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Mental Illness Limitations in LTD Policies

Posted on behalf of Goldberg Finnegan, LLC on Apr 05, 2017 in Long-Term Disability

man with depressionOne of the most insidious practices by insurance companies in crafting long-term disability (LTD) policies is the Mental Illness Limitation. This common language in long-term disability policies limits benefits paid to 24 months if the underlying condition is based on mental health. Obviously, this results in benefits being cut off much earlier than for physical limitations, which often pay up to retirement age (depending on the policy).

If it seems critically unfair that you will only get two years of benefits on a policy you have paid into expecting to be covered until retirement, that is because it is. In ERISA policies with these limitations, however, that is the case. There are judicially-created exceptions in California, but otherwise it is very hard to overcome the express language in such policies. Unfortunately, if you have a disabling condition such as schizophrenia, your LTD policy may only be limited to paying you benefits for 24 months.

Moreover, some insurers use tactics to try to turn your claim into a mental health claim when it is not. For example, a pain management doctor might wish to combine his neurological/pharmacological approach with a therapist who can teach stress reduction or mindfulness. An insurer might try to argue that this makes your pain a mental health claim to which the 24-month limitation applies.

Interestingly, these policies show that insurers are taking advantage of (or at best, reflecting) long-held beliefs and stigma against mental health, both by the medical community and the public at large. For example, a 1999 German study found that “the general public thought that mental health staff were useful for treating people with schizophrenia, but not for depression. The reason for this is that most people felt that schizophrenia was caused by biological or uncontrollable influences, while they understood depression to be a consequence of ‘social disintegration’ (including unemployment, drug or alcohol misabuse, marital discord, family distress or social isolation)...” Graham Thornicroft, Diana Rose and Aliya Kassam, Discrimination in health care against people with mental illness International Review of Psychiatry, April 2007, 19(2); 115. 

Obviously, the authors cite a study from almost 20 years ago, and a German one at that. But, amazingly, you can glean the same biases against mental illness being exploited by the insurance companies in their 24-month mental health limitations. Disabling impairments such as depression are seen as paradoxically the victim’s fault (i.e., by losing a job) and the product of external social ills such as poverty. As a result, just like in the study, depression and other mental health issues are disregarded because there is assumed to be no biological source of the illness.

Since 1999, there have been tremendous strides in our understanding of mental illness. With the aides of MRI’s and EEG’s, we have learned more about brain elasticity and genetics, among other breakthroughs which inform our understanding of the tremendously complex biological, social and neurological interactions that result in mental illness. Perhaps most helpfully, we have learned how much more there is to learn on these subjects.

Thus, mental health limitations in LTD policies cling to outdated understandings of mental health and mental illness, exploiting outmoded beliefs based on lack of knowledge. This makes it all the more worth fighting if your insurer is trying to assert such a clause against you in your LTD case. Although the clauses are often enforceable, legal room exists where an insurer is trying to tie physical and mental symptoms together in an effort to enforce a mental health limitation.

We can help. Please call our firm at (888) 213-8140 to discuss your LTD case today.

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