Schizophrenia, Schizoaffective Disorder, and Disability Insurance: A Claimant’s Guide
Living with schizophrenia and schizoaffective disorder is challenging. However, many people with these conditions can live independently, although they sometimes need support from loved ones and others. If you or a loved one can no longer work due to psychosis or schizophrenia, then the person affected may be eligible for short-term or long-term disability insurance benefits.
In this article, our experienced disability insurance lawyers discuss common issues that people with schizophrenia or schizoaffective disorder face, both in their everyday life and during their LTD claims.
What Is the Difference Between Schizophrenia and Schizoaffective Disorder?
Schizophrenia and schizoaffective disorder are closely related mental health conditions, but they do have significant differences. Someone with a diagnosis of schizophrenia primarily suffers from symptoms of psychosis, including:
- Delusions: Beliefs or convictions that are unsupported by reality
- Hallucinations: Seeing, hearing, smelling, or sensing something that is not there
- Disorganized speech: Incoherent, erratic, or incomprehensible speech
- Disorganized or catatonic behavior: Agitated and bizarre conduct, or becoming non-responsive
- Apathy: Lack of emotions or an inability to care for physical needs
Many people with schizophrenia also experience cognitive dysfunction and memory deficits. While medication may reduce symptoms for a time, relapse is remarkably common in people with schizophrenia. For example, a 1996 study, published in Neuropsychopharmacology, found that at least one-third of people become resistant to treatment within five years of their diagnosis.
Schizoaffective disorder involves these same psychotic symptoms combined with either depressive or manic symptoms. According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), there are two forms of schizoaffective disorder:
- Depressive type: Involves feelings of hopelessness and helplessness, decreased motivation, crying spells, thoughts of self-harm, and other symptoms
- Bipolar type: Episodes of mania, such as feeling “up,” insomnia, mood swings, erratic behavior, and depression
Schizoaffective disorder is often misdiagnosed as either bipolar disorder or schizophrenia.
Can I Get LTD Benefits for Schizophrenia and Schizoaffective Disorder?
The majority of people with schizophrenia and schizoaffective disorder live with severe impairments that prevent them from working. These impairments may include:
- Cognitive: Altered and impaired cognitive function is the most common problem associated with schizophrenia and schizoaffective disorder; medications typically do not improve cognitive function.
- Social and occupational: Many people struggle with limited social and occupational motivation, which is caused by the disease process rather than an intentional desire to avoid work and social interactions.
- Self-care: From cooking and cleaning to managing their medications and driving, a large percentage of people with schizophrenia or schizoaffective disorder need significant support and oversight.
- Attention and concentration: Nearly everyone with schizophrenia experiences issues with concentration, persistence, and pace. Episodic memory, which helps people learn and retain information, is often compromised.
Due to these combined challenges, many people with schizophrenia and schizoaffective disorder can’t work, especially during a relapse. And many of the impairments, particularly those involving cognition and concentration, continue even when the individual is not experiencing active psychosis.
Under these circumstances, it makes sense to apply for short-term or long-term disability insurance benefits. However, most people with schizophrenia or schizoaffective disorder cannot manage a disability insurance claim on their own since the process requires extensive legal and medical knowledge, attention to detail, and persistence.
If you or someone you love is living with schizophrenia or schizoaffective disorder and can’t work, it’s in your best interest to consult an experienced disability insurance attorney who understands the nuances of schizophrenia and schizoaffective disorder. For example, when you work with Bryant Legal Group, we’ll explain the precise terms and conditions of your LTD plan, assess your eligibility for benefits, and guide you through every step of the application. That way, you don’t have to worry about missing deadlines, evidence, or essential details during your claim.
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Will the Insurance Company Limit LTD Payments for Schizophrenia?
Most LTD policies limit mental health-related disabilities to two years of benefits. However, there are some notable exceptions to this rule. First, many disability insurance plans do not limit your benefits when you’re disabled due to schizophrenia.
While insurance companies have tried to argue that their plan’s “schizophrenia exclusion” does not cover schizoaffective disorder, these assertions have not typically held up in court. For example, in Duncan v. MetLife, a district court judge found that MetLife did not clearly define “schizophrenia” in its Plan Document. As a result, the judge refused to limit a disabled individual’s benefits to two years.
Notably, the DSM-5 uses the term “schizophrenia” in several ways: there is a specific diagnostic code for schizophrenia, but the guide also uses the term to discuss a broad range of conditions that includes schizoaffective disorder. The judge said that because the insurer had not clearly outlined whether the term “schizophrenia” meant a singular disease or the broader spectrum of conditions, the limitation did not apply.
Also, the majority of people with schizophrenia and schizoaffective disorder live with other disabling conditions. If you have physical limitations in addition to your mental health issues, your long-term disability plan’s two-year restriction should not apply in your case.
If you suffer from schizoaffective disorder, you shouldn’t assume that your LTD benefits will be limited to two years. Instead, you need to contact a knowledgeable disability insurance lawyer who can interpret your Plan Document and apply it to your unique circumstances.
Bryant Legal Group: Compassionate, Dedicated Legal Representation for People Living With Psychosis
At Bryant Legal Group, we’ve built a reputation for success based on our practical, compassionate, client-focused approach. We help individuals with schizoaffective disorder, schizophrenia, and other mental health conditions get the short-term and long-term disability benefits they deserve.
Rather than struggle alone, contact our office to schedule your free, no-risk consultation. Our team has recovered millions in compensation for our clients. We can help you understand your options at no cost to you, and if you decide to work with us, we’ll handle every aspect of your claim so you can go forward with peace of mind and confidence.
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