Nurse anesthetist denied long-term disability benefits for drug addiction by Continental casualty loses at trial and on appeal

Robert Stanford was a nurse anesthetist in a hospital in South Carolina. In his position, he was exposed to and responsible for administering anesthesia and narcotics to surgical and obstetric patients. Shortly after starting work, he began taking Fentanyl, a powerful narcotic. By September of 2003 he had become addicted to the drug, and entered rehabilitation the following month.

After release from rehabilitation, but before returning to work, Stanford relapsed, and returned to rehabilitation, where he stayed for 3 months this time. While in rehabilitation, he applied for long-term disability benefits with Continental Casualty, which provided benefits through his employer. While in rehab, his benefits were approved.

Stanford returned to work on March 12, 2004, but once again suffered a relapse, and returned to rehab on May 19, 2004. Once again, he applied for and received long-term disability benefits from Continental Casualty. However, in January of 2005, his benefits were terminated because his treating physician stated there was no impairment that prevented him from returning to work as a nurse anesthetist. Stanford appealed this decision, noting that he remained at risk for relapse if he was exposed to Fentanyl, and that his license had been restricted from having access to narcotics or working as a certified nurse anesthetist.

Continental Casualty denied the claim, stating that, “the policy does not cover potential risk.” With his administrative remedies exhausted, Stanford filed suit. The trial court determined that the decision to deny benefits was not unreasonable. Stanford appealed. The 4th District Court of Appeals reviewed the claim and determined that although Continental Casualty was a plan administrator operating with authority to interpret contract terms but under a conflict of interest because it also paid out the claims, the insurance company had not abused its discretion in denying the claim.

The reviewing court also found that it was not improper to not have a health care professional review the claim, since the main issue in this case was one of contract interpretation, and Continental Casualty had not disagreed with the Stanford’s treating physician: yes, the risk of relapse was high, but he was not currently physically or mentally impaired from returning to work. Lastly, the court noted that the risk of relapse for drug addiction differed from the risk of relapse for a heart attack victim: the drug addict has a choice about becoming relapsing, while a heart attack victim does not.

Comment: They key factor that resulted in this client being denied benefits was the fact that the claimant’s treating doctor opined that he was not disabled from returning to work in his prior occupation. Moreover, the fact this case was reviewed by the court under and arbitrary and capricious standard made it almost impossible for the court to determine that the disability carrier acted unreasonably. While risk of relapse alone is generally not enough to support a claim for disability, a claimant should always discuss and document all potentially disabling conditions with their treating doctors. See Stanford v. Continental Casualty Co., 514 F.3d 354 (4th Cir. 2008).

Leave a comment or ask us a question

Questions About Hiring Us

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, 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   *****

Sean D. (New York)

During a very difficult time fighting to receive compensation for an injury I found some comfort in the reassurance that I was not fighting alone. Alex and Michal kept me up to date with what was going on and what steps were next to move forward. During the mediation process Alex navigated this situation strategically at the same time reassuring me that we would leave with some success.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

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