Are Mental Health and Substance Abuse Disorder Benefits Available Under ERISA?

If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com

The question arises whether mental health befits and substance abuse disorder benefits available under ERISA. The answer lies in how the individual long-term disability plan is written.

In the case of Wit v. United Behavioral Health (No. 14-CV-02346 [and the related case No. 14-CV-05337-JCS]), the U.S. District Court in the Northern District of California ruled that if a company has a plan that allows for these type of benefits, the plan administrator may not abuse its discretion by adopting guidelines for the plan that:

Allows a conflict of interest in an attempt to keep expenses down and increase revenues into the plan;

Allows financial considerations to influence the development of the guidelines and not shielding the individuals who develop these guidelines;

Refuses to adopt generally accepted clinical guidelines despite the recommendations from clinicians to do so and against some states’ requirements stipulating standards of care.

The Court notes that a key issue raised in the case is the coverage for behavioral and substance use disorders as chronic, rather than acute conditions. The Plaintiffs argued that this distinction allowed for a termination of benefits once the conditions subsided and did not allow for long-term services needed to stabilize the condition.