If your mental health condition is severe enough that it prevents you from working or maintaining employment, it may be considered a disability and qualify you for long-term disability insurance benefits. Depression, anxiety, substance abuse, and other mental health conditions can lead to serious problems in functioning for individuals who suffer from them. This can affect your quality of life and make it difficult to work or sustain employment, especially when the problem persists for months or years.
Fortunately, when mental illness gets in the way of your ability to work and pay bills, you can receive financial assistance through long-term disability (LTD) insurance benefits. The key to a successful disability claim, however, is to receive and comply with treatment and gather enough evidence to prove that you are disabled.
Mental Illness and Applying for Disability Benefits
The Americans with Disabilities Act (ADA) considers mental illness to be a disability if it greatly limits one or more major life activities. If your mental health condition meets these criteria, you’re entitled to reasonable accommodations that will allow you to perform your job tasks. The ADA also prohibits employers from discriminating against employers with disabilities, including mental illnesses.
The Social Security Administration, on the other hand, considers a mental health condition to be a disability if it’s severe enough to limit you from working for at least 1 year.
Long-term disability insurance (LTD) is a type of insurance designed to replace a portion of your income if you’re unable to work due to a lengthy period of disability. You can receive this benefit if you can’t perform one or more of your regular work tasks or spend as much time at work due to your mental health condition. To get approved for benefits, however, the LTD insurer will have to ascertain that you’re unable to work for a long time, usually more than 3 to 6 months.
In most cases, long-term disability benefits do not begin until short-term disability payments cease. LTD benefits require a longer waiting period before a disabled person can begin receiving benefits. This waiting period is called the “elimination period” and is often around 90 days.
Mental illness disability benefits are frequently denied, so you need to be proactive with medical treatment. The key is to diligently follow the course of treatment recommended by your doctor. This shows that your condition is affecting your ability to work, but you still want to overcome your illness and return to your productive state.
Mental Illnesses That Qualify for Long-Term Disability Benefits
To be eligible for long-term disability benefits, your mental health illness must fall under one of the following categories:
Mental illnesses in this category include symptoms such as catatonic behavior, hallucinations, delusions, incoherence, and a significant functional decline. Such symptoms can be associated with conditions like:
- Delusional disorder
- Schizoaffective disorder
Individuals with these disorders may experience social withdrawal and paranoia that interferes with their ability to work and function in society.
These disorders are characterized by mood swings, loss of interest, difficulty making decisions, trouble concentrating, and clinically significant changes in weight, sleep, energy, or appetite. While people with depression are often told to “get over it,” depression is not a condition that a person can quickly recover from, and often impacts a person’s ability to work.
Anxiety disorders cause recurrent and debilitating feelings of excessive uncertainty, fear, and apprehension. Other symptoms include muscle tension, panic attacks, and sleeplessness. These feelings can occur in stressful situations, like prior to an important business presentation, but they can also arise in everyday settings.
Common anxiety disorders include:
- Social anxiety disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Panic disorder
These mental health conditions involve unhealthy eating behavior, often accompanied by a problematic outlook on body or health image. Symptoms include binge eating, preoccupation with body weight, self-induced vomiting, and food restrictions. Individuals with eating disorders can suffer serious physical consequences, such as loss of body function, malnourishment, and even death.
Common conditions in this category include:
- Anorexia nervosa
- Restrictive food disorder
- Bulimia nervosa
- Binge-eating disorder
These disorders are characterized by pervasive or inflexible behavior patterns. Common symptoms include seclusion, aggressiveness, passiveness, constant mood disturbances, inappropriate hostility, perfectionism, patterns of suspicions, and decision-making difficulties.
Mental illnesses in this category manifest during childhood or adolescence, but may go undiagnosed until adulthood. They include:
- Tourette’s syndrome
- Intellectual disorders
- Borderline intellectual functioning
These disorders are characterized by poor attention or impulse control, accidental injuries, and abnormal cognitive processing.
These mental health disorders are caused by a significant decline in cognitive functioning. Symptoms can include memory loss and problems with judgment, decision-making, and speech. Neurocognitive disorders include:
- Alzheimer’s disease
- Vascular dementia
Substance Abuse Disorders
These disorders affect a person’s brain and behavior, resulting in the inability to control their use of legal or illegal drugs, medications, or alcohol. Individuals with substance abuse disorders may also have other mental health disorders, including depression, anxiety, personality disorders, and bipolar disorders.
Look Out for LTD Mental and Nervous Limitations
Insurance companies offering long-term disability insurance can include a wide variety of terms, conditions, limitations, and exceptions to their plans. As such, you should carefully read your disability insurance policy to learn exactly what coverage you have in regard to any disability and mental health limitations.
It’s increasingly common for LTD insurance policies to have a “mental and nervous” clause that limits the length of time you can receive benefits for a mental disability. The policies vary substantially, but generally, most clauses limit payments for mental and nervous conditions to 24 months.
A mental or nervous limitation provision might read as follows: Any disability, due to injury or illness, which is based on self-reported symptoms, and any disability due to mental illness, drug abuse, or alcoholism will be limited to 2 years of benefits. Self-reported symptoms are typically defined as manifestations of your mental health condition that you report to your doctor that are not verifiable with clinical examinations or objective tests.
If, for example, you’re suffering from anxiety that is so severe that you can’t work, you may be eligible for long-term disability benefits. But if your plan has a “mental and nervous” limitation clause, you may not receive benefits after the stated time period is over, even if your disability lasts longer. Once you reach your plan’s cut-off date, the insurance company will stop paying benefits for your mental health claim.
Many LTD policies exempt certain mental illnesses from the 2-years mental and nervous limitations. Most often, the limitations do not apply to Alzheimer’s Disease, schizophrenia, dementia, bipolar disorder, and organic brain disease. If your policy exempts these disorders from coverage limitations, you may collect LTD benefits for as long as you remain disabled. In most cases, the two-year limitation applies to depression and anxiety.
It’s not uncommon for long-term disability insurance companies to redefine disabling conditions to fit the mental and nervous definition to cut costs. By categorizing your disability as a mental and nervous health condition, disability insurance companies lie to deny claims and limit the number of monthly benefits payments they have to make. A disability attorney can help you counter these tactics with compelling evidence. If the original cause of your mental health illness is a physical injury, such as a disabling brain injury or heart disease, the 2-year limitation should not apply to your LTD insurance benefits.
Proving Mental Illness for the Purposes of Long-Term Disability
It’s generally more difficult to identify and prove mental illnesses than physical health issues. If you have a serious cut, for instance, it’s easy to present pictures or physical evidence to prove the cut beyond a doubt. There are no such convenient proving methods for conditions like schizophrenia or anxiety.
When the need arises, however, there are steps you can take to prove the existence and severity of your mental health condition. To prove to the insurance carrier that your mental disorder qualifies for long-term disability benefits, your application must include comprehensive medical records related to assessments, diagnosis, and treatment you have received for the mental illness. The opinion of your treating physician, psychiatrist, or psychologist concerning the functional limitations your mental illness imposes on you when it comes to performing your job duties, will play an important role in the success of your LTD claim.
Disability claims for mental health often get denied, especially when they are based on conditions such as bipolar or depression disorders. Common reasons for denial include:
- Failure to seek treatment
- Failure to prevent the mental health condition from worsening
- Lack of enough documentation of treatment by healthcare providers
- Lack of enough evidence to show that you were diagnosed with a mental illness
- Failure to be responsive with the LTD insurance carrier
Even if you’re receiving treatment from a psychiatrist or psychologist who supports your claim, your LTD insurer is likely to deny your initial application and have you appeal your case. In such difficult cases, you want to work with a personal injury attorney from the onset. In most cases, the success of your LTD claim depends on the wording of your initial application and the supporting documents you provide. An attorney can interpret the long-term insurance policy and set forth a strong application to help obtain benefits and preserve them for as long as possible.
Chicago personal injury and workers’ compensation attorney Howard Ankin has a passion for justice and a relentless commitment to defending injured victims throughout the Chicagoland area. With decades of experience achieving justice on behalf of the people of Chicago, Howard has earned a reputation as a proven leader in and out of the courtroom. Respected by peers and clients alike, Howard’s multifaceted approach to the law and empathetic nature have secured him a spot as an influential figure in the Illinois legal system.