Monday, January 5, 2015

ERISA Long Term Disability: Is the "Risk of Relapse" a Disability?

A recent First Circuit Court of Appeals decision examined whether the risk of relapse by a long term disability claimant, who is addicted to drugs, constitutes  a disability.  In essence, the question present before the First Circuit in Colby v. Union Security Insurance Co. was whether the risk of substance dependence "can swell to so significant level" as to constitute a disability in the same manner that risk into cardiac arrest or risk of orthopedic complications can constitute a disability.
The Court looked at whether the claimant could safely return to her material duties of her regular occupation as an anesthesia doctor once she had successfully completed a drug rehab program.  The Court found that "categorically  excluding risk of relapse as a source of disability is simply unreasonable".  Consequently, it found that the insurance company abused its discretion in denying the claimant's case by not taking into consideration her risk of relapse.
This appellate decision is directly opposite to a decision issued about five years ago by the Fourth Circuit, which held --in an almost identical case-- that not considering risk of relapse by the plan administrator was not an abuse of discretion.  See Stanford v. Continental Casualty Company.   
Given this clear split between the First and Fourth Circuit, I anticipate that in the upcoming months plan administrators, throughout the country, will be amending plan documents to address this particular issue.  Expect new language in the plans specifically excluding the risk of relapse as a valid claim for disability.