an exclusion for the risk of relapse, but it did not choose to do so. Without such a written exclusion in place, the administrator acted arbitrarily and capriciously in refusing to consider whether the claimant’s risk of relapse swelled to the level of a disabililty. A benefits determination could not be reasoned when the plan administrator sidestepped the central inquiry. Further, the district court did not abuse its discretion in awarding retroactive benefits. It already had remanded the case once, to no avail.

The district court’s decision was affirmed.

If you need assistance navigating your claim for short term or long-term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com.  We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee.  We offer a free consultation and would love to speak with you.