What to Consider When Applying for Mental Disability Benefits
One of the most challenging long-term disability claims are for mental disorders, whether they are cognitive, emotional, psychological, or psychiatric in nature. Mental illnesses are not easy to diagnose, the symptoms can be difficult to assess, and it can be hard to provide measurable proof of the degree of disability.
However, that doesn't mean you cannot receive mental disability benefits. It's important to be able to anticipate the potential obstacles facing you.
Defining Mental Illness
As awareness and understanding of mental illness developed, many insurance companies added the term "mental illness" to their disability policies. However, the definition of mental illness may leave a lot to be desired. Definitions may be unclear or ambiguous or may not apply to specific conditions.
Cases tried in court have yielded three basic approaches to define mental illness by focusing on:
- Cause, or
- Treatment method (medical or psychiatric)
Cases which involve both a physical and mental condition can also create special problems for individuals seeking benefits. It is crucial to consult a disability attorney who will research similar cases and will be aware of laws related to your area.
How Does the Insurance Company View Mental Illness?
Disability claims examiners are not trained to understand the full scope of mental illness. Often, neither the examiner nor the insurance companies understand the finer points involved. For example, if a policyholder is not displaying symptoms of his or her disorder, the claims examiner may assume the disorder has been cured. Unfortunately, some examiners may be biased against all claims for mental illness disability benefits.
Mental Disorders Eligible for Long-Term Disability Benefits
Whether or not a mental disorder qualifies you for LTD benefits depends on the language used in your insurance policy. It is very important that you understand the definitions used and the terms of your policy related to mental illness.
Some insurance companies limit benefits for mental disorders to one or two years during your lifetime. Other policies may not include any language related to mental illness. The assistance of an experienced disability lawyer is invaluable when you review and identify your policy terms.
The most common categories of mental illness covered by disability insurance include:
- Affective disorders, also referred to as mood disorders, including depression, bipolar disorder, dysthymia, and cyclothymia.
- Anxiety disorders are persistent worries or fear that doesn't?t subside and may worsen over time. This type of anxiety has a negative impact on a person's quality of life.
- Organic disorders are mental dysfunction caused by a medical or physical disease rather than a psychiatric disorder.
- Somatic disorders are characterized by an abnormal focus a physical symptom or symptoms such as pain or fatigue. The extreme focus can cause emotional distress and difficulties functioning.
- Psychotic disorders are severe mental disorders that cause people to lose touch with reality and experience delusions or hallucinations. Schizophrenia is a type of psychotic disorder.
- Personality disorders are patterns of thoughts, behaviors, and feelings that are unhealthy and disrupt a person's ability to cope with normal activities
Several other conditions may qualify for mental disability benefits under the category of mental disorders. These conditions include ADHD, Asperger's Syndrome, bipolar disorder, depression, eating disorders, OCD, postpartum depression, and PTSD.
A rule of thumb that's important to remember is that you need to demonstrate how the symptoms prevent an individual from performing his or her work or living in a self-sufficiently. Any objective information or measurements you can include in your documentation will strengthen your case.
Limitations for Mental Disability Benefits
As previously mentioned, insurance policies may limit the length of time they will provide disability benefits for mental illnesses. Typically the benefit periods are between 12 to 24 months.
One example is a policy that will pay for any type of mental disorder up to 12 months during your lifetime unless the disability is related to schizophrenia, bipolar disorder, dementia, or organic brain disease.
Benefits for mental illnesses related to alcoholism or drug addiction, bipolar disorder, schizophrenia, anxiety disorders, etc., may be paid up to 24 months during your lifetime.
Usually, the only exception to coverage limitations is time spent in a hospital; these days do not apply toward your policy limits.