When you live with depression, anxiety, bipolar disorder, or another mental health condition, it can be hard to maintain employment. At Bryant Legal Group, we know how frustrating it is to suddenly find yourself unable to control your symptoms, especially if you’ve worked hard to build your career. Insurance companies, however, take a different view. Because they’re for-profit companies, insurers see long-term disability claims for mental health conditions as an expensive burden.
That’s why insurance companies often add limitations and exclusions that can affect your ability to get long-term disability benefits for mental illness. Most (but not all) group long-term disability insurance policies limit payment on mental health claims to one or two years of benefits. In this article, our experienced disability insurance lawyers outline factors that may affect your depression or mental health claim.
Mental Illness Is a Top Cause of Disability
According to the World Health Organization, depression is one of the top causes of disability. When you add in anxiety, bipolar disorder, post-traumatic stress, and other mental disorders, mental illness is a factor in the vast majority of disability cases worldwide. In the United States alone, one in five people live with a mental health disorder, and about 4% of us have severe mental illness.
Our mental health also has a profound impact on our ability to work. Many mental health disorders cause symptoms that interfere with our jobs, including:
- Poor attention and concentration
- Memory difficulties
- Anxiety and panic attacks
- Feelings of hopelessness, helplessness, and worthlessness
- Fatigue and sleep disturbance
- Lack of motivation and follow-through
- Crying spells
- Impulsive behavior
- Mood swings and personality changes
- Problems with decision-making and executive functioning
- Suicidal thoughts and self-harm
Globally, it’s estimated that we lose $1 trillion in productivity each year due to depression and anxiety.
Because our mental health issues are so profound and evaluating how severe a mental health condition can be very difficult, insurance companies have tried to lower their costs by limiting coverage of these conditions. Whether you have an employer-sponsored group disability insurance plan or a private policy, you need to understand insurance companies’ tactics and how to respond.
Look Out for “Mental and Nervous” Limitations
Unlike Social Security disability benefits, long-term disability insurance is offered by privately owned insurance companies. These companies can include a wide variety of terms, conditions, exceptions, and limitations to their plans. You should always carefully read your disability insurance plan’s documents before you file a claim for benefits.
Long-term disability policies often include a “mental and nervous” clause that limits the amount of time you can receive benefits for a mental disability. Policies vary substantially, but as a general rule, most “mental and nervous” clauses impose a one- or two-year limitation.
For example, if you are suffering from depression that is so severe that you cannot work, then you may be eligible for benefits under your long-term disability plan. However, if your plan includes a “mental and nervous” limitation, you’ll only receive benefits for a few years, even if your disability lasts longer. As soon as you reach your plan’s cut-off date, the insurer no longer has to pay benefits for your mental health claim.
There Are Exceptions to Most “Mental and Nervous” Clauses
It’s worth noting, however, that “mental and nervous” limitations have exceptions. For example, many long-term disability mental health limitations do not apply to organic brain disorders, like schizophrenia, Alzheimer’s disease, and other forms of dementia. Your disability lawyer can help you review your policy’s “mental and nervous” limitation and apply it to your unique circumstances.
However, be prepared for a fight. Long-term disability insurers sometimes try to redefine disabling conditions as mental health problems to cut costs. By categorizing your disability as solely a mental health condition, the insurer will try to avoid paying out significant lifetime benefits that they might otherwise owe. You and your lawyer will have to counter their tactics with compelling evidence and insight from your treating physicians and other experts.
Additionally, many people with depression and anxiety also have disabling physical conditions. According to the National Alliance on Mental Illness, if you have a mental health issue, you’re 40% more likely to have heart disease or a metabolic condition. If physical conditions, like heart disease, degenerative disc disease, or an autoimmune disorder, also prevent you from working, the “mental and nervous” limitation may not apply to your claim.
Insurance Companies Misinterpret Medical Evidence and Policy Language to Their Advantage
When you apply for disability benefits, you’ll fill out a series of forms and provide the adjuster with medical evidence and other information. Then, the insurance company rep must review all the information, apply your policy’s terms and conditions, and decide whether you’re eligible for benefits. Insurers sometimes misinterpret policies’ language, gloss over your medical records, and deny long-term disability benefits.
For example, the insurance adjuster may try to argue that your depression is disabling, but that your physical conditions are not as severe. Suppose that you have coronary artery disease, diabetes, and depression. The adjuster may agree that your depression is disabling and apply your policy’s two-year limitation on mental illness. However, they may also argue that you’ve fully recovered from your heart attack and that your uncontrolled blood sugars are due to your poor diet and lifestyle choices.
Disability insurance plans often include vague limitations and poorly written definitions of mental health conditions. For instance, some insurers have (unsuccessfully) tried to argue that a policy that fully covers schizophrenia may not provide the same level of benefits for “schizoaffective disorder,” a condition that involves similar symptoms and limitations.
In a long-term disability claim, you’ll need to collect and interpret critical medical evidence that explains your conditions and their severity. Then, your disability insurance lawyer will take all of these facts and analyze them based on your policy’s language and the law. Fortunately, Illinois law ensures that courts must interpret all ambiguous provisions in private insurance in favor of you, the policyholder.
Substance Use and Mental Health Are Often Linked, Bringing in Other Policy Limitations
More than 19% of people with mental illness also struggle with a substance use disorder. While our disability attorneys understand that addiction is a disease, insurance companies sometimes use people’s struggles with substance use against them. Many long-term disability plans limit addiction-related benefits to one or two years.
However, insurance adjusters will sometimes argue that overdoses and substance use are “self-inflicted,” and many LTD plans exclude injuries due to self-harm. Don’t fall for these tactics. Instead, consult an experienced disability attorney who can help you build your case and correctly interpret your policy’s language.
- Related Article: Why Substance Use and Addiction Can Complicate Your Disability Claim
Some Private LTD Policies Don’t Include “Mental and Nervous” Limitations, So Review Your Plan Carefully
When you purchase a private disability insurance policy, you have more control over the terms and conditions. You and your agent may have considered a variety of plans that offered different levels of coverage, terms and conditions, and monthly premiums. Some of these private insurance policies do not include “mental and nervous” limitations.
If you’re a business owner, professional, or another person who has private long-term disability insurance, you must carefully review your plan’s language. If you need help interpreting your policy’s dense and hard-to-read conditions, contact your attorney. They can use their years of experience and legal knowledge to help you navigate your Plan Document.
Bryant Legal Group: Fighting for Disabled People in Chicago and Throughout Illinois
When your disability claim involves mental health issues like depression, anxiety, or affective disorder, the insurance company may try to limit your LTD benefits. At Bryant Legal Group, our team helps people get the compensation they deserve. For decades, we’ve fought for people with mental illness, giving them the information and support they need at every step, and we’ve won millions in benefits for our clients.
To schedule your free, no-risk consultation, contact us at (312) 667-2536 or use our online contact form.