As we have written about previously, mental health issues can be as debilitating as those affecting a worker’s physical health. When a suffering worker files a mental health disability claim, however, he or she often finds his/her long term disability (LTDI) plan has special rules for such claims. Most long term disability insurance (LTDI) policies have a 24-month mental health limitation. These plans limit the payment of benefits to two years for individuals whose disability is the result of mental illness. If you are unable to work due to cognitive decline, including memory issues, difficulty concentrating, loss of attention or decreased problem-solving skills, the mental health limitation may apply to your LTDI claim.

Mental illness and physical illness are often related, however, and often occur in tandem. Before conceding future benefits to a mental health limitation, consider the following questions:

1. Are Your Mental Health Issues Secondary to a Physical Condition?

If you experience mental health problems as a result of a physical condition, such as a back injury or fibromyalgia, chances are the mental health limitation does not apply. Often people on strong pain medication regimens have difficulties concentrating. Further, the burden of dealing with a debilitating illness can cause depression. If your physical condition alone prevents you from working, the long term disability insurance company should not limit your benefits on the basis of your mental health issues.

2. Can Doctors Identify Structural Brain Damage?

If your disability primarily is due to mental impairment, the question then becomes what is the cause of your cognitive decline. Generally, LTDI policies exclude physical diseases and injuries to the brain from the mental health limitation. Insurance companies usually require evidence of structural brain damage or degeneration. Thus, if your disability is caused by a condition such as Alzheimer’s disease, dementia, stroke, coma or traumatic brain injury, benefits should continue beyond 24 months.

3. Is Your Illness Primarily Psychological / Behavioral?

The mental health limitation usually applies to conditions such as anxiety, depression, bipolar disorder and post-traumatic stress disorder, which can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). If the primary treatment for your illness involves a psychologist, psychiatrist or behavioral therapist, you may be subject to the limitation. As always is the case, before drawing any conclusions, you should read your LTDI plan carefully to make sure you understand its specific terms.

If you have been denied long term disability insurance benefits on the basis of a mental health limitation, Hawks Quindel’s disability attorneys may be able to help. Contact us to discuss your case.

Danielle Schroder

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