Appellate Court Upholds LTD Finding

September 13, 2005 ( - A federal appellate court has upheld a lower court ruling that a long-term disability plan administrator could reasonably decide that a participant's bipolar disorder was a mental disease - a determination that limited plan coverage.

In agreeing with Senior US District Judge Frederic Block of the US District Court for the Eastern District of New York, the US 2 nd Circuit Court of Appeals cleared the administrator of the JPMorgan & Co. plan of wrongdoing.

Appellate judges said the administrator’s decision was reasonable given that it consulted the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), published by the American Psychiatric Association. In so ruling, the court rejected plaintiff Christine Fuller’s contention that the administrator’s decision was unreasonable because bipolar disorder has a physical cause.

“It may well be that bipolarity is a manifestation of a chemical or electrical reaction in the brain and that it may be said to arise ultimately from a physical cause. But the issue under the Plan wording is whether Fuller’s ‘[d]isability’ ‘arises from’ a mental disorder, a question quite distinct from whether the disorder itself arises from a physical cause,” Circuit Judge Dennis Jacobs said in writing for the appellate court.

Under the JPMorgan plan, participants with long-term physical disabilities receive benefits until age 65, while participants with disabilities arising from mental or emotional disorders are limited to 18 months of benefits. JPMorgan paid Fuller benefits for 18 months, then terminated her benefits because it had determined, after consulting the DSM-IV, that bipolar disorder is a mental disease, according to court history.

After exhausting her administrative remedies, Fuller filed a lawsuit against JPMorgan alleging it acted arbitrarily and capriciously in violation of the Employee Retirement Income Security Act by classifying her bipolar disorder as a mental disease. Fuller also alleged that JPMorgan violated the Americans with Disabilities Act by treating those with mental disorders differently than those with physical disorders.

The appellate opinion in Fuller v. JPMorgan Chase & Co., 2d Cir., No. 03-7829, 9/9/05, is  here .