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Understanding Your Disability Policy | Mental Illness Limitation

ERISA Mental Illness Limitation Policies

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Your long term disability policy may limit your period of eligibility if your disability results from a psychiatric condition.  This is commonly referred to as a Mental Illness Limitation.  Notably, the limitation may affect you even if you are not disabled due to a psychiatric condition.

The Mental Illness Limitation Is Increasingly Common and Restrictive

Mental Illness Limitations are becoming increasingly common and restrictive in newer policies.

A Mental Illness Limitation clause may look similar to the following:

Disabilities, due to illness or injury, which are based on self-reported symptoms, and disabilities due to mental illness, will be limited to 24 months of benefits.  Self-reported symptoms are defined as “manifestations of your illness that you report to your doctor, including pain and fatigue, that are not verifiable by objective or clinical findings.”

Policies that contain a Mental Illness Limitation typically limit your benefits to two years if you are disability due to a psychiatric condition, such as depression or anxiety.  Of course, each policy is different, so the prescribed maximum period may be shorter or longer depending on the terms of your particular policy.

Some policies with Mental Illness Limitations contain exemptions for certain mental conditions.  These exemptions commonly include organic brain disorders, schizophrenia, Alzheimer’s disease, and dementia.  They occasionally exempt bipolar disorder.

The Mental Illness Limitation Can Cause Your Benefits To Automatically Stop

If your policy contains a Mental Illness Limitation and you are disabled solely due to a psychiatric condition, your benefits will most likely stop when the maximum allowable period expires. Unfortunately, the severity of your mental illness will become irrelevant after the maximum allowable period expires.

However, if you can demonstrate that you are disabled due to objective cognitive problems, your benefits may extend beyond limitation period.  A neuropsychological evaluation is typically required to sufficiently demonstrate cognitive problems.  The evaluation will involve a battery of tests to objectively measure your intellectual functioning, memory, executive functioning, speed processing, etc.  Validity testing should also be performed to confirm the objectivity of the results.  The full evaluation is usually performed over one to two days.

If you are disabled due to an exempted mental condition, you may continue receiving benefits beyond the limited period.  It is important to inform the insurance company of any changes in your diagnosis if you believe that your new diagnosis may be covered as an exemption.  You should not assume that the insurance company will know about your new diagnosis unless you inform it of the change.

Proof Is Necessary If You Have A Combination of Physical and Psychiatric Conditions

If your policy contains a Mental Illness Limitation and you have a combination of mental and physical conditions, your benefits may be in danger after the maximum allowable period expires.  This danger commonly occurs when someone develops depression or anxiety secondary to a disabling physical condition, such as chronic pain.

You will need to prove that your physical condition is severe enough to independently render disabled.  In other words, you would be still be disabled regardless of whether you had the psychiatric condition.

Your doctor's opinion may be helpful if you suffer from a combination of mental and physical conditions.  Your doctor may be able to comment as to which condition actually prevents you from working.  The insurance company is not required to accept your doctor’s opinion as truth, but the insurance company must take it into consideration.  Therefore, your doctor’s opinion is very important.

Physical Conditions Must Be Supported By Medical Evidence

Individuals who do not suffer from psychiatric conditions are usually not impacted by their policy’s Mental Illness Limitation.  They should, however, continue to treat with their doctors and undergo all recommended testing.  Such individuals will still need to show the presence of ongoing objective physical abnormalities to preserve future benefits.

Experienced Attorneys Can Interpret Your Policy’s Mental Illness Limitation and Protect Your Benefits

Often times, the future of your benefits depends on the wording of your initial application and supporting documents.  Thus, it is essential to know whether your policy contains a Mental Illness Limitation and plan your application accordingly.

The attorneys at Riemer & Associates are well-versed in long term disability policies containing Mental Illness Limitations.  We can interpret the policy and set forth a strong application to help preserve your future benefits for as long as possible.  Our trained legal staff can also assist you in a seamless transition beyond your policy’s Mental Illness Limitation.  Contact an attorney at Riemer & Associates today to discuss how we can help.

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