Colby v. Assurant Employee Benefits
818 F. Supp. 2d 365
D. Mass.2011Background
- ERISA action by Dr. Colby seeking LTD benefits and fees after USIC terminated benefits following rehab for opioid dependence.
- Dr. Colby’s back pain and degenerative disc disease overlapped with opioid dependence; she treated pain with fentanyl, became addicted, and entered Talbott Recovery Campus in 2004.
- USIC initially granted LTD benefits during Talbott rehab, then terminated benefits after discharge indicating relapse risk is not a current disability.
- Colby I (2009) held USIC could not categorically exclude relapse risk and remanded for analysis of relapse risk against the Plan.
- USIC denied post-Colby I remand claims again on grounds of no disability and later suggested a reasonable accommodation (shadow) as a basis to deny benefits.
- This action, reopened in 2009, proceeded as a case stated with cross-motions for summary judgment on the administrative record.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether relapse risk can qualify as a disability under the Plan. | Colby argues relapse risk is a disability under the Plan and cannot be categorically excluded. | USIC contends relapse risk is not a current disability and may be addressed by reasonable accommodation. | Yes; relapse risk can qualify if sufficiently high; categorical exclusion is unreasonable. |
| Standard of review in light of Glenn and Conkright. | Colby argues conflict-of-interest and deference issues require deferential review but meaningful consideration of relapse risk. | USIC argues Conkright defers to administrator interpretations; no need to disturb reasonable interpretation. | Deferential review with Glenn/Conkright framework; conflict considered as a factor. |
| Whether USIC’s post-Colby I denial rested on reasonable accommodation or disability. | Colby contends accommodation grounds were not properly explored and contradicted Colby I mandate. | USIC argued a shadow accommodation could disqualify Colby from LTD. | Reasonable accommodation evidence insufficient; accommodation analysis not properly followed. |
| Remedy for arbitrariness in denial. | Colby seeks retroactive LTD benefits for 36 months and attorney’s fees. | USIC disputes remedy scope. | Retroactive LTD benefits for 36 months plus attorney’s fees awarded; fees to be finalised. |
Key Cases Cited
- Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105 (U.S. 2008) (conflict of interest may be considered as a factor in review under ERISA)
- Conkright v. Frommert, 130 S. Ct. 1640 (U.S. 2010) (plan interpretation entitled to deference; not a per se bar to review)
- Stanford v. Continental Casualty Co., 514 F.3d 354 (4th Cir. 2008) (argued as contrary approach to relapse risk; rejected here for LTD plans treating physical and mental impairments alike)
- Kufner v. Jefferson-Pilot Fin. Ins. Co., 595 F. Supp. 2d 785 (W.D. Mich. 2009) (recognizes relapse risk could support disability where evidence shows high probability of relapse)
- Colby v. Assurant Employee Benefits, 603 F. Supp. 2d 223 (D. Mass. 2009) (Colby I; holding categorical exclusion of relapse risk was unlawful)