us by this court in a case two weeks ago called i have reversed part of the year the purpose of the physician's care provision in a disability insurance policy is not for the purpose of dictating the care for cases which have addressed this position in the past that provision that that is says it's intended to return to work it should be also held to be against public policy is also ambiguous and also conflicts with the general statement of the physicians care provision which is that care of the appropriate under prevailing medical standards it is our position that the matter should be reversed because everything there is two provisions beyond that in this particular policy that should be declared as against public policy and unenforceable and that the remaining portion of the provision that is the care be appropriate under prevailing medical standard as being that care which is appropriate for the condition disabling the injured and i'm paraphrasing under prevailing medical standards and that's what we normally find in all the cases then it goes on it skips a paragraph then it goes on the next paragraph and says also the care must be consistent with the nature of this order which i would contend this essentially said purposes is the same thing that that the perforation says and also says it is intended to return the insurance was occupation then jumping back one paragraph before it says also that if the condition is one third condition causing disability it is a mental and or substance abuse disorder then appropriate who as i've mentioned before especially in this particular case where the that we're not just dealing with someone that just was abusing drugs as the evidence is in the record this is a person of multiple conditions the t start tracing back you find some physical origin for that and of course that would invoke this progression and your honor raises another reason among many that the unraveling of this dispute should be by trial that's construed as meaning that they have to approve anything that meets the condition well that was certainly one way to interpret it is a basically say that that the only burden on the insurance on the  have appropriate care within prevailing medical standards and there's nothing left for the insurance company to approve i guess that's in the insurance company's interest because if you return to your occupation then they don't have to pay disability that doesn't it actually mean well and that any treatment out your back not necessarily because it was a required or recommended method of treatment by this particular doctor and so  in the community effects you can say that's not good enough for us we want to care that is care that's all they've been given for the president of the country before recall that this  you'll find is that all of his assumptions are that mr rabinowitz has stopped using drugs now we've put in the evidence which was not rebutted by the way that there are substantial indication here that he continues to use drugs in fact you won't find there's a  he claims to be disabled from cognitive impairment however they both say that we can't tell whether the cognitive impairment is from his current drug use or is a problem something else is it from you know organic brain damage else they say that they need the drug testing one to know whether or not he currently uses drugs so that if he is currently using drugs as dr blasting and dr hope say that can explain all of th dependency i suppose that would then vs you to the question of whether slaughterings plan of treatment was and whether it was intended to return him to h we need to understand whether or not he is using drugs so that an appropriate treatment plan and be implemented doctors folding are also says that he says everything is out the door if he continues to use drugs and we all know he didn't believe that you can if you've used drugs and therefore wasn't giving him the kind of treatment that he would need if he was fact it's very clear that he said if if i found out that he was using drugs he and i both agreed immediately go into hazleton again and get the treatment he needs without this treatment what happens is and has been happening for three years now he's been evil by allowing two to continue to abuse drugs and there's no chance that he'll ever get better because he's not getting the right treatment th he can return to work and he's able to do want to more of the important to be that of his occupation and he has a loss of income then he wouldn't be he would be entitled to some benefits but he might not be entitled to all of the benefits he would be entitled to if he were found to be totally disabled but we know from the record is that during the time that he was abusing drugs he did go back and work until he was taking depositions he was doing things and this is that it's time we know he was abusing drugs think about potential if he's not using drugs so right now and that's and so the idea that yes he continues if you suggest itself to drug testing and yes the care that he should be getting and it just doesn't work you know he's going to be entitled to the benefit care he's not getting the frequency of psychotherapy he needs to get over this problem and so this is a credit to the next step and that's why it's so critical in addition when he goes understanding what this problem must be treated in fact he's lied talks about that there are some cases that you can't refuse have actually you can't refuse to have certain tests that are diagnostic because in order to talk  him to be evaluated at that point so that they could understand what his problem was what the idiology of his complaints were so that without knowing you can adequately address the problem and that's the point and so all we're talking about there is you know you've offered to do it and what you know what your mouth or your your your money is and money were mouth is it lets you know your name and because that's important that's critical because if you're abusing drugs in the whole treatment program the doctor solving earth has been involved with goes out the door by his own admission and that's all we're trying to do here is to make sure under this clause we have the right we says we must approve the plan and as the district court correctly held that allows us certain discretion i is and so that becomes part of the plan is you know if he's using it every day that doesn't warrant chance of situation if he's using it occasionally that might be a less intensive situation but you have to adapt based on what you know what we know is he's not telling his doctor that he's using drugs is dr believes that and he says yes i find that there's a relapse and i need to give him intensive treatment and so the point is that condition and it needs to be ongoing so we can determine what is the frequency of usage so that he can differ really treated so that is critical here and that has been denied to the company by his refusal to submit to drug with the nature of the disorder and intern it turns out that the way he will get treatment is to go to the picture of him and ask them what they consider the property and then find a doctor who wants that particular day he was using drugs but that's just that's not that's a tribal issue i mean that's that is so there's no evidence that what exactly that there is as a matter of law the evidence in the record suggests the doctor  that would be one of the tribal issues that would then lead to the ultimate conclusion as to whether or not this was an appropriate plant for the condition causing disability which is not as simple as simply was he taking drugs remember this was a the question is does this relate individual that was had multiple conditions multiple diagnoses and this was a doctor who was trying to provide him with the best care that he could under the circumstances now in such simple remember this issue about have well that brings in the supposedly have a right to insist upon that and the answer that i heard him say would eventually yes well what about if you can afford what about today jamal won't be able to approve it what about if the doctors when it's contraindicated what kind of position are we putting simply say and challenge whether the treatment is within prevailing medical standards as appropriate care and if they and they have a right to challenge it and they have a right if they believe that that's what all the cases have that's actually is ok and i'm not every intended to return to personal work or that we have the right to approve plans that may or may not be within for family medical standards to meet and it really when i said public policy earlier what i really meant was that this is an interference which we have argued throughout the  it interferes with the position page position ability to care for those patients who sees them on a regular basis who is supposed to be concerned for the entire picture and like in this particular case well then the physician would say that's not consistent with the proper medical treatment to give him treatment that would get him back to work that wouldn't be the best way to treat it that would be ok but  would argue the evidence in this record suggests this person is not going to go back to work regardless of whether he's on a rock or a because of cognitive impairment but that's certainly the record is certainly at worst unclear enough to say it's a tribal issue because that permeates this record and the assumption being made by the insurance company question as a basis of a record going to actually be accurate answer to that would be able to have to bring and a number of things that have occurred since that time such as other evaluations he's had so it's that's really a difficult question to answer