ERISA-First Circuit Rules That A Risk Of Relapse Can Constitute A Disability, For Purposes Of A Long-Term Disability Benefits Plan

In Colby v. Union Security Insurance Company, No. 11-2270 (1st Cir. 2013), the district court had awarded long-term disability (“LTD”) benefits to the plaintiff, under a plan subject to ERISA. The defendant appealed.

In this case, the plaintiff, an anesthesiologist, became addicted to a substance known as Fentanyl, an opioid used in her medical practice. Upon receiving treatment, the plaintiff stopped taking Fentanyl. The plaintiff nevertheless filed a claim for LTD benefits under her employer’s group employee benefit plan (the “Plan”). The Plan was underwritten and administered by the defendant insurance company. The defendant approved the payment of the LTD benefits to the plaintiff, but only to a point. It then terminated the LTD benefits, on the grounds that, although the plaintiff was under a doctor’s care and feared a relapse, a risk of relapse is not a current disability, for which LTD benefits may be paid under the Plan. The plaintiff then brought this suit under ERISA.

The First Circuit Court of Appeals (the “Court”) reviewed the Plan and the record. It believed that the plaintiff was at a high risk of relapse into opioid dependence. Based on the language of the Plan, the Court concluded that, in an addiction context, 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, entitling the plaintiff to LTD benefits under the Plan. As such, the Court affirmed the district court’s award of LTD benefits to the plaintiff.

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