Most ERISA-governed long term disability policies include a limitation on the amount of time they will pay benefits when the disabling condition is one that the policy defines as a “mental/nervous” condition. Policies vary as to what they include in their definition of “mental/nervous” conditions and the wording of the limitation varies, too. A note about the wording of the limitation – it is extremely important how the policy words the limitation in terms of how evidence of a condition such as depression or anxiety is presented in a claim.
Generally, the limitation is 24 months of benefits will be paid if the claimant is disabled by a mental/nervous condition such as depression or anxiety. There are conditions, such as Multiple Sclerosis, Parkinson’s Disease, migraines, and disability after heart attack to name a few, that either have depression as a symptom of the disease itself, and/or result in depression from dealing with the disease. In such cases, you may not be disabled at all by depression but if it is mentioned in your medical records – and it very likely will be – very often an insurance company will seize upon the depression and attempt to apply the policy’s 24-month benefit limitation to your claim.
If your only disabling condition is a mental/nervous condition, and your policy contains a 24-month limitation, it may also contain a 12-month extension of benefits should you be hospitalized for your mental health condition at the end of the 24-month period. These are highly technical exceptions that often require the assistance of attorneys who understand how these exceptions are applied.
If you have a condition such as depression or anxiety listed in your medical records, we strongly recommend you seek legal advice from an attorney knowledgeable in ERISA-governed LTD policies before proceeding with your initial claim or appeal, as the case may be.
At Kantor & Kantor, we can help you navigate this issue. For more information about the disability insurance benefits process, please contact one of our attorneys for a free consultation at 877 783 8686 or use our online contact form.