Federal court finds risk of drug relapse is a disability

Many people in Wisconsin have long-term disability insurance policies through their employers. Others may have purchased long-term disability insurance independently. This is a very important type of insurance because it provides a safety net in case one suddenly can no longer work due to an illness or in injury. However, as with many types of insurance, it can be difficult to get the insurer to hold up to its end of the deal when it is time to obtain benefits.

When disabled people are denied long-term disability insurance benefits for questionable reasons it is often possible to fight the denial successfully. In a recent case in Boston, a federal court issued a precedent-setting decision when it ruled that a woman’s risk of relapse into a drug addiction was a compensable disability under her insurance policy.

The woman, a doctor, received long-term disability benefits while she was in treatment for an addiction to a pain medication. The benefits ended when she finished treatment, although she argued that there would be a risk of relapse if she returned to work at the hospital where the drug was available.

Her group benefits policy denied the claim, stating that a risk of relapse is not a disability itself. The woman then sued in a federal court, which agreed with her and cited her drunk driving arrest six months after leaving treatment as evidence of the likelihood of a relapse.

The court ruled that a high risk of relapse into a drug addiction is a disability, similar to the risk of relapse into cardiac problems. Furthermore, the court explained that the insurer could have excluded risk of relapse from its coverage by writing this in its policies, but it failed to do so.

This case illustrates the fact that it is possible to fight a denial of benefits and succeed. Insurers are not always right and they do not always have your best interests at heart. In order to protect your interests and rights in a long-term disability benefits dispute, it may be necessary to seek legal counsel.

Source: Insurance & Financial Advisor, “Drug-addicted doctor entitled to disability insurance benefits,” Jan. 22, 2013

  • Our law firm in Milwaukee provides long-term disability benefits counsel nationally. To learn more about fighting a disability denial, please visit our Long-Term Disability Benefits page.


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