In George v. Reliance Standard Life Ins. Co., 776 F.3d 349 (5th Cir. 2015), a case of first impression, a divided Fifth Circuit panel decided when a disability is “caused by or contributed to by” a mental illness. The plaintiff was a helicopter pilot who was disabled due to pain suffered at the site of a leg that had been amputated before he started the job in question. He also suffered from depression and PTSD. The insurer determined that he could perform sedentary work, but that his mental illnesses would prevent him from working. Thus, the insurer concluded that the mental illness “’contributed to’ his overall impairment status,” resulting in the application of the mental illness limitation in the policy.

The Fifth Circuit rejected that argument, determining that every federal circuit court to interpret similar provisions “has interpreted the ‘caused by or contributed to by’ language to exclude coverage only when the claimant’s physical disability was insufficient to render him totally disabled. In other words, those courts have asked whether the mental disability is a but-for cause of the total disability.” The court held that the plaintiff’s mental illness was not a but-for cause, because his physical condition was enough to prevent him from performing a gainful occupation (the court also had determined that the administrator had not properly applied the gainful occupation test).

The dissent accused the majority of sloppy legal reasoning, asserting that none of the decisions on which the majority relied involved an independently disabling physical illness; and that those other cases merely held that a mental illness that is the actual cause of the disability plainly made the limitation applicable. However, the situation in George was different, and concerned physical and mental illnesses that were (arguably) independently disabling. Where a mental illness is independently disabling, it certainly “contributes to” a disability, even if there is also a disabling physical illness. Yet the majority did not address that issue, instead finding the mental illness irrelevant if there was also a physical cause. Moreover, the dissent noted that the “majority’s reading also assumes a certain order of operations – that we first look at the extent of the physical symptoms before considering whether the mental condition causes or contributes to the disability. I see nothing in the policy to support such an analysis of what is, after all, an exclusion.”