Mental Nervous Limitations and How Long Term Disability Carriers Will Use This Clause to Deny Your Benefits | Tampa Bay Disability Attorneys
It is not uncommon for Long Term Disability policies to limit coverage for mental conditions. Unfortunately, this is constitutional. However, many Long Term Disability carriers try to plug your Long Term Disability claim into a mental nervous limitation so that they only have to pay you two years of benefits.
These cases are also language dependent. For example, a plan may provide that a mental illness as a “mental, emotional, nervous condition of any kind.” Boy that’s rather expansive. If you suffer from fibromyalgia you most likely have depression. In the case of Bosetti vs. United States Life Insurance Company, 2009cal.app.LEXIS1166(July 17 2009), the Long Term Disability carrier applied a two year policy limit for disability due to “mental, nervous or emotional disorders.” The California court rejected this position saying that they were concerned with the “situation or the physical event disabling on it’s own, causes addition mental symptoms or the converse.” For example a physical ailment, such as a heart attack, can cause depression or a mental disorder called anorexia nervosa can cause the physical symptoms of malnutrition.
When mental symptoms arise from a separate physical event, or physical symptoms arise from a separate mental event, the court ruled that the term “mental disorder” is ambiguous. As a result, the court asked if it would whether it would reasonable to expect that the disabling physical conditions arising from the depression not be subject to the mental limitations in the policy. In other words, if Bosetti’s disability was caused only by her depression and her fibromyalgia did not cause this or produce any symptoms then the mental limitation would apply. However, the court ruled that if her physical problems contributed to the disability or were the cause, the mental nervous limitation didn’t apply.
It is not uncommon for Long Term Disability carriers try to get your psychiatrist to say that you are totally disabled as a result of your fibromyalgia or depression and not take into consideration your physical symptoms. They again issue a notice of decision with an “Aha! Gotcha!” under the mental nervous limitation clause.
If you suffer from any physical condition that causes any psychiatric problems such as depression or anxiety, it is important that you understand the games the Long Term Disability carrier will play with you and your doctor in an effort to plug you into the mental nervous limitations. Nancy Cavey, who handles LTD and ERISA cases throughout the United States, can help you understand your policy terms, work with you and your doctors to make sure that your doctors are providing the Long Term Disability carriers with the right information and that you are properly filling out your activities of daily living form so that you won’t jeopardize your continuing entitlement to Long Term Disability benefits.