Background
Ms. Marecek became addicted to painkillers after a sinus operation in 1987 and was also diagnosed with major depressive disorder the following year. In June 1988, BellSouth approved Ms. Marecek’s disability benefits when its own doctor found that she was too sick to perform her job duties. BellSouth then determined that Ms. Marecek was able to return to work on August 1, 1988, and denied her further benefits, even though she was only able to work for two hours that day and cried the entire time.
BellSouth’s Sickness & Accident Disability Benefit Plan (“Plan”) and Claim Decision
Bellsouth’s Plan provided that an employee is qualified to receive sickness disability benefits “on account of physical disability to work by reason of sickness.” However, the Plan did not specify if an employee was still eligible for benefits if they were only found to be partially disabled.
In support of her claim for ongoing benefits, Ms. Marecek provided BellSouth with a physician certificate in which her treating doctor recommended that she only work part-time for at least one month. BellSouth denied extending her disability benefits, and also denied her request to use vacation days, forcing Ms. Marecek to resign from her job.
After its Medical Director consulted with Ms. Marecek’s supervisor, BellSouth found that although she was treated for conditions after her resignation, “these conditions were not disabling at the time of her resignation and therefore, do not qualify for sickness disability benefits” under the Plan.
The Court’s Decision
In holding that Ms. Marecek was entitled to total disability benefits under the Plan, the court explained that:
1. Her claim was arbitrary and capriciously denied by the Plan’s fiduciaries;
2. Her claim was not given a full and fair review by the Plan’s fiduciaries;
3. BellSouth’s argument that Ms. Marecek did not provide written evidence that she was totally disabled was without merit; and
4. Ms. Marecek’s attempt to return to work and “give it a go” does not prove she is disqualified from receiving disability benefits.
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