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Ninth Circuit Affirms Denial of ERISA LTD Benefits; Distinguishes Kunin v. Benefit Trust Life Ins.

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The Ninth Circuit Court of Appeals, in Simonia v. Glendale Nissan/Infiniti Disability Plan, No. 09-09-55569, 2010 WL 1896455 (9th Cir. May 3, 2010), affirmed Hartford Life Insurance’s denial of long term disability benefits, and concluded that Hartford properly classified the claimant’s diagnosis of depression as a “mental disorder” subject to the plan’s twelve-month payment limit.

The Court rejected the claimant’s argument that the doctrine of contra proferentem applied, and distinguished Kunin v. Benefit Trust Life Ins. Co., 910 F.2d 534, 541 (9th Cir. 1990). In Kunin, the Court held that the plan administrator had acted unreasonably in determining that autism was a “mental illness” within the meaning of the policy, where the plan documents did not define the term “mental illness”. The Kunin Court applied the doctrine of contra preferentem, finding that “the insurer should be expected to set forth any limitations on its liability clearly enough for a common layperson to understand; if it fails to do this, it should not be allowed to take advantage of the very ambiguities that it could have prevented with greater diligence.”

In contrast to the facts of Kunin v. Benefit Trust, the Kunin Court held that Hartford’s plan documents were not ambiguous with regard to whether depression was a “mental disorder” within the meaning of the plan:

Simonia’s depressive disorder is unambiguously a ‘mental disorder’ under the plain language of the plan; and as a result, the doctrine of contra preferentem does not apply.

Id. The Court’s holding is based on its finding that the term “Mental Disorder” is defined as “a disorder found in the current diagnostic standards manual of the American Psychiatric Association. . . [and depressive disorders are included in the manual]. Id. at *1.