Long Term Disability for Mental Illness: What You Need to Know

As the dialogue around mental health grows, so does the recognition of the profound impact that psychiatric conditions can have on your ability to work and function.  If your mental illness prevents you from performing your job duties, you may be eligible for long term disability insurance benefits.

However, it’s important to understand that mental illness disability claims are often more complex and difficult to navigate compared to claims with disabling physical conditions.

Here’s what you need to know before filing your long term disability claim for mental illness.

Can I get long term disability for mental illness?

Yes.  If you have been provided long term disability (“LTD”) insurance via your employer or through a privately purchased policy, you may be eligible to receive benefits for a mental illness.  LTD benefits are typically designed to provide financial support if you’re unable to work due to a disabling medical condition.  Many mental illnesses fall under this umbrella by causing symptoms that make it impossible to continue working.  Most insurance policies will cover an array of psychiatric conditions, though as explained below, there may be limitations in how long you can receive benefits.

To approve your mental illness disability claim, your insurer will need to understand the nature, severity, and frequency of your symptoms, and how these symptoms impede you from performing your occupational duties.  Without substantial evidence supporting your claim, your insurer may deny your benefits.

What mental illnesses are covered by long term disability insurance?

Some common mental illnesses covered under LTD insurance include but are not limited to:

• • Depression, including Major Depressive Disorder;
  • Bipolar disorder;
  • Anxiety disorders, including Obsessive Compulsive Disorder, PTSD, and panic disorders;
  • Schizophrenia;
  • Borderline Personality Disorder;
  • Eating disorders;
  • Substance use disorders; and
  • Schizoaffective Disorder

It’s important to note that the specific conditions covered can vary depending on your insurance policy, and your policy may have specific criteria that need to be met for your mental illness claim to be approved. Your eligibility also depends on the severity of your illness and its impact on your ability to perform your job duties.

Will my benefits be limited if my disability is a mental illness?

Possibly.  It will depend on the terms of your policy.  Many long term disability policies contain what is commonly called a “Mental Illness Limitation.”  The Mental Illness Limitation restricts how long you can receive benefits if you’re approved for a psychiatric condition.  Typically, the Mental Illness Limitation limits your benefits to two years.  Whether you are subject to a Mental Illness Limitation, and the length of the Mental Illness Limitation, will depend on the exact terms of your policy.

If your disability claim is approved solely under a psychiatric condition diagnosis, and you do not have or develop any contributing physical condition, your benefits will most likely end after the maximum eligibility period under your Mental Illness Limitation.  This remains true even if your condition does not improve by that time.

Generally speaking, there are a few ways to surpass the Mental Illness Limitation and continue receiving benefits if your claim was approved solely due to a psychiatric diagnosis:

• • You can demonstrate a physical condition causing disability.  If you become disabled due to a physical condition during the period you are receiving benefits for your mental illness disability, you may submit proof of your physical disability to your insurer.  If your insurer determines you have sufficient evidence of a physical disability separate from your psychiatric condition, they may continue approving you for benefits past the Mental Illness Limitation.
  • Your policy exempts your condition from the Mental Illness Limitation.  Some policies exempt certain psychiatric conditions from the Mental Illness Limitation, such as organic brain disorders, schizophrenia, Alzheimer’s disease, dementia, and occasionally bipolar disorder.  If your psychiatric condition is exempted from Mental Illness Limitation, it will not apply to your claim.
  • You can demonstrate you have objective cognitive impairment due to a condition that is not psychiatric or does not fall under the Mental Illness Limitation.  If you suffer from a physical condition or a condition that is exempted from the Mental Illness Limitation that causes significant and persistent cognitive impairment, you may have a claim to benefits past the Mental Illness Limitation in your policy.  For example, you may have depression but also have experienced a Traumatic Brain Injury ("TBI").  Even if the TBI is causing your impairment, your insurer may attribute your cognitive deficits to your depression in order to limit your benefit duration.  To surpass the Mental Illness Limitation, your insurer will require evidence that pinpoints the TBI as the cause of your cognitive issues.  A neuropsychological evaluation can provide your insurer with objective data on your cognitive deficits and the source of its cause.

How can I prove my mental illness long term disability claim?

Even if a mental illness is listed as covered in your policy, your insurer still requires that you provide medical documentation and evidence demonstrating that your condition meets the policy’s criteria for disability.  A diagnosis alone will not be enough to get your claim approved.

Examples of evidence you may submit to support your psychiatric condition claim include:

• • Medical records (or, in cases where your providers are not willing or able to provide session information, treatment summaries) from your mental health providers;
  • Opinion letters from your treating mental health providers that detail your diagnosis, ongoing symptoms, and their opinion on your ability to work;
  • A list of prescribed medications, your dosages, and any side-effects you experience;
  • Psychological testing results;
  • Neuropsychological Evaluation testing, if you experience cognitive impairment as a result of your psychiatric condition;
  • A personal affidavit where you explain your background, the demands of your job, the onset of your psychiatric condition, and how your symptoms prevent you from working or carrying out daily activities of living;
  • Statements from your employer, co-worker, family, and/or friends in support of your disability claim that describe how your psychiatric condition has impacted your daily life and work;
  • Any documentation that illustrates how your mental illness has negatively affected your work performance (such as poor performance reviews, records of decreased productivity, missed workdays, disciplinary actions, etc.);
  • A vocational assessment from a trusted expert that analyzes your occupational demands in-depth and provides an informed opinion of whether you are capable of performing your job duties with your psychiatric condition and symptoms.

You should always consult with a disability attorney before filing, appealing, or litigating an LTD claim on your own.  An experienced ERISA attorney can help in assembling the most compelling and targeted medical and vocational evidence for your LTD claim.

How can an attorney help me with my mental illness long term disability claim?

The assistance of an ERISA attorney can significantly improve your chances of a successful LTD claim outcome, especially when dealing with the complexities of mental illness claims.  The attorneys at Riemer Hess understand the unique challenges of securing long term disability benefits for psychiatric conditions and how to maximize your chances of benefit approval.

Riemer Hess can help you receive disability insurance benefits for your psychiatric condition in a number of ways.  We’ll review your LTD policy to determine any Mental Illness Limitation that affects your claim, work with your treating mental health providers to obtain records and letters of support, and compile all available evidence to substantiate your claim.  We understand how to best present your evidence to your insurer and avoid any common mistakes during the claims process.