Long Term Disability for Mental Illness

Long-term disability benefits for mental illness can provide the support many people need to establish routines and support to help them navigate life. Mental illness can be crippling, and appropriately addressing it can take a significant amount of time and money. At Dawn Rosenthal Trial Attorneys, we believe that insurance companies should be accountable for providing the coverage you pay for. If you have an eligible mental health condition for which your insurance provider will not provide benefits or seems to be intentionally delaying benefits, our San Diego long-term disability claim attorney is here to fight for your rights to access the benefits you pay for.

Options for Long-Term Disability Benefits

In most situations, people don’t plan to become disabled. While your experience of mental illness may not be new, the severity can fluctuate, or you may realize that your current coping strategies and treatment methods aren’t working. Your options for long-term disability can vary depending on whether your mental health diagnosis is new.

Social Security Disability

Social Security Disability Insurance (SSDI) is a federal program to provide safety nets for individuals with disabilities. SSDI benefits typically will not include a pre-existing condition exclusionary period, and a pre-existing condition will not bar you from receiving benefits as long as you meet the eligibility criteria, which typically include a recognized diagnosis from an accredited professional and that the symptoms of this diagnosis impact your ability to work. The Social Security Administration requires that you file the claim between nine and 49 days from the onset. However, if you file the claim past the 49 days, you may still be eligible if you provide an explanation for the late application. You may often collect SSDI benefits and benefits from a private policy.

Long-Term Disability Insurance

Long-term disability insurance differs from SSDI in that it is a private policy you pay for directly instead of funding through the government and taxes. Long-term disability insurance providers are not held to the same standards as health insurance providers through the Americans with Disabilities Act, and they are not affiliated with government entities, allowing them to be more selective and exclusionary with coverage. In practice, this means many private LTD policies may include a pre-existing condition exclusionary period that prevents you from recovering the benefits from 12-24 months after the policy starts. However, this can vary based on the insurance provider and policy. This policy may make it more complicated to utilize your benefits and often means you must be particularly meticulous as you work with your mental health providers to gather documentation for the claim.

Long-Term Disability Insurance Qualifying Mental Illness

Qualifying diagnoses are not particularly limited in what is included. However, diagnoses that rely on self-report without physical confirmation may face limitations to the duration of coverage. However, this may not be the case in organic brain disorders such as schizophrenia. Some of the more commonly qualified mental health conditions include:

• Anxiety Disorders, including OCD or panic disorders
• Bipolar
• Substance Abuse
• Eating Disorders
• Personality Disorders

The primary consideration for most claims is the severity of symptoms and how they impact your ability to work. One of the arguments for fewer time restrictions on organic brain disorders is the fact that the illness is something that will always be present and often managed inconsistently. In comparison, the chances of recovery after a year or two for other diagnoses may be higher when there is no physical evidence. For example, PTSD from an accident or traumatic event has an evident cause and onset, along with multiple treatment options that may fully resolve symptoms. These types of instances may present a clear case for your LTD claim.

Supporting Your Claim for Mental Illness-Based Long-Term Disability

The journey of receiving a mental health diagnosis and treatment is not always so linear, which can cause complications in pre-existing condition clauses. It is not uncommon to receive a diagnosis and begin trying to navigate treatment, only to realize months later that you require a higher level of care that may leave you unable to work. Or, you may have a change in life circumstances that dramatically exacerbates your ability to cope, leaving you unable to work. Most mental health diagnoses do not come with the immediate assumption of disability, and this may complicate factors for your claim. However, there are ways to navigate these challenges:

• Documentation: maintaining and providing accurate and detailed documentation of your treatment and condition is critical to a claim. This includes ensuring you are clearly and honestly reporting your symptoms to the physician
• Education: Ensure you are taking action based on appropriate information. The California Disability Benefits 101 page states that making decisions based on misinformation is one of the most common pitfalls of an effective plan
• Seek treatment: Most policies will not approve benefits if you are not seeing a provider to manage your conditions. Some policies will include a physician or provider visit as a requirement

Sometimes, you can come prepared entirely with a qualifying diagnosis, an understanding of your policy, and valid documentation to support the severity of your condition, and your claim may still be denied, or the policy provider may push back with bad faith practices.

Signs of Bad Faith Practices in Your Long-Term Disability Provider

The first step in assessing whether your provider is delaying or denying your claim in bad faith is to ensure you are familiar with your policy terms and are eligible for benefits according to those. Sometimes, a provider may have vague language to justify a denial or reduction, hoping the policyholder doesn’t challenge it. Understanding your policy can empower you to act in those circumstances. Other indicators that you may need additional legal support may include:

• Consistent failure to respond to calls, e-mails, or messages promptly (often this is around 48 hours)
• Accusatory or threatening language. If your provider tells you that you must sign a waiver and cannot have an attorney review it or pressure you to make concessions without adequate time to review
• They fail to pay you on an approved claim
• They intentionally undervalue your claim

Bad faith insurance practices often revolve around the insurance company, making it feel so overwhelming and challenging to get what you need that you give up. This is not okay, and our team at Dawson & Rosenthall, P.C. will fight for your right to access benefits to which you are entitled and hold bad faith providers accountable. You can contact us today for a case consultation to discuss your situation and explore your options.