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Solved: Shirley McLeod was hired by Valley Media in 1998 to


Shirley McLeod was hired by Valley Media in 1998 to fill a position described as “Operations—General Warehouse,” which consisted of stocking videocassettes in a warehouse and involved long periods of standing. McLeod signed up for health insurance and other benefits under the Valley Media Plan, with an effective date of April 1, 1999. The Plan, which was funded and administered by Hartford Life and Accident Insurance Company, provided that: No benefit will be payable under the Plan for any Disability that is due to, contributed to by, or results from a Pre-existing Condition unless such Disability begins:
(1) After the last day of 90 consecutive days while insured during which you received no medical care for the Pre-existing Condition.
(2) After the last day of 365 consecutive days during which you have been continually insured under this Plan. “Pre-existing Condition” was defined as:
(1) Any accidental bodily injury, sickness, mental illness, pregnancy, or episode of substance abuse.
(2) Any manifestations, symptoms, findings, or aggravations related to or resulting from such accidental bodily injury, sickness, mental illness, pregnancy, or substance abuse: for which you received Medical Care during the 90 day period that ends the day before:
(1) Your effective date of coverage.
(2) The effective date of a Change in Coverage.
Medical Care is received when:
(1) A Physician is consulted or medical advice is given.
(2) Treatment is recommended, prescribed by, or received from a Physician.
On February 22, 1999, McLeod consulted Dr. Eileen DiGregorio because of numbness in her left arm. Dr. DiGregorio had already treated McLeod for a number of years for cardiac insufficiency and bulging discs. Dr. DiGregorio provided medical care for the numbness during the February 1999 visit, but did not diagnose or otherwise suggest that McLeod might have multiple sclerosis (MS). McLeod continued to seek treatment over the next few months from Dr. DiGregorio and two neurologists, none of whom produced a diagnosis of MS. In August 1999, McLeod was diagnosed with MS. With the benefit of hindsight, a number of physicians, including her treating physicians, attributed McLeod’s various pre-coverage symptoms and ailments to MS. In March 2000, McLeod applied to Hartford for short-term disability benefits. Her claim was initially approved, but when she applied for long-term disability benefits (LTD), Hartford denied her application on the grounds that her disabling condition, MS, was a preexisting condition for which LTD benefits were not payable under the Plan. After exhausting her administrative appeals, McLeod filed a complaint against Hartford alleging, among other things, that Hartford had breached its fiduciary obligations under ERISA when it denied her application for LTD. Is this decision a pure eligibility decision or a mixed eligibility/ treatment decision? What standard of review should be applied to Hartford’s decision? Should McLeod’s claim be upheld? [McLeod v. Hartford Life & Accident Insurance Co., 372 F.3d. 618 (3d Cir. 2004).]


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