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Argument That Bi-Polar Disorder is Biological Illness Fails – 2nd Cir.

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  • Argument That Bi-Polar Disorder is Biological Illness Fails – 2nd Cir.

    Argument That Bi-Polar Disorder is Biological Illness Fails – 2nd Cir.

    Attached is an unpublished decision out of the Second Circuit, Kim v. The Hartford Life Insurance Company. In this case, plaintiff challenged the 24 month mental/nervous limitation in the long term disability policy. She asserted that bi-polar disorder is a biological disorder, rather than a mental disorder. The Second Circuit disagreed and affirmed the district court’s ruling.

    First, Kim argues that Hartford's reliance on the DSM to classify her disability as a "Mental Illness," and thereby deny her continued benefits, was arbitrary and capricious because the DSM is scientifically invalid and out-of-date based on current medical research. She cites criticism of the DSM by medical professionals, as well as recent scientific research indicating that bipolar disorder is a physical illness rooted in biological causes.

    We are not persuaded: in denying Kim's claim, Hartford acted well within its "full discretion and authority" to construe the Policy's terms. App. 187. The Policy defines "Mental Illness" by explicit reference to the current version of the DSM. The applicable version of the DSM, in turn, classifies bipolar disorder -- Kim's sole diagnosis -- as a mental disorder. Hartford lacks authority to modify the terms of the Plan, as Kim concedes, and is obligated to process claims in accordance with the Plan's written terms. See 29 U.S.C. § 1102(a)(1) (plan "shall be established and maintained pursuant to a written instrument"); Heimeshoff v. Hartford Life & Acc. Ins. Co., 571 U.S. 99, 108 (2013) (noting "the particular importance of enforcing plan terms as written"). The authority to amend the Plan's written terms lies with the Plan's sponsor, the School, which is not a party in this case. See Curtiss-Wright Corp. v. Schoonejongen, 514 U.S. 73, 78 (1995) ("Employers or other plan sponsors are generally free under ERISA, for any reason at any time, to adopt, modify, or terminate welfare plans.").

    Moreover, even assuming that Kim has raised valid criticisms of the DSM, the DSM remains broadly accepted, and we have already indicated that it is "an objective authority on the subject of mental disorders." Fuller v. J.P Morgan Chase & Co., 423 F.3d 104, 107 (2d Cir. 2005).2 And as we previously stated, "[i]t 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 Kim's argument "conflates her disability with its underlying cause." Id. Indeed, both the DSM and the Policy recognize that mental illnesses may have underlying physical causes. See App. 104 (DSM definition of "mental disorder" notes that "there is much 'physical' in 'mental' disorders and much 'mental' in 'physical' disorders"); App. 147 (Policy definition of "Mental Illness" notes that it "may be caused by biological factors").

    Thus, regardless of whether bipolar disorder has a physical cause, Hartford's classification of Kim's disability as a "Mental Illness" and its subsequent denial of her claim for continued benefits -- in reliance on the DSM and in accordance with the explicit terms of the Policy -- was "plainly reasonable." Fuller, 423 F.3d at 107.
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