Federal Judge orders Union Security (Assurant) to re-evaluate disability denial due to failure to consider risk of substance abuse relapse as disabling condition

In any claim for any disability benefits, the deciding factor which disability insurance companies will decide on will be whether you are what they define as being “disabled” or not. Most insurance companies however, will try to define the scope of what constitutes “disabled” as narrowly as possible to their advantage. The situation is especially compounded when a claimant is disabled due to substance abuse. Substance abuse cases involved both physical disabilities and mental disabilities. However, insurance companies will try to distinguish between a physical disability and a mental disability as they tend to regard risk of relapse into substance abuse more as a matter of choice to overcome temptation rather than a physical disability.

In Dr. Julie Colby v. Union Security Insurance Company and Management company (Assurant Benefits) (USIC), the plaintiff, Dr Colby through her disability attorney, filed a lawsuit against USIC to claim for long term disability (LTD) benefits under Merrimack Anesthesia Associates Long Term Disability Plan. The plaintiff claimed that USIC’s decision to deny her claim for LTD benefits were arbitrary and capricious and it was acting in contravention of the Employment Retirement Security Act of 1974 (ERISA).

The Facts of this Long Term Disability Case

Dr. Colby was an anesthesiologist who in 2004 became addicted to a powerful opioid called Fentanyl. She had been using this drug as a mean for her to cope with chronic back pain. In the course of her duty, she also administered the same drug to some of her patients. Subsequently, her coworkers discovered her addiction which resulted in her quitting her job and losing her medical license. She then enrolled herself into an in-patient substance abuse recovery program on August 16th 2004 and claimed for LTD benefits under her LTD policy with USIC on September 24th 2004. USIC granted Dr Colby benefits during the duration of her stay at the substance abuse rehabilitation center but terminated them when she was discharged on November 20th 2004.

USIC claimed that the plaintiff, with her discharge from the rehabilitation center, she no longer displayed any symptoms of active substance abuse. Their main justification for terminating her disability benefits was that “the risk of relapse into substance abuse is not the same as a current disability.” In short, USIC disregarded the “potential” risk of relapse into active drug abuse as a disability that will impair Dr. Colby from performing the material duties of her job as an anesthesiologist. Dr. Colby appealed twice to USIC’s decision to terminate her LTD benefits but was unsuccessful and as a result she filed a lawsuit to challenge USIC interpretation of the LTD Plan.

The District Court’s Ruling

The District Court ruled that USIC’s disregard of the potential risk of Dr Colby’s relapse back into active substance abuse in its determination to terminate Dr Colby LTD benefits under the terms of the LTD plan was indeed arbitrary and capricious.

The District Court reasoned that the LTD plan did not distinguish between a physical disability and a mental disability. And based on all the medical conclusions by the medical professionals who examined Dr Colby’s mental health, Dr Colby did suffer from opioid dependence which is a mental disorder that is recognized in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This was a conclusion (opioid dependence) which even USIC admitted in their letter terminating Dr. Colby’s benefits. In addition, USIC also admitted that if a person who is suffering from a physical sickness and if the person’s return to work would pose a high risk of relapse, that person would be covered under the LTD plan.

The courts around the country are split on whether a risk of relapse is a disabling condition.

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Assurant claimants nationwide?

We represent Assurant clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Assurant disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Assurant. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Assurant.

How do you help Assurant claimants?

Our lawyers help individuals that have either purchased a Assurant long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Assurant:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Mike A.

Dell & Schaefer are an excellent Law Firm. They got my Disability Claim reinstated after being dropped by The Standard Insurance company. Insurance companies are always looking for a way to target and drop disability insurance claims of people who truly are disabled and deserve the insurance they have paid for. Dell & Schaefer know of these “tricks” the insurance companies play and waste no time getting your claim reinstated.

Since I have engaged Dell & Schaefer as my attorney, the insurance company no longer hassels me with annoying letters, or calls and they have put my mind at ease that I will not be dropped. In my opinion, Dell & Schaefer are known to the insurance companies as excellent attorneys and therefore do not play games with the their clients. I would recommend Dell & Schaefer to anyone, as they are not only excellent at what they do, but are a pleasure to have on your side.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us