Most Long Term Disability policies I have reviewed over the years have provisions which limit the period of time benefits are payable on claims involving mental or nervous conditions, such as, anxiety, depression, etc. I say “etc” because, in fact, the insurance companies typically try to expand the definition to its broadest limit.
There are a couple of pitfalls of which a claimant needs to be aware of regarding mental illness limitation.
First, there are two (2) types of clauses in use in the industry. One provides for a limitation if the mental illness causes the disability. This is the better of the two (2) types of clauses in use. Insurance companies, nonetheless, will try to pigeonhole claims into this two (2) year limitation even though the claim is actually based on clearly identified medical conditions, separate and apart from any psychiatric or psychological based conditions.
The other clauses limit the benefits when the mental or nervous condition even contributes to the disability. If your long-term disability benefits plan has this type of clause, you must proceed with caution. This is because the insurance company will use any evidence of any mental or nervous condition, such as one visit to a counselor or a short series of prescriptions, or the like to contend the claimant has a contributing mental or nervous.
Also of importance in this area of insurance policy interpretation is the grossly overbroad definition of the mental illness. This is because, at least according to the insurance companies, it is difficult to assess the disabling nature of conditions they contend are based solely on subjective complaints, thereby ignoring the reality presented the patient enduring such a condition. Now, some companies do “less out” certain, clearly diagnosable conditions but otherwise, the definition they use is unduly broad and requires every claimant to have been in, essentially, perfect health in order to be entitled benefits.
If there is an effort to pigeonhole your claim by such language, the attorneys at Herbert M. Hill, P.A. have successfully defeated such efforts on numerous occasions. However, this is not intended as legal advice applicable to any individual person’s unique legal situation. Its sole purpose is to give a general idea of the existing status of the law as it applies to the point of law addressed above.
Please do not rely on the foregoing comments as legal advice or make legal decisions based thereon. If you have questions arising out of this point of law, you should contact an attorney who routinely handles claims involving policies of disability insurance. While many law firms claim to handle such claims, long-term disability claims represent over 90% of the cases handled by Herbert M. Hill, P.A.
It is our specialty and not something we do on the side as with most other firms. Nor do we ever represent insurance companies. We would welcome the opportunity to discuss your mental illness limitation case with you, at no charge. You can contact me toll-free at 844-454-5995 or, locally, at 407-839-0005 or at firstname.lastname@example.org.
If you would like, after discussing your case, we can set up a conference. In most circumstances, that conference would be free of charge but in no circumstance would you be under any obligation to hire me nor would you feel any pressure from me to do so.
Herbert M. Hill, P.A. is a law firm located in Orlando, Florida with a practice extending throughout the state of Florida. While the vast majority of cases handled are for disability insurance benefits, areas of practice include employee benefit claims of all sorts. The firm handles any claims arising under the Employee Retirement Income Security Act (known and referred to as “ERISA”) for disability benefits, medical benefits, retirement benefits of any sort, including pension, 401k, termination agreements or the like as well as claims arising under private disability policies.