Federal Court Rules Risk of Relapse a Disability

Do insurers have to pay long-term disability benefits if a recovering addict faces a high risk of relapse by returning to work?

Yes, according to a precedent-setting decision from a federal appeals court. The U.S. Court of Appeals for the First Circuit last week upheld a district court’s earlier ruling that the possibility of relapsing into an addiction can be considered a disability and an employee at serious risk of relapse would be entitled to long-term disability benefits from insurers.

The Wall Street Journal (subscription required) reports that the ruling came in a case where the plaintiff (an anesthesiologist) became addicted to Fentanyl, a prescription opioid used in her work. Subsequently, the plaintiff had to spend three months recovering at a substance abuse treatment center. Her employer’s group benefit plan was administered and underwritten by Union Security Insurance Co. However, the insurer stopped her $4,000 a month long-term disability employee benefit payments once her treatment was over.

Her doctors and therapist were of the opinion that the plaintiff faced a serious risk of relapsing into addiction if she went back to her workplace, where the drug was easily accessible. Six months after leaving the center, the plaintiff was arrested for drunk driving.

Interestingly, the 1st Circuit’s decision contradicts a 4th Circuit ruling that denied benefits to an anesthetist addicted to the same drug as the plaintiff in this case.

If you or a loved one has been denied disability benefits by an insurer, contact Sokolove Law today for a free legal consultation and to find out if a personal injury lawyer may be able to help you.

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