WPCG IW7RY EcYi:.["YJlsKn D!Qob1C.*%A*rwxy?rAqsQ6#bGFc$wUNw붻8ևZQmhu[D_D{iSidt,hUm-*3TK h!.+\_)06/K$WrJ8#:.?Qdb~4?> {3]ѪZ?:} (CَO `lf_û,%!6qC;-4lx4Vn-{l/gO:qmvΛTS2R;ĉKnFRۢ<o8{,b=I 0Ԏ+xh VDhQ&ڥPH<$F<$2oJBt[+q^ ۴mqÿ ږc}Lc&/q$\Cb T\5z]a#! U N+ %y 0(w@4  m '# 0lJ 0D(>"`U2Fp 1X=@</ek> "\"$%Z'R)N(+ 1*+^ +U6+ 1+ 0wz,q, 0 cb/ 1/ BL0@i0 1u1 12M2U>3 1044tN5 06L7e8 1J9j9 1;;;;;;;;;;;;;;;;;[=========1?_9?@JAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJAJA D 0 eD-E 0eEXF 0eGGGHP LaserJet III (2nd Floor),,,,,,0x9 Z6Times New Roman RegularX($ UEVavva -fiedV3|x$U _XҋXXX   `   11    ݀Seriousmentalillnessisdefinedas one12  monthDSMdisorderotherthansubstanceabusedisorderaccompaniedbyseriousfunctionalimpairment.Thisdefinitionismandatedbyfederallawforpurposesofstateblockgrantsformentalhealthtreatment,_ԢP.L._102321,106Stat.323,380,388(1992),andiscommonlyusedbyresearchers.((3$ !      0  (#$  0   _XҋXXX   `   5    ݀ReportoftheTransactionsoftheSocietyof  Actuaries,ReportsofMortality,Morbidity,andOtherExperience,246(1984). 4_   `   3    ݀!XҋXXXԀHealthInsuranceAssociationofAmerica,Source  BookofHealthInsuranceData(19841985),p.12,Table1.3.#X#LXX!Xҋq# _   `   4    ݀!XҋXXXԀB.F.Spencer,GroupBenefitsinaChanging  Society,181(1981)#X#LXX!Xҋq#ԴQ 9Z+.Courier New Regular(CEKQW]cioAutoList4A.A.A.A.A.A.A.A. N_   `   13    ݀XҋXXXKathyMcCabe,HospitalOpensPsychUnit:_ԢWhidden_  willKeep44Beds,BostonGlobe(North),May16,2002,  p.1. _ҀXҋXXX   `   7    ݀HealthInsuranceAssociationofAmerica,A  SurveyofDisabilityManagementPrograms,Dec.1999,availableat<<_Ԣhttp:www.hiaa.org_/_Ԣpdfs_/_Ԣdmpsurvey.pdf_>>. _XҋXXX   `   26    ݀Jill_ԢGaulding_,80CornellL.Rev.at1687. 2_XҋXXX   `   20    ݀Frank_ԢPalmieri_,FirmSettlesADACaseInvolving  MentalHealth,EmployeeBenefitNews(April1,1998). [_XҋXXX   `   18    ݀ClarkBrooks,UnfairDisabilityCoverage  Alleged:SanDiegoSuedOverInsuranceBenefitsforMentalIllnesses,SanDiegoUnionTribune,B1,Feb. X 15,1998. 4_Ҁ   `   15    ݀XҋXXXCh.184,Actsof2002,lineitem50950016  (mandatingtheconsolidationofMedfieldState   Hospital). _Ԁ   `   16    ݀XҋXXXId. R_XҋXXX   `   1    ݀NationalAssociationofInsuranceCommissioners,  ModelRegulationonUnfairDiscriminationinLifeandHealthInsuranceontheBasisofPhysicalorMentalImpairment,(1993). y_ҀXҋXXX   `   2    ݀Jill_ԢGaulding_,Race,SexandGenetic  DiscriminationinInsurance:WhatsFair?,80Cornell  _ԢL.Rev_.1646,1652(1995). _ҀXҋXXX   `   10    ݀EEOC,InterimEnforcementGuidanceonthe  ApplicationoftheAmericanswithDisabilitiesActof1990toDisabilityBasedDistinctionsinEmployerProvidedHealthInsurance,EEOCNoticeNo.915.002 L z (June8,1993)(availableattheEEOCwebsite,<>). _XҋXXXԀ   `   8    ݀ Moralhazard,atermcoinedbytheinsurance  industryinthenineteenthcentury,referstotheconceptthatinsuranceagainstlosslowerstheincentiveoftheinsuredtopreventorminimizetheloss.TomBaker,OntheGenealogyofMoralHazard,75Tex._ԢL.Rev_.237,238239(1996). _XҋXXX   `   9    ݀ Adverseselectionreferstotheconcernthat  insurancecoverageofaparticularriskwillleadthoseintheriskgrouptopurchaseit,andthoseoutsidetheriskgrouptoavoidthepolicybecauseofitshighercost,shrinkingthepoolandraisingcosts.Addendump.6(Slipop.p.6n.8). }CEKQW]cioAutoList5A.1.A.A.A.A.A.A.q-c<Q 9Z+Courier New(ڽCEKQW]cioAutoList6A.A.A.A.A.A.A.A.(O$0  2 e  a  .3  0` (#(# g_   `   6    ݀XҋXXXSeeStateDefendantsMemoranduminOpposition  tothePlaintiffsMotionforSummaryJudgmentandinSupportofTheirMotionforSummaryJudgment(hereafterDefendants_ԢSumm_._ԢJud_.Memo.)12.SeealsoHealth L InsuranceAssociationofAmerica,DisabilityClaimsforMentalandNervousDisorders4(July1995)#X#LXXXҋs#.(;$2 e  0  .3  0   CEKQW]cioAutoList2A.A.A.A.A.A.A.A. d 6_XҋXXX   `   27    ݀OfficeofTechnologyAssessment, Medical  TestingandHealthInsurance,_ԢOTA_ԄH384,60,Table25(1988).3#37=CIQYag1.a.i.(1)(a)(i)1)a) CEKQW]cioAutoList3A.A.1.A.A.A.A.A. C_   `   12    ݀,X) XXXԀ!XҋX X,X)DepartmentofMentalHealth,FiscalYears2002  2004StateMentalHealthPlan(2001)7071.#,X) XX!Xҋ#<( 9Z+&Courier Regular(CEKQW]cioAutoList7A.A.A.A.A.A.A.A. _   `   14    ݀XҋXXXԀId. j_   `   29    ݀XҋXXXԀHealthInsuranceAssociationofAmerica, A  SurveyofDisabilityManagementPrograms,(Dec.1999),availableat<>.#X#LXXXҋr#(b$0  0` (#(#2#   .3  0 ` (#` (# _SXҋXXX     19    ݀11DisabilityComplianceBulletin(Vol.6)p.5  (March12,1998).#X#LXXXҋ-# _Ҁ   `   17    ݀XҋXXXSee,<>.#X#LXXXҋf#(CEKQW]cioAutoList8A.A.A.A.A.A.A.A. `_XҋXXX   `   28    ݀See,SenateCommitteeonLaborandHuman  Resources,Sen.Rep.116,101stCongress,1stSession,  at8485(1989).#X#LXXXҋ-#(hCEKQW]cioAutoList91.1.1.1.1.1.1.1. _XҋXXX   `   23    ݀_ԢMerrile_ԀSing,StevenHill,Suzanne_ԢSmolkin_Ԁand  Nancy_ԢHeiser_,TheCostsandEffectsofParityforMentalHealthandSubstanceAbuseBenefits,US_ԢDHHS_Pub.No.(_ԢSMA_)983205(Mar.1998). Q_!XҋXXX   `   22    ݀G.L.c.175#X#LXX!Xҋ-#XҋXXX#L#X#LXXXҋ#!XҋXXX#LԀ47B.#X#LXX!Xҋ#  U_XҋXXX   `   21    ݀29U.S.C.1185aand42U.S.C.300gg5  (expiredSept.30,2001);GAO,CompliancewithMentalHealthParityActof1966:Effects/CostsofImplementation(May2000). _XҋXXX   `   24    ݀GAO,supran.20. _XҋXXX   `   25    ݀Ruth_ԢKirchstein_,_ԢNatl_ԀInstitutesofHealth,  InsuranceParityforMentalHealth:Costs,Access,andQuality,FinalReporttoCongressbytheNationalAdvisoryMentalHealthCouncil,1011,3235(2000).See,generally,Beth_ԢMellen_ԀHarrison,Recent P Developments:MentalHealthParity,39_ԢHarv_._J.on_Legis.255(2002)26679.1, 2, 3,Level 1Level 2Level 3Level 4Level 54#*&2Quick 1.   .0  A, B,Level 1Level 2Level 3Level 4Level 54#3n2Quick A.  .0 I., II.,Level 1Level 2Level 3Level 4Level 54#52Quick I.  .0  =#7Xd#   !  _XXXX XuXXX  3 COMMONWEALTHOFMASSACHUSETTS  SUPREMEJUDICIALCOURT Suffolk,ss.0 0 0h  0h h 0  0p  0p p No._SJC_Ԁ08787 t   __________________________________________________________________  _VALJEANNE_ԀCURRIE, 8     `     h     PlaintiffAppellant  v.GROUPINSURANCECOMMISSION,ETAL.,   `     h     Defendantsappellees__________________________________________________________________  ONAPPEALFROMTHEJUDGMENTOFTHESUPERIORCOURTDEPARTMENT,SUFFOLKDIVISION  __________________________________________________________________   @`  @ BRIEFOFAMICICURIAEMASSACHUSETTSASSOCIATION  \ FORMENTALHEALTH;NATIONALALLIANCEFORTHEMENTALLYILL/MASSACHUSETTS;AND,JUDGEDAVIDBAZELONCENTERFORMENTALHEALTHLAWINSUPPORTOFTHEPLAINTIFFAPPELLANT~__________________________________________________________________ `     h   SusanStefan `     h   BBO#600897 `     h   CenterforPublicRepresentation `     h   246WalnutStreet `     h   Newton,MA02160 `     h   6179650776 `     h   RobertD.Fleischner `     h   BBO#171320 `     h   CenterforPublicRepresentation `     h   22GreenSt. `     h   Northampton,MA01060 `     h   4135866024 @-(, 3  8uXXdXXd8   #XXXXui#!XXXX @"TABLEOFCONTENTS   TableofAuthorities!!H(#iii 8 InterestofAmici""J(#1#XXX!X #!XXXXԈ 0 StatementofIssues""J(#3#XXX!X| #!XXXXԈ   #XXX!X #!XXXXStatementoftheCase""J(#3 <   (#(#K(#StatementofFacts""J(#4#XXX!XT #!XXXX@(#(#K(#  4  #XXX!X #!XXXXSummaryofArgument""J(#5#XXX!Xx #!XXXXԈ   Argument""J(#9#XXX!X #!XXXXԈ 4  5    5I  .0 `   THENATUREOFDISABILITYINSURANCEANDITS5ی,` (#` (# Ќ     ` IMPACTONPEOPLEWITHDISABILITIES""J(#9  0   (#(# L &(#)L   ` A.0 AHistoryoftheMental/PhysicalDisability X DistinctioninInsuranceCoverage""J(# (# (#9#XXX!XT#!XXXX  ,|   #XXX!X#!XXXX0 ` B.0 ` (#` (#TheDistinctionBetweenHealthInsuranceand 0 DisabilityInsurance8"8"I(# (# (#12    II.0 ` NOACTUARIALDATASUPPORTSTHEAPPELLEES\` (#` (#    ` POSITION8"8"I(#16 0 3n     ` 3nA  .0   TheLegalRelevanceofActuarialData8"8"I(# (# (#163n-ی ( Ќ     ` B.0 ThereIsNoActuarialEvidencetoShow (# (#    `  ThattheIncreaseinCostAssociated   `  withDroppingtheRequirementfor   `  HospitalizationWouldDriveAway   `  InsurancePurchasers8"8"I(#20 ! # 0   `  1.0(#(#NoActuarialDataSupportstheUsex#%(#(# 0  0` (#(#0 ` (#` (#0 (# (#ofHospitalizationasaProxyfortheInabilitytoworkDuetoPsychiatricDisability8"8"I(#(#(#21 %D!(   *&     `   *&3 2  .0    LittleorNoReliableActuarialData *&3r ی'"*(#(# Ќ     `    ExiststoSupportAppellees   `    ContentionthatItsPolicyis   `    Necessary8"8"I(#25 *h%-  +'/ _ *&     `   *&` 3  .0    NoActuarialDataSupportsthe *&` ی(#(# Ќ  0  0` (#(#0 ` (#` (#0 (# (#ContentionthattheNatureofMental (#(#    `    HealthDiagnosisorTreatment   `    ContributestoVastlyIncreased   `    InsuranceCosts8"8"I(#27 P  *&     `   *& 4  .0    InsuranceCompaniesRelyonMyths,   Stereotypes,andFalseAssumptions *&+ ی (#(# Ќ     `    inMakingCoverageDecisions,Often   `    IgnoringTheirOwnActuarialData8"8"I(#28 $ t    III. ` EVENIFCOSTSAREHIGHER,EQUALLYEFFECTIVE       ` COSTCONTAINMENTSTRATEGIESCANBEDEVISED   ` THATDONOTDISCRIMINATEONTHEBASISOF   ` PSYCHIATRICDISABILITY8"8"I(#31 H  CONCLUSION8"8"I(#35 @  APPENDICES#XXX!X~#!XXXX     l #XXX!X#!XXXXTableofAuthorities #XXX!X #!XXXX   CASES  d _Baranek_Ԁv.Kelly,630F.Supp.1107(D.Mass.1986)8"8"I(#19 h _Barone_Ԁv.Hackett,602F.Supp.481(_D.R.I._Ԁ1984)8"8"I(#19   CarPartsDistributionCenterv.Automotive   Wholesalers_Assn_,37F.3d12(1stCir.1994)8"8"I(#19 `   ConcernedParentstoSave_Dreher_ԀParkCenterv. d  CityofWestPalmBeach,846F.Supp.986 D  (_S.D.Fla_.1994)X X E(#31,32 $  _Dahill_Ԁv.PoliceDepartmentofBoston,434Mass.233 |  (2001)8"8"I(#21 \  Doev.MutualofOmaha,179F.3d557(7thCir.1999)8"8"I(#17 T _Doukas_Ԁv.MetropolitanLife,950F.Supp.422  (_D.N.H._Ԁ1996)8"8"I(#30  EEOCv._CNA_ԀInsuranceCo.,96F.3d1039(7thCir.1996)8"8"I(#18 @ Goldmanv.StandardInsuranceCompany,1999U.S.Dist.LEXIS20191(_N.D.Ca_.Dec.20,1999)8"8"I(#29 0 LeonardF.v.IsraelDiscountBank,101F.3d687  (2ndCir.1996)8"8"I(#26  Lewisv.AetnaLife,7F.Supp.2d743(_E.D.Va_.1998), (x _revd_,Lewisv._Kmart_,180F3d166(4thCir.1999),  X  cert.den.528U.S.1136(2000)8"8"I(#17  8! LynnTeachersUnionLocal1037v.Massachusetts "# CommissionAgainstDiscrimination,406Mass.515 |#$ (1990)8"8"I(#18 \$% Parkerv.MetropolitanLifeIns.,121F.3d1006 &T!' (6thCir.1997)8"8"I(#18 &4"( _Weyer_Ԁv.TwentiethCenturyFoxFilmCorp.,198F.3d1104 (#* (9thCir.2000)!!H(#18 l)$+ ЀWinslowv._IDS_ԀLifeInsuranceCompany,29F.Supp.2d +d&- 557(_D.Minn_.1998)8"8"I(#30 +D'. Ї_Worden_Ԅ_Gregoire_Ԁv._Walmart_,2001_Mass.Comm.Discr_.  ЀLexis81Nov.28,2001)8"8"I(#18   STATUTESandLEGISLATIVEHISTORY   \ 29U.S.C.1185a8"8"I(#27   42U.S.C.300gg58"8"I(#27 h  G.L.c.32A10D""J(#4  `  ЀG.L.c.151BH!H!G(#7,9   G.L.c.151B98"8"I(#20 `  G.L.c.17547B8"8"I(#28 X  Ch.184,Actsof2002,lineitem50950016X X E(#23,24  _P.L._Ԁ102321,106Stat.323,380,388(1992)8"8"I(#23#XXX!Xc #!XXXXԈ X SenateCommitteeonLaborandHumanResources,Sen.Rep.116,101stCongress,1stSession(1989)!!H(#32 $  BOOKS,PERIODICALS,PAMPHLETS  | 11DisabilityComplianceBulletin(Vol.6)p.5(March12,1998)8"8"I(#26 T #XXX!X,#!XXXXBaker,Tom,OntheGenealogyofMoralHazard,75TexasLawReview237(1996)8"8"I(#14  Brooks,Clark,UnfairDisabilityCoverageAlleged:SanDiegoSuedOverInsuranceBenefitsforMentalIllnesses,SanDiegoUnionTribune,B1, ! # Feb.15,19988"8"I(#26 "$ DepartmentofMentalHealth,FiscalYears20022004StateMentalHealthPlan(2001)8"8"I(#23 ,%| ' EEOC,InterimEnforcementGuidanceontheApplicationoftheAmericanswithDisabilitiesActof1990toDisabilityBasedDistinctionsinEmployerProvidedHealthInsurance,EEOCNoticeNo.915.002(June8,1993)8"8"I(#16 P)$, _Gaulding_,Jill,Race,SexandGeneticDiscriminationinInsurance:WhatsFair?80CornellL.Rev. +'/ 1646(1995)xxA(#10,24,29  Harrison,B.M.,RecentDevelopments:MentalHealthParity,39_Harv_.J.onLegis.255(2002)!!H(#28 ,| HealthInsuranceAssociationofAmerica,DisabilityClaimsforMentalandNervousDisorders(July1995)8"8"I(#13   HealthInsuranceAssociationofAmerica,SourceBookofHealthInsuranceData(19841985)8"8"I(#11 $ t  HealthInsuranceAssociationofAmerica,ASurveyofDisabilityManagementPrograms,Dec.1999X X E(#14,34   _Kirchstein_,R.,_Natl_ԀInstitutesofHealth,InsuranceParityforMentalHealth:Costs,access,andQuality,FinalReporttoCongressbytheNationalAdvisoryMentalHealthCouncil,(2000)8"8"I(#28  McCabe,Kathy,HospitalOpensPsychUnit:_Whidden_ԀWillKeep44Beds,BostonGlobe(North),May16,20028"8"I(#23 @ NationalAssociationofInsuranceCommissioners,ModelRegulationonUnfairDiscriminationinLifeandHealthInsuranceontheBasisofPhysicalorMentalImpairment(1993)""J(#9 d OfficeofTechnologyAssessment,MedicalTestingandHealthInsurance,_OTA_ԄH384,(1998)8"8"I(#31 0 _Palmieri_,Frank,FirmSettlesADACaseInvolvingMentalHealth,EmployeeBenefitNews(April1,1998)8"8"I(#27 \ ReportoftheTransactionsoftheSocietyofActuaries,ReportsofMortality,Morbidity,andOtherExperience(1984)8"8"I(#13 !# Sing,M.,Hill,S.,_Smolkin_,S._Heiser_,N.,TheCostsandEffectsofParityforMentalHealthandSubstanceAbuseBenefits,US_DHHS_ԀPub.No.(_SMA_)983205(Mar.1998)8"8"I(#28 % !( Spencer,B.F.,GroupBenefitsinaChangingSociety(1981)#XXX!X-#!XXXX8"8"I(#12 L(#+ #XXX!X;:#!XXXX TableofAuthorities  *$&. 8#LXXdXXd8  InterestofAmici   : ` OnJune28,2002theCourtenteredanordersolicitingamicusbriefsinthisappeal.Three  p organizationsthatadvocateforindividualswithmentalillnessrespectfullyrespondtothesolicitationandsubmitthisbriefinsupportoftheplaintiffappellant. ` Individualswhoareservedbyorwhoaremembersoftheseorganizationshaveencountereddiscriminationininsurance.Consequently,amicihaveaninterestin   theresolutionofthiscase.Moreover,sinceeachorganizationadvocatesforfairandnondiscriminatoryinsurancebenefits,includinglongtermdisabilityinsurance,theyareuniquelypositionedtoconveyauthorityandargumentstothisCourtconcerningthediscriminatorynatureoftheCommonwealthslongtermdisabilitypolicy. ` Foundedin1913,amicusMassachusettsAssociation (!x" forMentalHealth(MAMH)provideseducation,advocacy,leadership,andinformationtoagencies,individuals,andfamiliesonnational,state,andlocalmentalhealthissues.MAMHusesitsnetworkofvolunteerstoadvocate,planandadviseonallaspectsofmentalhealth,includingtheprovisionofcommunitybased 0+&. services,insurance,housing,employment,andeducationformentalhealthconsumersandtheirfamilies. ` AmicusNationalAlliancefortheMentally P Ill/Massachusetts(NAMI/Mass)isthisstatesaffiliateoftheNationalAlliancefortheMentallyIll.NAMI/Massisagrassrootsselfhelp,supportandadvocacyorganizationofconsumers,familiesandfriendsofpeoplewithseriousmentalillness,suchasschizophrenia,bipolardisorder(manicdepressiveillness),majordepression,obsessivecompulsivedisorder,andanxietydisorders.#XXX!XX9#!XXXXԀTheMassachusetts X chapterhasover2,400members.NAMI/Massprovideseducationaboutmentalillness,supportsincreasedfundingforresearch,andadvocatesforadequateandnondiscriminatoryinsurancecoverage,publicservices,treatment,housing,rehabilitation,andjobsforpeoplewithseverepsychiatricillnesses.#XXX!XB#!XXXX H   ` Amicus,theJudgeDavidL.BazelonCenterfor  @" MentalHealthLawisanational,nonprofitpublicinterestorganizationwhichworkstoadvancethelegalrightsofpeoplewithmentaldisabilitiesandensuretheirequalaccesstotheservicesandsupportstheyneedforparticipationincommunitylife.TheBazelonCenterhassuccessfullychallengedmanyofthebarriers *H&. todignityandchoicethatconfrontpeoplewithmentalillness.TheBazelonCenterworkstoclarifyandupholdtherightsofpeoplewithmentaldisordersandtoensurethemequalaccesstohealthcare,insurancecoverage,housingandemployment.  StatementofIssues   H  F ` AmiciadoptandincorporateMs.Curriesstatement   oftheissuesinthecase.Argumentinthisbrief,however,islimitedtothefirstissue: ` 1. DoestheGroupInsuranceCommissionpolicy  violateG.L.c.151B,4(16),bydenyingplaintiffappellantCurriescontinuedlongtermdisabilitybenefitssolelybecauseherdisabilityislabeledasmentalratherthanphysical?@  StatementoftheCase  ` ЀOnMay1,2000,Ms.Currie,astateemployee,filedherComplaintintheSuperiorCourtDepartment.(Appendix[A.]95.)ShechallengedprovisionsofherGroupInsuranceCommission(GIC)longtermdisability(LTD)insurancepolicywhichconditionedthereceiptofbenefitsbeyondoneyearonconfinementinaninstitutionincasesofdisabilitybasedonmentalillness,whileprovidingongoingbenefitswithoutsimilarconditions#XXX!XD#!XXXXԀtoemployeeswithphysical +`&. _disabilities.HercomplaintallegedthattheprovisionsviolatedherrightsundertheMassachusettsConstitutionandtheCommonwealthsdisabilityantidiscriminationlaw.(A.95.)OnJune5,2000,aSuperiorCourtjudgepreliminarilyenjoinedthedefendantsfromterminatingMs.CurriesLTDbenefits.Anamendedcompliantwasfiled(A.191)#XҋXX!XҋK#!XҋXXXҋandtheinjunctionwas   twiceextended.(A.398,440.) ` However,afterhearingargumentsonthepartiescrossmotionsforsummaryjudgment,theSuperiorCourt,onFebruary6,2002,dismissedthecomplaint.(TheSuperiorCourtsorder[hereafter Slipop.]appearsintheAddendumtothisbrief[Addendum]atp.4.) ` Ms.CurrieappealedthejudgmentoftheSuperiorCourt,andonMay24,2002,wasgranteddirectappellatereviewbythisCourt.TheCourtsolicitedamicusbriefsonJune21,2002. 0    StatementofFacts   @" P ` Thematerialfactsarenotindispute.GeneralLawc.32A,10D,requirestheGICtoestablishaLTDplanforstateemployees.(Addendum,p.14.)TheGIC,inturn,determinestheconditionsofparticipation,theamountofbenefits,theirduration,andthepremiumrates.Anunderwriteractsasplanadministratorand *H&. determinesindividualeligibility.(Addendump.2[Slipop.p.2].) ` Ms.CurriespolicyprovidesLTDbenefitsforoneyearforindividualsdisabledduetomentalillness.(A.667.)Afteroneyear,benefitsceaseunlesstheindividualisconfinedtoahospitalorinstitution,inwhichcasebenefitscontinueforthedurationoftheconfinement.(A.667.)Physicallydisabledemployeesareaffordedbenefitsuntiltheyareabletoreturntoworkorreachtheageof65,withoutregardtowhetherornottheyarehospitalized.(A.665,Addendump.3[Slipop.P.3].) ` Ms.Curriehasbeenastateemployeesince1985.(A.76,Addendump.2[Slipop.p.2].)ShehaspaidpremiumstoparticipateintheGICsLTDplan.(A.44,78.)Ms.Curriehasschizophrenia(amentaldisabilityunderthetermsoftheGICpolicy)which,inJune1999,forcedherfromwork.(A.7677,83,86.)Thoughhospitalizedforabriefperiod,Ms.Curriehasreceivedoutpatientpsychiatriccarewhichhasenabledhertoavoidhospitalization.Nevertheless,sheremainsunabletoreturntowork.(A.77,82,89,91.) ` Ms.CurrieappliedforLTDbenefitsunderherpolicyandherapplicationwasapprovedinOctober *&. 1999.However,shewasalsoinformedthatthebenefitswerelimitedtooneyearor,thereafter,onlyifshewasconfinedinamentalhospital.(A.48,667,Addendump.3[Slipop.p.3].)Theoneyearofbenefitshasexpired.#XҋXX!XҋM# P   `     h SummaryofArgument   H   ` ThisbriefsupportsMs.CurriesclaimunderG.L.c.151B.AmicicontendthattheCommonwealthmaynot `  faciallydiscriminateagainstitsemployeeswithpsychiatricdisabilitiesbyrefusingtopermitthemtopurchaseeffectiveprotectionagainstlongtermdisabilitywithoutprovidingactuarialevidencethatitslimitsoncoverageforpsychiatricdisabilityarenecessarytomaintaintheviabilityoftheLTDprogram. ` Amicimaketwoarguments.First,thechallenged ` provisionisnotbasedonvalidunderwritingorclassifyingrisks,andwithoutsuchjustificationitconstitutesillegaldiscrimination.(Infraat1620.)  !p" Second,theCommonwealthisnotfreetomeetitslegitimatecostcontainmentgoalsbychoosingthemostdiscriminatoryoptionamongahostofpossiblealternativestocontrolcostsinitslongtermdisabilityprogram.(Infraat3134.) )$,  ` TheGICcannotshowanactuarialbasistojustify @+&. theneedforadifferentiationincoveragebetweenpsychiatricandphysicaldisabilityasdrasticastheonechallengedinthiscase.Whileitiscommonlybelievedthatinsurancecompanieshaveextensivelyresearchedandvalidateddatasupportingdistinctionsincoverage,thisisnotnecessarilythecase.(Infra  H  at1016.)Defendantsincaseschallengingdisparities   ininsurancecoveragegenerallydonotdefendbyshowingasoundactuarialbasisfortheirpolicies,butasinthiscasebydenyingthattheyneedtoshowanyactuarialbasisfortheirpoliciesatall.Amici X contendthatunderMassachusettslaw , iftheGICcan h shownoactuarialbasisfordisparityindisabilitycoverageprotectionthatfaciallydiscriminatesagainstaprotectedclass,itcannotbeentitledtosummaryjudgment.(Infraat2031.)    ` TheGICsprimarydefenseisbasedonfederalcourtsinterpretingtheAmericanswithDisabilitiesAct(ADA) . Foravarietyofreasons,federalcourtsin "0$ othercircuitsinterpretingtheADA,whichhasa safeharborprovisioninapplicabletodisabilitydiscriminationunderG.L.c.151B,haverarelycalledupondefendantstoprovideanyactuarialrationaleincasesinvolvingpsychiatricdisability.(Infraat18 @+&. 19.)Inanyevent,thiscourthasnotinterpretedG.L.  c.151BinlockstepwiththeADAwhentheintentoftheLegislatureandtheinterpretationsofMCADhavepointedindifferentdirections,astheydohere . In   addition,theFirstCircuitsinterpretationoftheADAscoverageofinsurancepoliciesconflictswitheachofthecasescitedbyappelleesfromothercircuits.(Infraat1820.) x   ` AmiciagreethatmaintainingaviableLTDprogram 8  fortheCommonwealthsemployeesisalegitimatestateinterest,butdisagreethatthisresolvestheissuebeforethisCourt.ThecruxofthequestionunderG.L.c.151BiswhetherthediscriminatorypolicyatissueinthiscaseisnecessarytomaintaintheviabilityoftheLTDprogramfortheCommonwealthsemployees.(Infraat2031.) 8  ` ThemarginalincreaseincostsattributabletopayingdisabilitybenefitstopeoplewithpsychiatricdisabilitieslivingincommunitysettingsratherthaninhospitalsisnotsosubstantialastothreatentheviabilityoftheLTDprogram,andtherearemanyothercostcontainmentstrategiesavailablethatwouldnotdiscriminatesostarklyagainstpeoplewithpsychiatricdisabilities.AmicicontendthattheStateviolated @+&. ТG.L.c.151Bwhenitchosethemostdiscriminatorycostcontainmentstrategyinthefaceofexplicitstatepolicytothecontrary,andwhenother,lessdiscriminatorymeanswereeasilyavailable.(Infraat   3134.) !XҋXXXҋ  Argument   `  hI.THENATUREOFDISABILITYINSURANCEANDITSIMPACTONPEOPLEWITHDISABILITIES.hL &((&L %3    ` %3i2  A  .3  0   AHistoryoftheMental/PhysicalDisability L  DistinctioninInsuranceCoveragei#XҋXX!Xҋh#%3ij݌ p   Ќ   ` Stateshavegenerallyregulatedtheinsuranceindustryunderwhatiscommonlycalleda fairdiscriminationmodel.Underthismodel,insurancecompaniesareallowedtoclassify,ordiscriminate,aslongastheclassificationscorrespondto soundactuarialprinciples,orto actualorreasonablyanticipatedexperienceandaslongasthedifferenceinratestructurescorrespondstodifferencesinrisk.  #  1      ׀ `   ` Asthecivilrightsmovementgainedforce,an antidiscriminationmodel(ratherthan fairdiscrimination)wasusedwithsomesuccesstochallengeinsurancecompanypracticesthatadversely &P!( affectedsuspectorquasisuspectclassifications,suchasethnicminoritiesandwomen.Morerecently,theantidiscriminationmodelhasbeeninvokedtorestrictthewidespreadpracticeofrefusingtoselllife,health,ordisabilityinsurancetowomenwhoarevictimsofdomesticviolence,andtoprohibitinsurersfromusinggeneticscreeningtodenycoveragetoindividualswhoarehighlylikelytodevelopbreastcancer,HuntingtonsChorea,andotherdiseasesforwhichgeneticmarkershavebeendiscovered._Ԣ  #  2      ף_   ` Thefairdiscriminationandantidiscriminationmodelsgenerallysharetheassumptionthatinsurancecompanypoliciesareactuariallysound.Womenwhoarevictimsofdomesticviolenceandpeoplewhohavegeneticmarkersforcertaindiseases,are,infact,morelikelytofilemedical,disabilityandlifeinsuranceclaims.Accordingly,argumentsinfavorofequalaccesstohealthanddisabilitybenefitsforpeoplewithpsychiatricdisabilitiesareoftenframedinantidiscriminationterms,essentiallyconcedingthattheunderlyingactuarialbasisfordiscriminationisvalid. x'"*  ` However,amorethoroughexaminationofinsurancecompanypracticestowardpeoplewithpsychiatricdisabilitiesshowsthatthesedecisionsareoftenbasedonoutdatedstudies,drawthewrongconclusionsfromgoodstudies,orevenrelyonpreciselythesortsofirrationalstereotypesassociatedwith unfairdiscrimination. ` Grouplongtermdisabilitycoverageisarelativelynewentranttotheinsurancefield.Itbegantobewrittenintheearly1960sasanadjuncttogrouphealthinsurance.  #  3      ׀Thus,exceptionsandexclusionsin @ healthcarecoverageweregenerallyadoptedintothenewlongtermdisabilitycoveragewithoutrationaleorresearch.Healthcarecoverageexclusionsfor mentalandnervousconditionswere,inturn,basednotonresearchbutapparentlyononedisastrousindividualexperience:0 ` Intheearlydaysofmajormedicalplans,itwasnotcommontohaveanyspeciallimitonmentalandnervousdisorders.However,theemployeesofalargepublishingcompanyinNewYorkCity(wherethereisnoshortageofpsychiatrists)helpedtochangethatpracticewhentheydiscoveredthatthemajormedicalplanwouldpaymostoftheexpensesincurredwhilevisitingapsychiatrist.Thecarriersufferedlargelossesonthecaseand x'"* subsequentlyintroducedthementalandnervousdisorderlimitation.  #  4      ` `   ` Subsequentcarrierlimitationsonmentalandnervousdisordersfollowedsuit,withoutresearchingwhethertheexperienceofthisparticularcarrierhadanybearingonthepopulationsofpeopletheycovered.Thesehealthinsuranceexclusionswerecarriedoverintothelongtermdisabilityproduct,withoutanyconsiderationofthedistinctionsbetweenhealthinsuranceanddisabilityinsurance. ` B.0 TheDistinctionBetweenHealthInsuranceand l DisabilityInsurance@  7{ ` Thereareanumberofrelevantdistinctionsbetweenhealthinsuranceanddisabilityinsurance.Mostobviously,healthinsurancepaysforhealthtreatmentforemployees:therapy,medication,hospitalization,testing,andemergencycare.Itscostsarerelatedtothecosts,modeandfrequencyoftreatment.Disabilityinsurance,ontheotherhand,replacesincomeforaformeremployeewhoiscurrentlyalthoughnotnecessarilypermanentlyunabletowork.Theamountofdisabilityincomecollectedisbasedonpredisabilityincomelevelandnotonthetypeorseverityofthe x'"* disabilitysuffered,themodalityofitstreatment,oritsexpense. ` Becausesomanyfewerworkersbecomedisabledthanrequiremedicaltreatment,disabilityinsuranceisamuchsmallerprogramintermsofcostsandexpenses.Forexample,plansthathaveasixmontheliminationperiodbeforecommencementofbenefitsrecordatotalincidenceofclaimsmentalandphysicalofjust3.59perthousand.   #  5      ׀Generally,claimsforbenefitsbasedon @  psychiatricdisabilitieswithmoregenerouslimitationsthanGICsrunabout7to8percent ofallclaims @ filed._Ԣ$   #  6      ף_ԀTherefore,ifGIChas38,000coveredemployees, P itprobablyreceivesbetweennineandtenclaimsbasedonpsychiatricdisabilityperyear.Becausetherearesofewclaims,itiseasytousecasemanagement,rehabilitation,andutilizationreviewtocontrolcostsassociatedwiththoseclaimstechniqueswhichaHealthInsuranceofAmericaAssociationstudyshowsave$13.00  @" foreverydollarinvested._Ԣ  #  7      ף_Ԁ   ` Inaddition,whileemployerstypicallypayasubstantialamountforhealthinsurancepremiums,disabilityinsuranceprogramsareoftenasisthecasehereelectiveandpaidforentirelybyemployees.Thus,theGICsrefusaltochangethetermsoftheprogramisnotbasedonitsowncosts,butonthepredictionthatextrapremiumcostwoulddriveawaysufficientnumbersofthecurrentlyparticipatingmemberstomaketheentireprogramunaffordable.However,theGIChasproducednodataonwhattheextracostwouldbe,andwhatmarginaladditionalcostwouldmotivatecurrentpurchasersofdisabilityinsurancecoveragetoceasecoverageentirely.Thereisnothingtosuggestthatthoseemployeeswhochoosetopayfordisabilityinsurancewouldrefusetocontinueelectingcoverage. ` Theoftencitedmoralhazard_Ԣ,  #  8      ף_Ԁandadverse  (" selection  #  9      ׀argumentsarealsodifferentinhealth  insuranceanddisabilitybenefits:payingdisabilitybenefitsforpsychiatricdisabilitiesdoesnotencouragepeopletoreceiveadditionaltreatmentssuchaspsychotherapythattheymightnototherwiseseek.Becauseofthecostofhealthcare,andbecausehealthinsurancecoversentirefamilies,witheachmemberpotentiallyhavingcostlyhealthconditions,itisalsomorelikelythatpeoplewilladverselyselectforhealthinsurancecoveragethanfordisabilitycoverage. ` ThedistinctionsbetweenhealthinsuranceanddisabilityinsurancehaveledtheEqualEmploymentOpportunityCommission(EEOC)totakethepositionthatdisparitiesbetweencoverageforphysicalandpsychiatricdisabilitiesinhealthinsurancearenotforbiddenbytheAmericanswithDisabilitiesAct,butthatsuchdisparitiesincoverageindisabilityinsurancedoviolatetheADA.  #  10      ף  (" II.NOACTUARIALDATASUPPORTSTHEAPPELLEESPOSITION ` Despitethedifferencesbetweenhealthinsuranceanddisabilityinsurance,theargumentsthatareputforwardinfavoroflimitationsoncoverageforpsychiatricconditionsforbothformsofinsurancearesimilar. ` Insurersusuallyarguethattheirpracticeofchargingdifferentialratesorexcludingcertaincategoriesofpeopleorlossesfromcoveragearesimplyreflectionsofeconomicreality.Peoplewhoappeartobediscriminatedagainstaretreateddifferentlybecausetheyposeobjectivelygreaterrisksofloss.Theprincipalargumentsappeartobethatmentalillnessesaremoresubjective,moredifficulttodiagnose,moredifficulttotreat,andthatitishardertodeterminethelinebetween truedisabilityand nondisability. ` A.TheLegalRelevanceofActuarialData  ("  ` TheGICarguesthatthedecisiontodrasticallylimitcoverageforpeoplewithpsychiatricdisabilitiesneednotbesupportedbyactuarialdata,orindeedanyevidenceatall.SeeDefendants_ԢSumm_._ԢJud_.Memo.,p. x'"* 9.Thisargumentwasmadeinthesectionofthatmemorandumdevotedtoconstitutionalclaims.Whateverthevalidityoftheargumentinthatsection,amici P contendthatunderG.L.c.151B,appelleesmustpresentactuarialdatasupportingtheirfaciallydiscriminatorypoliciesinordertoshowthateliminatingthesepolicieswouldfundamentallyaltertheirprogram .     ` PositionssuchastheGICsrelatingtocoveragearecommon: _ԢKmart_Ԁhasnotmetthisburden[ofactuarialjustification]andacknowledgesthatithadnoactuarialjustification[forpickingthediscriminatoryplan].Lewisv.AetnaLife,7F.Supp.2d h 743,747(_ԢE.D.Va_.1998),_Ԣrevd_,Lewisv._ԢKmart_,180F3d ( 166(4thCir.1999),cert.den.528U.S.1136(2000).  Seealso,Doev.MutualofOmaha,179F.3d557(7th X Cir.1999)(defendantstipulatesthatnoactuarialdatasupportsitsrestrictionsonAIDScoverage). ` DefendantshavenotbeenrequiredtoshowanyactuarialbasisfortheirdecisionsbecausefederalcourtsinothercircuitsinterpretingtheADAhaveaccepteddefenseswhicharenotacceptableunderFirstCircuitandMassachusettslaw.Forexample,oneofthecasescitedbelowbytheGICholdsthatdiscriminationchargesagainstinsurancecompaniesundertheADAmay X+&. onlybebroughtintheareaofphysicalaccessibility.Parkerv.MetropolitanLifeIns.,121F.3d1006(6th X Cir.1997)(enbanc).OthercasescitedbyappelleesholdthatonlyemployeeswhoareabletoworkhavestandingtosueunderTitleIforemploymentdiscrimination,evenrelatingtoprovisionsindisabilityinsurance.EEOCv._ԢCNA_InsuranceCo.,96   F.3d1039,1044(7thCir.1996).Stillothercourts x  havedecidedthattheADAssafeharborprovisionsprecludeliability . _Weyer_Ԁ_v.Twentieth_ԀCenturyFoxFilm  Corp.,198F.3d.1104,1115(9thCir.2000).   ` However,underbothFirstCircuitprecedentandMassachusettslaw,noneoftheseprecedentshaveforce.Employeeswhoarenolongerabletoworkmayrecoverondiscriminationclaims,_ԢWorden_Ԅ_ԢGregoire_Ԁv._ԢWalmart_,2001_ԢMass.Comm.Discr.LEXIS_Ԁ81at*17(Nov.28,2001)(findingforplaintiffeventhoughhermultiplesclerosisrenderedherunabletowork),andthisCourthasheldthattheLegislatureintendedthesafeharborprotectionappliesonlytoagediscriminationininsurance.LynnTeachersUnionLocal1037v. 8&!( MassachusettsCommissionAgainstDiscrimination,406 'H#* Mass.515(1990).Thus,mostoftheADAprecedentscitedbytheGICbelowareinapplicableto `+&. Massachusettslaw. ` TheFirstCircuitsdecisioninCarParts X DistributionCenterv.AutomotiveWholesalers_ԢAssn_, h 37F.3d12(1stCir.1994)holdsthataninsurersuch  ( astheGICmaybesuedundertheemploymentdiscriminationtitleoftheADAifitfunctionsasanemployeroractsonbehalfoftheemployerinprovidingoradministeringemploymentbenefitssuchasinsurance.Id.at17.TheFirstCircuitimplicitlyrejected  p  argumentsthatthecontentsofinsurancepoliciesarenotsubjecttotheADA,andthatemployeeswhonolongercanworkmaynotsueundertheADA.Seealso, 0 _ԢBarone_Ԁ_Ԣv.Hackett_,602F.Supp.481,483(_ԢD.R.I._ @ 1984)(stateagencythatadministersbenefitsmaybesuedas employerunderTitleVII);_ԢBaranek_Ԁv.Kelly, X 630F.Supp.1107,1113(D.Mass.1986). ` Thus,thefederalprecedentscitedbyappelleeshavelittleforceintheFirstCircuit,andevenlessapplicabilitytoMassachusettslaw.UnderMassachusettslaw,amicicontend,defendantswillfinallyhaveto $ & showthatthereisanactuarialbasisfortheirallegedlynondiscriminatoryactuarialdecision:choosingapolicythatsinglesoutpsychiatricdisabilitiesandthepeoplewhosufferfromthemfor p+&. drasticallyadversetreatment.L "ڽ((&L %3    ` %3ä2ڽ  B  .3  0   ThereIsNoActuarialEvidencetoShowThat X theIncreaseinCostAssociatedwithDroppingtheRequirementforHospitalizationWouldDriveAwayInsurancePurchasers%3ä ݌$  Ќ   ` Theremainderofthisbriefisdevotedtotheargumentthatthereisnoactuarialevidencetoshowthattheincreaseincostassociatedwithdroppingtherequirementforhospitalizationwoulddriveawayinsurancepurchasers.Thefirsttwosubsectionsthatfollowwillcontendthat,eveniftheclaimthatthelinebetweenpsychiatricdisabilityandnondisabilityisdifficulttodraw,choosinghospitalizationasawaytodrawthelineisnotsupportableinlogicorlaw.Thethirdandfourthsubsectionswillchallengethecoreargumentthatextendingcoveragetopeoplewithpsychiatricdisabilitieswhoarenothospitalizedwouldbetoocostly. ` Therefusaltoextenddisabilityinsurancecoveragetopeoplewithpsychiatricdisabilitiesislargelybasedonstereotypesandunfoundedassumptions,preciselythekindofdiscriminationthatG.L.c.151Bprohibitsandwasdesignedtocombat.TheGeneralCourthasinstructedthatthisstatuteistobeconstruedliberallytoaccomplishitsremedialpurposes.G.L.c.Ϣ151B9.AsthisCourthasnoted, Surelyoneaspect +&/ ofthatremedialpurposeistoencourageimpairedpersonstoovercomeormitigatetheirdisabilities._ԢDahill_Ԁv.PoliceDepartmentofBoston,434Mass.233, P 240(2001). ` Ms.Currie,whoisdiagnosedwithschizophrenia,isseekingtoovercomeherdisability.Withoutincomeprotectionduringperiodsofdisability,herchancesofaccomplishingthisgoalaresignificantlydiminished.Ifsheworkedformostotheremployers,shewouldbeeligiblefordisabilitybenefitsunderthefederalSocialSecurityDisabilityInsuranceprogramwithouthavingtobehospitalized.BecausesheisemployedbytheCommonwealthanddoesnotparticipateintheSocialSecuritysystem(A.41,79),heraccesstomeaningfulincomeprotectionthroughgrouplongtermdisabilityinsurancehasbeenforeclosed,simplybecauseshehasapsychiatricdisability. `  1.0  NoActuarialDataSupportstheUseof  @" HospitalizationasaProxyfortheInabilitytoWorkDuetoPsychiatricDisabilityl#%   z `  ` Inclaimsinvolvingpsychiatricdisability,thesingleargumentthatisnotalsoapplicabletohealthinsurancecoverageistheuncertaintyofdeterminingjustwhenapersonwithapsychiatricdisabilityis disabledenoughtowarrantcoverageforinabilityto +'/ work.Becauseofthisallegeddifficulty,itisargued,hospitalizationservesasascreeningmechanismandproxyfortruedisabilityinthecaseofpsychiatricdisability. ` Thiscouldbetrueforoneoftworeasons:thatitissodifficultformentalhealthprofessionalstodetermineactualdisabilityinapatientthathospitalizationservesasabetterproxyforsuchadisablingconditionthanaphysiciansjudgment,orthatpeoplearemoredisposedtomalingerlongtermpsychiatricdisabilityandphysicianscannotdetectthesemalingerers. ` However,nodatasupportseitherofthesecontentions.Bycontrast,muchdataexiststosupporttheoppositeconclusion:thattherequirementofhospitalizationsimplyservesasanartificialanddiscriminatorylimitationonthenumberofpotentialapplicantsfordisabilityinsuranceratherthananactuariallysupportedreflectionofthenumberofemployeessoseverelydisabledbypsychiatricconditionsthattheycannotwork. ` InMassachusetts,inparticular,thenumberofpsychiatricbedsavailableinhospitalsettingsrepresentsatinyfractionofthenumberofpeoplewho *&. aresodisabledbypsychiatricconditionsthattheycannotwork.TheDepartmentofMentalHealth,usingnationalepidemiologicalstudies,hasestimatedthat5.7%ofthepopulationsufferfrom seriousmentalillness._Ԣ   #  11      ף_ԀBasedon1990censusdata,thatis260,173 P  Massachusettscitizens.+\  #  12      ׀Thereareabout3,700  H  inpatienthospitalbeds,bothprivateandpublic,availableinMassachusetts:about1100inthepublicsystemand2590privatehospitalbeds._Ԣ   #  13      ף_ԀThe @  Commonwealthhaslost313privatepsychiatricbeds12.5%ofthetotalnumberofprivatebedsavailableand100statepsychiatricbedsinthelasttwoyears.\   #  14       8 andthemostrecentstatebudgetrequirestheclosingofanotherstatehospital.  #  15      ףPrivatefacilitieshave 8 waitinglistsforbeds.d  #  16      ׀Totheextentthatthismeans  thatpeoplearereceivingneededtreatmentincommunityratherthanhospitalsettings,amiciapplaudthis P development.However,totheextentthatappelleesarguethatbeinghospitalizedisatrueproxyforbeingunabletoworkduetoapsychiatricdisability,theyaredrasticallyundercounting.ItissimplynotfairthatCommonwealthcitizenslikeMs.Curriewhocannotworkduetopsychiatricdisabilityhavetheirlivelihoodsdependentontheeverdiminishingnumberofhospitalbedsavailable. ` Ratherthanaproxyfortruedisability,theuseofhospitalizationasascreeningmechanismsimplyassuresthatthenumberofpeoplereceivingdisabilitybenefitsonthebasisofpsychiatricdisabilitywillbekeptartificiallylowbythelackofavailablepsychiatricbedsinMassachusetts.Thisisnotadistinctionsupportedbyactuarialanalysis,norisitalegalbasisfordiscriminationonthebasisofpsychiatricdisability. '"* L -(("L ` 2.0 LittleorNoReliableActuarialDataExists  toSupportAppelleesContentionthatItsPolicyisNecessaryX   ` Itistruethatthepercentageofdisabilityclaimsrelatedtopsychiatricdisabilityhaverisenoverthepastdecade.Inpart,thismaybebecauseofincreasedworkforceparticipationbypeoplewithpsychiatricdisabilities,whichisagaintobecelebrated.Inpart,thismaybebecauseofincreasingstressintheworkforceassociatedwithmergers,layoffs,andincreasingworkloads. ` However,theincidenceratetherateofdisabilityclaimstothecoveredpopulationisstilllow,becauserelativelyfewlongtermclaimsareactuallyfiledforreasonsrelatingtomentalillness._ԢUnumProvident_,thelargestprovideroflongtermdisabilityinsurancewith28.5%marketshare,reported400,000newclaimsforbothshorttermandlongtermdisabilityin2001,outofatotalcoveredpopulationof25,000,000.2  #  17      ףOfthelongtermdisabilityclaims, "$ claimsrelatingtocancer,pregnancy,backinjuries,andcardiacproblemswerefiledmostoften,accountingfor45%ofallclaims. ` ReportsfromLTDinsuranceprogramsforgovernment  )p$, employeesaremixed.WhereasSanDiegoeliminateddisabilitycoverageforpeoplewithmentalhealthconditionsin1994becauseofthevolumeofclaims(andwaspromptlysued),  #  18      ׀Phoenixsettledasimilarlawsuit   byagreeingtoinstituteparityindisabilitybenefits,andreportedlittleinthewayofrisingcosts.Whenaskedaboutinstitutingparityforlongtermdisability,thePhoenixpersonnelfiscalspecialistwasquotedassaying: Economically,Idontthinkithadmuchofanimpactatall.1  #  19         ` ThelowcostofprovidingparityinlongtermdisabilitybenefitsforpsychiatricconditionsisperhapsmostgraphicallyillustratedbythefactthatthedefendantinLeonardF.v.IsraelDiscountBank, 8 101F.3d687(2ndCir.1996)(tablecase)settledacase H challengingdisparityinlongtermdisabilitybenefitsonthegroundsthatprovidingequalaccesstolongterm disabilitybenefitsforallitsemployeeswasless  @" expensivethanlitigatingthecase._Ԣ  #  20      ף_Ԁ   L } (-L #;   #;0 ` 2}  3  .3  0 ` `   NoActuarialDataSupportstheContention X thattheNatureofMentalHealthDiagnosisorTreatmentContributestoVastlyIncreasedInsuranceCosts#;S݌$  Ќ   ` InpartbecauseofsignificantCongressionalandstatelegislativeactivitymandatingcertainlevelsofparityforhealthinsurancecoverage,substantialresearchhasbeendoneonthecostofextendinghealthinsurancebenefitstoincludementalillness.Thisresearchhasshownthatinsuranceindustrypredictionsofsignificantlyhighercostsweresubstantiallyunwarranted,aswerethefarhigherhealthinsurancepremiumschargedforsuchcoveragewhenitwasprovided.Forexample,despitepredictionsthatalimitedfederalparitylawwouldincreaseclaimscostsbyasmuchas16percent,actualincreaseswerefoundtobenegligible.TheGeneralAccountingOfficereportedthat90percentofemployersreportednoincreases.HD  #  21      ף !#   ` Theexperienceofstatesthathavemandatedmore T#% completeparity!includingMassachusetts>  #  22      ף!isthat   costshaveincreasedverylittle.Generally,costincreaseshavebeenmeasuredatbetweenonepercent_Ԝ=d  #  23      כ_ P andtwotofourpercent.I|  #  24      ׀TheNationalAdvisoryMental   HealthCouncilhasmadesimilarfindings,estimatingthatmovingtofullfederalparity,closertowhatmanystatesrequire,wouldincreasepremiumcostsby1.4percent._ԜJ$  #  25      כ_Ԁ H  L 5h( L %3    ` %3J2h  4  .3  0   InsuranceCompaniesRelyonMyths, @  Stereotypes,andFalseAssumptionsinMakingCoverageDecisions,OftenIgnoringTheirOwnActuarialData%3J݌l  Ќ   `     h      p    ` Insurancepracticesbasedoninvalidassumptionsarehardlyuniquetopsychiatricdisabilities.Forexample,insurershavedeniedcoveragetopeoplebecausetheycarryasinglegeneforsicklecellanemiaor_ԢGoucher_sDisease,inspiteofthebasicmedical  factthatsuchindividualshaveabsolutelynochanceofdevelopingthedisease._Ԣ  #  26      ף_ԀItshouldnotbesurprising X thatsocialstereotypesandprejudicecarryoverintoindividualassessmentsanddecisionmakingofinsuranceagentsorevenhighlevelexecutives. ` Whatissurprising,however,isthetenacityofthestereotypesatthepolicyandpracticelevel.Insurancecompanieshavehistoricallyreliedonmanualsandactuarialresearchpreciselytohaveanobjectivebasisfordecisionmaking.YetinmanycasesbroughtundertheADA,insurancecompaniesrefusingcoveragetopeoplewithpsychiatricdisabilitieswereactingagainsttherecommendationsoftheirownmanuals.Thesedecisionswerenotdrivenbytheprofitmotive:companiesoftendeniedcoveragealtogethertoindividualswhomthemanualsconsideredtobereasonablerisksforcoverage. ` Forexample,oneinsurerhadauniformpolicyofdenyingdisabilityinsurancetoanyonewhohadreceivedanymentalhealthservices,includingsimplyseeingatherapist,withintwoyearsofapplyingfortheinsurance.Goldmanv.StandardInsuranceCompany,1999 x'"* _ԢU.S.Dist.LEXIS_Ԁ20191(_ԢN.D.Ca_.Dec.20,1999).Another 8)$, insurerprecludedcoverageforanyonewith anoccurrenceofbipolardisordermorethantwiceinalifetime,oroncewithinfiveyearsofapplyingforthepolicy._ԢDoukas_Ԁv.MetropolitanLife,950F.Supp.422   (_ԢD.N.H._Ԁ1996).Yetanotherinsurerdeniedcoveragetoanyone whohasreceivedtreatmentforamentalornervouscondition,regardlessorseriousness,withinthetwelvemonthspriortoapplication.Winslowv._ԢIDS_ `  LifeInsuranceCompany,29F.Supp.2d557(_ԢD.Minn_.  p  1998).InWinslow,theunderwritingmanualdidnot 0 requiretheautomaticrejectionofanapplicant,butsimplyalongerexclusionperiod;nevertheless,thecompanyagainstitsownfinancialinterestrejectedtheapplicant.Noinsuranceunderwritingtextsupportsanyofthepolicydecisionsdescribedabove,butinsurancecompaniesmadethemanyway. ` Themanualsthemselvesarenotwithoutdifficulties.AbookonunderwritingproducedbytheInsuranceInstituteofAmericagrouped mentalimpairmentwith acriminalrecordand useofdrugsindescribingrisksthatshouldbelookedat veryclosely.In1988,insurancemanualswererecommendinghigherpremiumsforpeoplewith mildpsychoneurosisandtotalexclusionfromcoverageofpeoplewith (+x&. schizophrenia._Ԣ(  #  27      ף_Ԁ   ` However,mostinsurancecompanieshavebeenwillingtoprovideparityfor mentalandnervousconditionsinhealthanddisabilityinsurance,butunreasonablyinflatedadditionalpremiumshavediscouragedemployersfrompurchasingthiscoverage.Asarguedbelow,thereareotherwaystoachievecostcontainmentthanexclusionordrasticlimitationsofcoverage.III.EVENIFCOSTSAREHIGHER,EQUALLYEFFECTIVECOSTCONTAINMENTSTRATEGIESCANBEDEVISEDTHATDONOTDISCRIMINATEONTHEBASISOFPSYCHIATRICDISABILITỲ ` Whenwomensparticipationintheworkforceincreased,applicationsformaternityleaveandpregnancydisabilityincreased,andpresumablyinsuranceclaimsandcostsincreased.Nevertheless,asasocietywearevastlyimprovedbytheparticipationofwomenintheworkforce,andtodenywomenaccesstocoverageunderdisabilityinsuranceforgenderspecificdisabilitiessuchaspregnancywouldberejectedasgenderdiscrimination,evenifitsavedconsiderableamountsofmoney. ` Similarly,althoughCongressfoundthatonereason x'"* forthestaggeringlyhighunemploymentofpeoplewithallkindsofdisabilitieswasemployerfearofrisinghealthinsuranceanddisabilityinsurancecosts,itexplicitlyrejectedthisrationaleasdiscriminatorywhenitpassedtheADA.4  #  28      ףItisprobablytruethatas P  employmentofpeoplewithseriouspsychiatricdisabilitiesincrease,applicationsforhealthinsurancebenefitsanddisabilitybenefitsthroughemployerprogramswillalsoincrease,notbecauseofabuse,malingeringandmoralhazardbutsimplybecausetherewerefarfeweremployeeslikeMs.Curriewithschizophreniainthepast. ` Whetherextendingcoveragetopeoplewithpsychiatricdisabilitiescostsmoreshouldnotbetheendoftheinquiry.Moststatesandmanyemployersarefacedwithdifficultbudgetconcerns.Thelawforbidsthemfrommeetingthoseconcernsbydisabilitydiscrimination.ConcernedParentstoSave_ԢDreher_ԀPark  (" Centerv.CityofWestPalmBeach,846F.Supp.986, "$ 991992(_ԢS.D.Fla_.1994). ` In_ԢDreher_ԀPark,theCityofWestPalmBeachs &P!( recreationdepartmentdealtwithadecliningbudgetby '#* drasticallycuttingrecreationprogramsforpeoplewithdisabilities.WestPalmBeachemphasizedthatdisabledpeoplewerenotexcludedfromregularrecreation,inmuchthesamewaythatdefendantsininsurancecaseshavearguedthatpeoplewithpsychiatricdisabilitiesarefreetobuyinsurancepolicieswhichdonotcovertheirparticulardisability.Thecourtin_ԢDreher_ԀPark,   wasnotpersuaded,implyingthattheenormousdisparitybetweenthecutstotheregularprogramandthecutstotheprogramforpeoplewithdisabilitiestendedtoshowintentionaldiscriminationonthebasisofdisability.Id.at992. P  ` AnumberofnondiscriminatorystepsexisttomitigatethecostsofLTDinsurance.Decreasingthepercentageofsalarypaidindisabilityincome;capsonamountofdisabilitybenefitspaidtoallrecipients,ceasingbenefitpaymentsatage64ratherthanage65,ormorerigorousfocusonutilizationreviewandrehabilitationefforts,areonlyafewofnumerouswaystocontaincoststhatarenotdiscriminatory. ` Thereisuniversalconsensusthataggressiverehabilitationapproachessuchasassigningcasemanagersanddevisingprogramstoallowemployeestoreturntoworkparttimeareenormouscostsavers.The *H&. HealthInsuranceAssociationofAmericaestimatesthateverydollarspentontheseprogramsinlongtermdisabilityreturnsthirteendollarsofsavings./  #  29      ףYet P manyemployersdonothavesuchprograms;inothercases,employershavethembutemployeesareunawareofthem.Theseprogramsareespeciallyeffectiveincasesinvolvingpsychiatricdisabilities.      Conclusion @  @h  @  @  @p  @    ` ForthereasonsstatedaboveandinotherbriefsonbehalfofMs.Currie,thisCourtshouldvacatethedecisionofthelowercourtandremandforfurtherproceedings.   h      p    h   `     h Respectfullysubmitted, `     h AMICICURIAE p 0   4     `     h Bytheirattorneys `     h _____________________ `     h SusanStefan `     h BBO#600897 `     h CenterforPublicRepresentation `     h 246WalnutStreet `     h Newton,MA02160 `     h 6179650776 `     h ______________________ `     h RobertD.Fleischner `     h BBO#171320 `     h CenterforPublicRepresentation `     h 22GreenStreet `     h Northampton,Massachusetts `     h 4135876265August16,2002  CERTIFICATEOFSERVICE   ` IcertifythatIservedatruecopyoftheforegoingbriefupontheattorneysofrecordforeachofthepartiesbymailingtoeach,regularmail,postageprepaid,twocopieshereof. `     h ___________________________ `     h RobertD.FleischnerAugust16,2002  +'/   APPENDICES  1.MemorandumofDecisionandOrderonPartiesCrossMotionsforSummaryJudgment...........12.G.L.c.32AϢ10D..................................................143.G.L.c.17547B.................................15̜