Published by The Pellegrin Firm March 10, 2020

All too often, long-term disability insurers look for reasons to deny payment to disabled insureds.  This is just as true of insureds with addiction and mental health issues as it is of insureds with physical limitations. In a recent case out of Missouri, a federal judge rejected an insurance company’s denial of benefits to an impaired nurse anesthetist.

The plaintiff was a certified nurse anesthetist who had had addiction problems many years in the past and relapsed on alcohol in 2015. Eventually, he began injecting fentanyl, including at work. The plaintiff stopped working when his employer terminated him. He admitted to drug use after coworkers found used syringes and reported him.  His employer drug tested him, whereupon he confessed to using drugs and tested positive.

The disability insurer stated that he wasn’t covered by the policy, provided through the employer, because he was fired before a physician ever certified disability, even though it was clear that he relapsed on drugs and alcohol while he was still employed and covered by the policy. The judge found the disability clearly existed while he was covered by the policy. Further, the court found that the insurer was adding requirements for coverage that just do not appear in the policy. When long-term disability insurers play fast and lose with addiction, they risk pushing impaired insureds back to work too soon. This is especially dangerous when insureds work in the medical field and working impaired risks lives. Long-term disability policies are meant to provide a cushion for people to get help and hopefully move on with their lives. Playing games with definitions in such circumstances is extremely risky and may be a matter of life and death.

The case under discussion is Bernard v. Kansas City Life Insurance Co., No. 19-4043, 2020 WL 974873 (W.D. Mo. Feb 28, 2020).