In Okuno v. Reliance Standard Life Ins. Co., 836 F.3d 600 (6th Cir. 2016), the court considered the proper interpretation of a mental illness limitation on coverage for disabilities “caused by or contributed to by” mental illness.
In what appears to be an issue of first impression in the Sixth Circuit (except perhaps for an unreported decision), the court held that the mental illness limitation cannot justify termination of benefits if physical ailments alone are sufficient to disable the claimant. The court called this the “but-for” test, in that the limitation applies only if the claimant would not be disabled but for the mental illness. “Thus, an application is not appropriately denied on the basis that a mental or nervous disorder ‘contributes to’ a disabling condition; rather, the effect of an applicant’s physical ailments must be considered separately to satisfy the requirement that review be reasoned and deliberate.”
The court stated that “this reasoning has been widely adopted[,]” citing cases in the Third, Fifth and Ninth Circuits.