The Wall Street Journal‘s Law Blog reports that a

federal appeals court [the First Circuit] on Thursday [last] ruled that insurance companies can be required to pay long-term disability benefits to a recovering drug addict if the person would face a significant risk of relapse by returning to work.

The Law Blog expands:

The case…involved an anesthesiologist from Massachusetts…who became heavily addicted to Fentanyl, a prescription opioid used in her practice.

[The anesthesiologist] spent about three months at a treatment center, according to her attorney.  After she was discharged, her employee benefit plan that was administered by Union Security Insurance Company cut off her long-term disability benefit payments, totaling $4,000 a month.  Her therapist and other doctors feared that she had a high risk of relapse and cautioned her not to return to work where it would be easy to access the drug, the opinion said.

The anesthesiologist justified her suit by claiming that she shouldn’t have to fall off the wagon for her claim to be accepted.  She shouldn’t have actually to be disabled in order to collect disability benefits.  Never mind that there was no certainty of relapse asserted, by her or the Court, only a likelihood.  Never mind that her condition was entirely self-inflicted.  Never mind that she could have found work—even in the medical field—other than as an anesthesiologist.

Indeed, as the Appellate Court said quite clearly, she had not relapsed, and so she wasn’t back in her disability condition.  She was, though, out those $4,000 per month, payable for an actual disability.

The Court then noted in its opinion (cynically, say I)

The plaintiff’s risk of relapse was not merely theoretical.  In perhaps the most striking actualization of this risk, the plaintiff was arrested in May of 2005—some six months after her departure from [the treatment center]—for driving under the influence of alcohol[.]

Notice that.  She was driving under the influence of alcohol, not Fentanyl.  Some risk of relapse onto the drug.

The Court also noted in justification of its ruling (again cynically, say I) that the insurance company could have inured itself from this sort of…suit…by  “writing into the plan an exclusion for risk of relapse.”

The insurer, though, hadn’t included such an explicit exclusion because at the time they sold the policy they had no reason to believe a Federal Appeals court would rule so capriciously.  After all, the Fourth Circuit already had ruled differently on an identical case:

[The] Fourth Circuit…said the denial of benefits to an anesthetist addicted to the same narcotic was “reasonable.”

Now we know better.  If there’s a possibility of a disability occurring in the future, that disability exists presently.

Another brick in the wall of manufactured dependency.