Magazine article Clinical Psychiatry News

Court Faults Insurance Carriers That Discriminate. (Definition of Mental Illness Ambiguous)

Magazine article Clinical Psychiatry News

Court Faults Insurance Carriers That Discriminate. (Definition of Mental Illness Ambiguous)

Article excerpt

In a precedent-setting decision, the U.S. District Court for the District of Columbia has erased the distinctions that have long separated physical and mental illnesses in insurance policy coverage.

In Fitts v. Federal National Mortgage Association, Judge Henry H. Kennedy ruled on Feb. 26 that Fannie Mae and Unum Life Insurance Company of America had improperly classified Jane Fitts' bipolar disorder as a mental rather than a physical illness. Because Fitts' illness was seen as a mental illness by Fannie Mae and Unum, she was subjected to a 24month limit in disability benefits. An attorney for Unum said that the ruling will be appealed.

"The distinctions insurance companies have made in policy benefits between mental illness and physical illness are totally without justification," said Dr. Robert Hirschfeld, dean of the department of psychiatry at the University of Texas, Galveston, and a fellow of the American Psychiatric Association. "These distinctions have been used for years to provide fewer benefits for those with mental illness, and that's absolutely unfair.

In the decision, the court ruled that Unum's definition of mental illness in its long-term disability plan was ambiguous. It also noted that Fitts' bipolar disorder could be defined as a physical illness because she was genetically predisposed to develop the condition because her father and brother had exhibited symptoms of it, and that brain scans indicated abnormal atrophy and brain waves on the left side. She also had physical symptoms stemming from the disorder, such as headaches, chest pains, and insomnia.

"Certainly, mental illness involves substantial genetic components and brain changes," Dr. Hirschfeld said. "I'm pleased to see the judge courageously challenge the distinction between physical and mental illness in insurance policies."

During the court case, Dr. Frederick T. Goodwin, research professor in the department of psychology at the George Washington University, Washington, testified that bipolar disorder is a neurobiologic condition that affects the physical and chemical structure of the brain, involving chemical imbalances and abnormal brain activity. Studies also indicate that bipolar disorder affects the brain's neurotransmitters and corresponds with organic lesions in the brain. Bipolar disorder is also a physical illness because it is a disease afflicting a physical organ of the body, just like diseases affecting the heart, the kidneys, or liver, he concluded.

Dr. Suzanne J. Griffin, a psychologist and pharmacologist who treated Fitts since 1996, also noted that bipolar disorder is linked to changes in blood flow to the brain similar to the changes exhibited in heart disease or Alzheimer's disease. …

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