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Mental health disorders and long-term disability coverage

On Behalf of | Aug 19, 2022 | Erisa

The Centers for Disease Control and Prevention says one out of every four Americans – 82 million – lives with a disability that impacts their life activities. The agency also says one in five currently live with a mental illness, and half of the entire population will be diagnosed with a mental disorder or illness at some point in their lives.

When it comes to a long-term disability rendering someone unable to work and make a living, most people only think in terms of physical disabilities, such as chronic back injuries or cancer. However, mental illnesses and disorders can be just as or more debilitating for the millions who suffer from these conditions.

Is mental illness covered under ERISA plans?

Post-traumatic stress disorder (PTSD), depression and anxiety disorders make up 30% of all mental illness diagnoses in the United States. But not all private employer long-term disability plans choose to cover cognitive conditions. If you suffer from a mental disorder and cannot work, you must consult your employer’s Summary Plan Description booklet before filing a claim to see if your condition is included.

While mental illness coverage is not mandated under Employment Retirement Security Act (ERISA) rules, another federal law offers some protections. Under the Mental Health Parity Act of 1996, companies with over 50 workers cannot place lifetime or annual limits on mental health benefits that differ from limitations placed on medical or surgical benefits for physical disabilities. Some exceptions apply.

Filing a claim for a mental disability

Receiving long-term disability benefits for a mental illness can be harder to prove since they can’t be diagnosed through a scan or blood test. Mental health claims can be highly complicated in what is already a complex process. You must be under the care of a psychiatric or medical physician who can explain why your condition makes it impossible for you to work.

For those whose duties and responsibilities are more cognitively demanding, having a mental disorder can make it impossible to perform their duties. In addition to comprehensive information from a doctor, it’s crucial to work with an experienced ERISA attorney who understands the nuances of mental health conditions and filing individual long-term disability insurance claims.