A telecommunications worker became depressed and anxious and went out on medical leave late in 2004. His employer provided 26 weeks’ short-term disability, and he then applied for long-term disability benefits. He received them for a year, but the plan then required reapplication, and he and the plan administrator have been wrangling ever since.

What happened. “Ford” worked for Lucent Technologies, a New Jersey telecommunications company, testing computer hardware and software as part of product development. Cigna acted as Lucent‘s plan administrator, and phase 2, after a year of benefits, required that a beneficiary be incapable of performing any job for the employer for which he was qualified that would pay at least 60 percent of his former salary.

Ford provided copious reports from his psychiatrist and psychotherapist for both phases of his benefit application. Cigna found them full of contradictions, a situation that grew more complex when Ford‘s psychiatrist had him tested by a neuropsychologist. At some points in their reports, the two original providers described Ford as depressed, confused, hopeless, helpless, and unable to concentrate. At other points and on other dates, all three doctors described Ford in much more upbeat terms.

Cigna decided that Ford was not disabled, and he appealed—twice. Twice, Cigna had independent physicians review all the records and notes; they pronounced Ford capable of working in any capacity. Finally, Ford sued.

In federal district court, a judge reviewed the case and ruled entirely in Ford‘s favor, for several reasons, including that Cigna had paid more attention to nontreating doctors‘ opinions, that it had a conflict of interest in trying to save Lucent money, and that it had not assessed Ford‘s capabilities under the 60 percent provision. Lucent and Cigna appealed to the 3rd Circuit, which covers Delaware, New Jersey, and Pennsylvania.

What the court said. Appellate judges reviewed previous rulings on benefits governed by the Employee Retirement Income Security Act (ERISA). And, they overturned most of the district judge‘s decisions. They said the 60 percent provision wasn‘t relevant, since Cigna believed Ford could do his former job. One remaining issue was Cigna‘s conflict of interest—whether it tried too hard to save money in order to compete in the administrator market more effectively. Judges sent that issue back to the district court. Funk v. Cigna and Lucent Technologies, U.S. Court of Appeals for the 3rd Circuit, No. 10-3936 (2011).

Point to remember: It is clearly far more difficult to assess mental disabilities and capabilities than physical ones, with fewer metrics available.