Appeals Court Throws Out LTD Benefits Cutoff

April 28, 2005 ( - A federal appeals court has ruled that a long-term disability benefit plan administrator wrongly cut off benefits to a hospital clerk afflicted with uncontrollable hypertension.

The US 6 th Circuit Court of Appeals ruled in a 2-1 split decision that Unum Provident Corp. should not have cut off disability benefits to plaintiff Diane Moon after about a year after deciding that Moon’s affliction did not disable her from performing light work.

After running out of administrative appeals, Moon sued Unum Provident, but suffered a setback when Chief District Judge Robert Holmes Bell of the US District Court for the Western District of Michigan backed the disability provider. Moon asked the appeals court to review Bell’s ruling.

The majority of the appeals court reversed, finding that Unum acted arbitrarily and capriciously in terminating Moon’s benefits because it did not offer a reasoned explanation to support its conclusion that Moon was not disabled. The majority noted that “merely because our review must be deferential does not mean our review must also be inconsequential.”

According to the appeals opinion, the majority said the primary basis for Unum’s physician for rejecting the view of Moon’s treating physician was a blood pressure measurement that showed Moon had higher blood pressure when lying down than when sitting. Unum’s physician said that based on this, the hypertension did not prevent sitting and working. This one measurement did not support a reasoned explanation for the termination of benefits in light of the administrative record available to Unum’s physician, which supported the finding that Moon was disabled, the majority said.

“Rather than contend with the reality that all of the doctors who examined Moon agreed she had chronic and severe hypertension which was not susceptible to successful treatment, (Unum’s physician) seized upon a single blood pressures measurement performed by a doctor who himself cautioned that Moon’s hypertension appeared to be intractable,” the appeals judges wrote.

The full opinion in Moon v. Unum Provident Corp., 6th Cir., No. 03-1626, 4/12/05 is  here .