It can be very challenging to get long term disability benefits for mental disorders, even though you may still be eligible. The reason is mental illness typically doesn’t show up on diagnostic tests and the severity of the condition can be difficult to measure objectively.
LTD claims processors are not licensed psychologists and often fail to understand the true limitations of a mental illness. They are typically quick to deny disability claims for mental illness because the disease does not show up on a blood test. Many disability insurance adjusters also fail to understand that many mental illnesses have a cyclical nature, including schizophrenia and bipolar disorder. An insurance agent may assume someone is “cured” because they are not displaying symptoms when this really just means that symptoms have abated temporarily and are almost sure to return.
There is also a strong bias against mental illness in popular culture. This bias extends to some disability insurance agents who do not consider mental disease a real illness.
Mental Illnesses Eligible for Long Term Disability (LTD) Benefits
Many forms of mental illness and impairments can qualify for LTD benefits if the condition prevents you from working and a residual functional capacity test shows functional, social, or intellectual limitations. Qualifying conditions include:
— Bipolar disorder
— Schizophrenia and other psychotic disorders
— Affective disorders like schizoaffective disorder
— Personality disorders
— Substance abuse disorders
— Organic mental disorders
LTD Limitations on Mental Illness
It’s becoming more common for LTD insurance companies to limit payments for nervous and mental conditions to just two years. This provision is found in almost all employer-provided ERISA LTD plans and many individual LTD policies. With individual policies, it may be possible to buy a rider to remove this limitation in exchange for a higher premium.
Most policies have a limitation that states that disabilities based primarily on self-reported symptoms and disabilities caused by mental illness, drug abuse, and alcohol abuse are limited to 24 months of benefits. This provision defines self-reported symptoms as manifestations you report to your doctor, such as fatigue or pain, that can’t be verified by objective tests and clinical exams. Depression is almost always included in the list of conditions for which benefits are limited to 24 months.
Some mental illnesses are exempt from this limitation in many cases. Commonly exempted disorders include dementia, schizophrenia, Alzheimer’s disease, organic brain disease, and sometimes bipolar disorder. If your policy exempts these disorders from the limitation, you can collect LTD benefits indefinitely as long as you remain disabled.
Documenting Your LTD Claim
To improve the chances of having your claim approved, it’s vital that you properly document your claim and receive consistent treatment from a mental health professional. Your treating doctor should write an explanation about your condition and limitations rather than using the form provided by the insurance company which is designed to elicit responses that allow the insurer to deny your claim. Be sure your doctor explains any limitations you have with:
— Stay on-task all day
— Maintaining concentration and focus
— Avoiding excessive absences
— Responding appropriately to criticism
— Interacting appropriately with the public and co-workers
— Remembering, understanding, and performing simple actions
If you are attempting to file an LTD claim for a mental disorder or your claim has been denied, it’s important to work with an experienced Philadelphia LTD attorney to help document your condition and avoid common mistakes that can get your claim denied. Contact Edelstein Martin & Nelson for a free consultation with a disability lawyer in Philadelphia to get help with your claim.
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