A federal appeals court on April 5, 2021, agreed with the trial court that the insurer had denied the short- and long-term disability insurance claimant’s applications wrongly and without the required substantial evidence to do so. Last year, we talked in this space about the lower court’s conclusion that the claimant was disabled from his long-time drug addiction that had recently relapsed, putting surgical patients for whom he provided anesthesiology services and monitoring at risk of harm if he made a mistake.
Now, the appeals court has released its decision on appeal.
The insurance company’s position
Disability insurers are known to make some outlandish arguments to support claim denials or benefits terminations. In this case, the claimant was a certified nurse anesthetist who had reportedly used fentanyl while on the job after a relapse from a period of sobriety. His two treating doctors both said that the claimant’s opioid addiction rendered him unable to work as a nurse anesthetist and that this was a chronic, indefinite limitation.
Eligibility for disability benefits under his policy required him to be unable to do the material duties of his regular job because of illness or injury. Because the claimant had been able to work with patients and was only terminated after his employer detected his drug use on the job, the insurance company said that he was capable of performing his regular occupation – that his drug use “did not preclude [his] ability to perform [his] occupational duties.”
In other words, if a health care employee with a long-term addiction to a dangerous narcotic had been working while actively using for two years without harming any patients, their clinical addiction did not make them disabled. However, both the lower and appeals courts disagreed.
Lack of substantial evidence
The appeals court noted that the claimant’s employer fired him because of a “serious concern for the safety of the patients.” Put another way, “safely administer[ing] anesthesia” was a substantial job duty that a nurse anesthetist could not perform under the influence of a dangerous opioid, even if the health care professional had done so without injuring a patient before. Obviously, the risk would be too high. Therefore, the claimant/nurse anesthetist was disabled according to the policy terms and should receive benefits.
How can DI Law Group help?
A delay or denial of a disability claim can be financially devastating. DI Law Group represents long-term care and all disability insurance claimants at every stage of the insurance process. If you have any questions regarding your life insurance claim, our team of attorneys would be happy to provide you with a free consultation. Please contact us at 888-644-2644 or visit our website at www.dilawgroup.com.