In a controversial and precedent-setting opinion, a federal court found that a doctor who was addicted to a pain medication is entitled to disability insurance benefits because the chance of relapse after treatment is considered a long-term disability.
The 1st Circuit Court of Appeals in Boston decided that anesthesiologist Julie Colby was disabled after completing treatment for her addiction to an opioid and a subsequent arrest for drunken driving six months later.
Union Security Insurance Co. cut off Colby’s $4,000 monthly long-term disability benefit payments at the end of her treatment, but her doctor and therapist argued that she had a high risk of relapse if she returned to the hospital where she worked, where the drug was readily available.
She was covered under a group benefits policy.
Six months after leaving the treatment center, Colby was arrested for drunk driving. Because of this, the court wrote that “the plaintiff’s risk of relapse was not merely theoretical.”
United Security denied claims, saying the risk of relapse was not a current disability.
The court disagreed.
“In our view, a risk of relapse into substance dependence — like a risk of relapse into cardiac distress or a risk of relapse into orthopedic complications — can swell to so significant a level as to constitute a current disability,” the court wrote in its opinion.
Colby had exhausted administrative attempts at disability payments, then sued in federal district court, which found in her favor.
The appeals court affirmed the circuit court’s decision, ultimately ending at the appeals court level.
The appeals court wrote that United Security could have excluded the risk of relapse into its policy, but did not do so, therefore the insurer “acted arbitrarily and capriciously in refusing to consider whether the plaintiff’s risk of relapse swelled to the level of a disability.”