Colby v. Union Security Insurance Co. & Management Co. for Merrimack Anesthesia Associates Long Term Disability Plan, 705 F.3d 58

Dr. Julie Colby, a physician, worked 60–90 hours/week as a partner at MVAA until July 2004 when she tested positive for fentanyl and revealed opioid dependence.
She entered inpatient treatment at Talbott Recovery Campus and was diagnosed with opioid dependence, dysthymic disorder, and obsessive-compulsive traits; back pain and depression were also noted.
MVAA had an ERISA-governed long-term disability plan administered by USIC, with a 90-day waiting period and a 36-month occupation-based coverage window.
USIC initially paid LTD from end of the waiting period through Talbott but refused further benefits, deeming relapse risk not a current disability.
Colby pursued administrative appeals, then filed suit; district court found USIC’s categorical relapse exclusion unreasonable and remanded for analysis of relapse probability.
On remand, the district court awarded Colby LTD for the remaining 36 months; USIC sought reversal, leading to the current appeal.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Can risk of relapse be a current disability under the occupation test?	Colby asserts relapse risk can render her disabled.	USIC contends relapse risk is not a current disability and not covered.	Yes; relapse risk can constitute a current disability under the plan.
Does plan language exclude risk of relapse from coverage if not expressly stated?	Plan silence on relapse means no unwritten exclusion should apply.	Plan excludes only conditions explicitly described; relapse is not covered.	No unwritten exclusion; implicit exclusions cannot override plan language.
What standard governs review of ERISA plan denials in this context?	Court should apply deferential review to the administrator’s decision.	Same deference but with a broader emphasis on objective proof.	Abuse of discretion (arbitrary and capricious) with substantial evidence required.
Was retroactive reinstatement of benefits an appropriate remedy?	District court’s retroactive LTD is proper given improper denial.	Remand or alternative remedies could be appropriate; not necessarily retroactive.	Retroactive LTD benefits appropriate; not abuse of discretion to award.

Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (Supreme Court 1989) (establishes deferential abuse-of-discretion review for ERISA plans)
Conkright v. Frommert, 130 S. Ct. 1640 (Supreme Court 2010) (resources-based review with deference to plan interpretations)
D & H Therapy Assocs., LLC v. Boston Mutual Life Ins. Co., 640 F.3d 27 (1st Cir. 2011) (emphasizes substantial evidence and reasonableness under deferential review)
Leahy v. Raytheon Co., 315 F.3d 11 (1st Cir. 2002) (clarifies standard of review and evidence considerations)
Massachusetts Nat'l Bank v. B & T Masonry Constr. Co., 382 F.3d 36 (1st Cir. 2004) (strictly construes ambiguities against insurer in exclusions)
Stanford v. Cont'l Cas. Co., 514 F.3d 354 (4th Cir. 2008) (discusses relapse-related disability in LTD denial context)
Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105 (Supreme Court 2008) (confirms considering insurer's dual role as a factor in review)