Major Rogers v. Department of Health & Environmental Control, 174 F.3d 431 (4th Cir. 1999) – decided April 8, 1999 – United States Court of Appeals for the Fourth Circuit – Robert E. Hoskins

Occasionally, ERISA or disability claims involve peripheral issues governed by other laws.  When that occurs, I, obviously, tend to the ERISA issues and, if I feel competent to do so, I also try and handle any other issues that may be raised by the case under laws other than ERISA.  If necessary, I will bring other attorneys with appropriate experience to assist with other areas of law.  This tendency has resulted in my being involved in two published decisions involving the Americans With Disabilities Act (ADA).

I represented Major Rogers who had a disability claim through his prior employer.  Mr. Rogers’ claim arose shortly after the ADA was passed into law. Shortly after its passage, many important issues under the ADA were unsettled.  Among the issues that had not been decided, in the Fourth Circuit, was whether a disability policy that provided different levels of benefits for physical as opposed to mental/nervous disabilities violated the law.  Rogers was the first case decided by the United States Court of Appeals for the Fourth Circuit to address that issue.  In Rogers, the court held that the ADA does not mandate equal levels of benefits under disability plans for persons suffering from mental/nervous problems as opposed to physical.  The court stated:

“Insurers have historically and consistently made distinctions between mental and physical illness in offering health and disability coverage.  For instance, the National Association of Insurance Commissioners, in commentary to its model regulation on unfair discrimination, makes clear that “the regulation is not intended to mandate the inclusion of particular coverages, such as benefits for normal pregnancy, or of levels of benefits such as for mental illness.”  Model Regulation on Unfair Discrimination in Life and Health Insurance on the Basis of Physical Impairment, Drafting Note § 3, reprinted in IV NAIC Model Regulation Service, 887-1 (July 1993); see also Group Insurance 442 (William F. Bluhm ed., 2d ed. 1996) (“Most LTD [long-term disability] plans impose a lifetime limit of 24 months on benefits for disabilities due to mental and nervous conditions when not confined to an institution.”); EEOC:  Interim Guidance on Application of ADA to Health Insurance, supra (“Typically, a lower level of benefits is provided for the treatment of mental/nervous conditions than is provided for the treatment of physical conditions.”). 

Congressional activity since the passage of the ADA indicates that Congress does not read the ADA to require parity of coverage for mental and physical disabilities.  When Congress considered the Mental Health Parity Act (MHPA) (passed as an amendment to the Health Insurance Portability and Accountability Act of 1996 (HIPAA)), an MHPA co-sponsor remarked that it was “a compromise to begin down the path of parity and nondiscrimination for the mentally ill people in this country who have health insurance.”  142 Cong. Rec. S9917 (daily ed. Sept. 5, 1996) (statement of Sen. Domenici) (emphasis added).  The legislation includes a provision that prohibits employers from imposing lifetime or annual limits on mental health benefits when they impose no such limits for physical health benefits.  The provision, however, exempts employers whose costs would increase by more than one percent as a result of the new coverage mandate.  See 42 U.S.C. § 300gg-5(1)-(2) (Supp. 1998).  It is important that neither the MHPA nor the HIPAA regulate disability income insurance.  See Parker, 121 F.3d at 1018.  All of this suggests that Congress does not believe that the ADA already mandates equal treatment in benefits coverage for mental and physical disabilities.

Everything that we have considered - - from pre-ADA Supreme Court cases on the Rehabilitation Act to post-ADA congressional activity - - leads us to one conclusion: the ADA does not require South Carolina to provide the same level of benefits for mental and physical disabilities in its long-term disability plan for state employees.  (Click here to view the Fourth Circuit’s decision.)”