Your Insurer May Try to Characterize Your Physical Disability as a Mental Illness

Carefully Examine the Policy Language

How your employer’s long-term disability policy defines “mental illness” is crucial. There is no standard definition. Policies define the term differently and some do not define it at all.  Some specifically address mental illnesses that may be related to a physical illness/injury while others do not.

Older Policy Language

Older policies often are ambiguous, for example defining mental illness as:

Any psychological, behavioral, or emotional disorder or ailment of the mind, including physical manifestations of psychological, behavioral or emotional disorders, but excluding demonstrable, structural brain damage.

Newer Policy Language

Newer policies have clearer definitions. For example, they may define mental illness as “any disorder found in the current diagnostic standards manual of the American Psychiatric Association,” or by listing conditions that are considered to be mental illnesses and thus subject to the 12 or 24 month limitation.

Vague or Unclear Policy Language

The more ambiguous the definition, the more room your New York disability lawyer has to argue that your condition does not come within it.

When the definition of mental illness is vague, the courts have reached different decisions. More claimant-friendly courts look at whether the illness has a physical basis (as virtually all mental illnesses do), and, if so, will find it not subject to the limitation. Other less claimant-friendly courts decide based on whether a layperson would believe the illness to be a mental illness based on its symptoms or whether the illness is treated with therapy and/or psychotropic drugs.

Don't Fall Into the Insurer's Trap

Many insurers try to characterize a physical disability as a mental disability. It is very common for an insurance company to approve benefits for a mental health condition while ignoring a physical condition in an effort to limit benefits. Beware of this trap.

If you have a physical disability and are also depressed as a result of being disabled, a New York disability lawyer will make sure your doctor clearly indicates in a letter to the insurer that your depression is secondary to and as result of your physical disability.

Conclusion

It’s best to consult New York disability lawyers before you file a claim and even before you stop working. Claim forms are drafted for the benefit of insurance companies. They often contain landmines for unwary. Answers that are not carefully crafted can damage your claim. Call Riemer Hess at 212-297-0700.