Federal Court Strikes Down Boundary Between Physical And Mental Illness

Precedent has Implications for Both Health and Long-Term Disability Insurance

Feb 28 2002

Arlington, VA - The U.S. District Court for the District of Columbia has opened a breach in the artificial wall that has long separated coverage of physical and mental illnesses in insurance policies.

In Fitts v. Federal National Mortgage Association (Civil Action 98-00617), Judge Harold H. Kennedy ruled on February 26, 2002 that Fannie Mae and Unum Life Insurance Company of America (Unum) improperly classified an employee's bipolar disorder (manic depression) as a mental rather than physical illness, which subjected her to a 24-month limit in benefits.

"The decision has symbolic importance in the ongoing Congressional debate over parity for mental illnesses in health insurance," said Ron Honberg, legal director of the National Alliance for the Mentally Ill (NAMI). "It will have a practical impact on precisely how the industry drafts long-term disability insurance contracts in the future. It also is another step toward ending discrimination based on myths and stigma."

"What is most important is that the court weighed science-based factors in reaching its decision. Mental illnesses are brain disorders. They have fundamentally physical causes. Insurance companies cannot arbitrarily ignore the reality of the mind-body connection," Honberg said.

The court's decision turned on an interpretation of an ambiguous definition of mental illness in Unum's contract with Fannie Mae. Noting that "courts are split over whether ailments like bipolar disorder fall within the definition of mental illness contained in employee benefits plans," Judge Kennedy identified "three basic approaches" which have focused on symptoms, causes or treatments.

The court found both cause-based and symptom-based approaches to be "intuitively appealing" and reasonable, but observed that advances in science make public perceptions of mental illness an evolving concept. There is no hard, fast rule to govern the definition.

In the case of Jane Fitts, an attorney who began work for Fannie Mae in 1982 and was diagnosed with bipolar disorder in 1995, the decision noted several points:

  • Fitts was "genetically predisposed" to develop bipolar disorder because both her father and brother exhibited symptoms of the illness.
  • Brain scans indicated abnormal atrophy or brain wave activity on the left and right sides of her brain.
  • Physical changes affecting her as a result of the illness included headaches, chest pains and insomnia.
  • Fitts provided the court with a declaration from Frederick T. Goodwin, M.D., former administrator of the National Institute for Mental Health (NIMH), a research professor at George Washington University School of Medicine, and author of the textbookManic Depressive Illness, that bipolar disorder is a physical illness because it is a neurobiological disorder that affects the physical and chemical structure of the brain.
  • Suzanne J. Griffin, M.D., who has treated Fitts since 1996, also had provided a declaration that the illness is linked to changes in blood flow to the brain similar to changes exhibited in Alzheimer's disease and heart disease.

"The court declared that the dispute was not over facts, but definitions," Honberg said. "In the 21st Century, there is better understanding of the physical nature of mental illness. It's not just scientists who understand this, but also, increasingly, the average person. This decision is a reflection of that reality."