Opinion ID: 3014056
Heading Depth: 4
Heading Rank: 1

Heading: your effective date of

Text: discretion was not unlimited and that the coverage heightened standard of review applies, we (italics supplied). would be compelled to declare that Hartford’s denial of benefits was unjustified McLeod contends that in order to have been since it is undisputed that McLeod did not properly denied coverage under the Plan, she receive treatment for MS during the look- would have had to receive care from a back period. There is, however, one physician for the MS or for the significant difference between McLeod’s “manifestations, symptoms, findings, or case and the one presented in Lawson: Here, aggravations” of MS during the look-back the policy language is more precise and period. She submits that intentionality is a encompasses a broader range of elements in key component of receiving medical care its definition of what constitutes a pre- and that the presence of the word “for” in existing condition than did the policy at the policy language is crucial. issue in Lawson. In Pilot Life Insurance. Co. v. In the Plan at issue here, a pre- Dedeaux, 481 U.S. 41, 56 (1987), the existing condition includes medical care Supreme Court noted that Congress intended received for any “manifestations, symptoms, that “a federal common law of rights and findings, or aggravations related to or obligations under ERISA-regulated plans resulting from such accidental bodily injury, would develop.” Importing and extending sickness, mental illness, pregnancy, or the logic of Lawson, a contract case, into the substance abuse” (emphasis added) as ERISA context, is consistent with that opposed to the policy at issue in Lawson teaching. Finding the Lawson analysis which defined a pre-existing condition as a persuasive, we construe the term “for” to “Sickness, Injury, disease or physical conta in the Lawson eleme nt of condition for which medical advice or intentionality. Given that construction, treatment was recommended by a Physician Hartford’s interpretation must be rejected at or received from a Physician” during the all events, and certainly when a heightened relevant look-back period. Lawson, 301 standard of review applies. F.3d at 161.5