Monday, April 22, 2013

Beware Of The Insurer's Attempt to Pigeon-Hole Your Claim Into The 24 Month Mental Nervous Coverage If It Doesn't Apply

Most disability policies (whether ERISA plans or private policies) do not exclude coverage for what are termed "Mental/Nervous" conditions. However, they do place an important limitation on such coverage -- typically 24 months of benefits instead of coverage through age 65 or for life. If you're a 45 year old person, that can mean a difference of hundreds of thousands or even millions of dollars in coverage. 

Sometimes the issue is clear. You have a disability that is caused solely by a Mental/Nervous condition -- depression, anxiety, etc. In that case, the only coverage available may be the limited 24 months of benefits. In many other cases, there is a physical cause of the disability that is not accompanied by anything that could be termed "Mental/Nervous." Again, coverage in that situation is clear -- you have coverage for the physical cause that should run until you are 65 or for your lifetime if that is the coverage provided. 

The difficult cases -- where insurers try to take advantage of you and pigeon hole your case into "Mental/Nervous" -- are those where you have a disability caused by physical issues, but you also have accompanying "Mental/Nervous" symptoms that may contribute to your disability. After all, most people who suffer from a physical disability lose their job and lose a major part of their identity. It is not at all unusual for such a person to become depressed, anxious, sad, etc. The bottom line, however, is that under the laws of most states, the insurer cannot classify your disability as "Mental/Nervous" unless those issues are the primary cause of your disability, i.e., those issues are what prevent you from performing your job. Of course, policies and plans vary quite a bit and each person's situation is unique, so make sure you consult a knowledgeable ERISA/Long Term Disability attorney about your individual situation. 

For more information, or if your long term disability ERISA claim has been denied, speak to an experienced disability insurance attorney at Delfino Green & Green.

No comments:

Post a Comment