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Do I Qualify For Disability Insurance Benefits for Psychosis?

CaveyLaw.com > Practice Areas  > Long Term Disability & ERISA Lawyer  > Long Term Disability Disabling Conditions > Do I Qualify For Disability Insurance Benefits for Psychosis?

Disability insurance companies don’t always make it easy for policyholders who have psychosis or other mental nervous conditions to get the disability benefits they deserve.

Psychosis, a loss of contact with reality, is a symptom of either schizophrenia or bipolar disorder. The classic signs of psychosis are:

  • Hallucinations, where you hear, see or feel things that don’t exist, or
  • Delusions, false beliefs based on fear or suspicion of things that aren’t real. These include bizarre delusions, paranoid delusion, and delusions of grandeur.

The psychotic symptoms seen in schizophrenia include:

  • Disorganized thought, speech or behavior,
  • Disorganized thinking, jumping between unrelated topics and making strange connections, and
  • Unresponsiveness.

Symptoms and psychotic episodes can vary from person to person. Milder and less disabling symptoms can include:

  • Feelings of suspicion,
  • Depression and suicidal feelings,
  • Obsessive thinking,
  • Perceptions that are distorted, and
  • Sleep problems.

The severity and frequency of these symptoms will impact whether a policyholder is disabled. However, you should know that many psychosis disability claims are denied because the disability insurance company says:

(1) There is no objective basis of the diagnosis,

(2) There is no objective basis for the restrictions and limitations assigned by your physician, or

(3) There is no causal relationship between your psychotic symptoms and/or your restrictions and limitations, and your inability to do your own or any occupation.

Why The Definition of Mental or Nervous Conditions In Your Policy Is Key

If there is no mental nervous limitation in your policy, you are lucky. You will be eligible for benefits for the life of the policy if you remain disabled.

How your policy defines “mental illness” or “nervous conditions” is key to how long you get disability benefits. Many policies limit benefits to 24 months for psychosis, schizophrenia and bipolar disorder.

There is NO uniform policy definition for these terms, and many were written poorly. Some disability insurance policies define mental illness as:

  • “Any psychological, behavioral, or emotional disorder,”
  • “Any disorder found in the current diagnostic standards manual of the American Psychiatric Association.”

Other policies list conditions they have decided are mental or nervous conditions and list other conditions they have decided are not.

Some policies limit benefits to 24 months if any mental nervous condition contributes in any way to your overall disability.

It is not uncommon for Ms. Cavey to represent a policyholder with psychosis, schizophrenia or bipolar disorder who also has alcohol or drug problems and eating disorders. Some policies limit coverage for alcohol or drug problems and eating disorders. Even if there is no mental nervous limitation, a carrier will mischaracterize the policyholder’s problems so the carrier only has to pay 24 months of benefits.

Nancy Cavey, who has 35 years experience handling disability cases, has battled often with disability carriers about these ambiguities. Courts have reached many different decisions on what mental nervous policy terms mean. It is crucial you know what the courts will do before you apply for benefits, and that you fill out your application properly.

She works closely with you, your family and your physician to overcome a claims denial or termination of benefits after 24 months.

Nancy Cavey offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.

What Mental Conditions Can Have Limited Pay Periods

Psychosis has many diagnostic labels. Look closely at your policy as there can be limited pay periods for:

  • Drug induced psychosis,
  • Organic psychosis,
  • Reactive psychosis,
  • Schizophrenia,
  • Schizophreniform disorder,
  • Bipolar disorder,
  • Manic depression,
  • Psychotic depression or
  • Schizoaffective disorder.

Before you apply for benefits, it is crucial that you understand the games carriers play and how they manipulate the mental nervous limitations to their advantage.

That is particularly true if you have an organic psychosis caused by a head injury or disease like encephalitis, AIDS or a tumor. Many policies exclude organic psychosis from the mental nervous limitation, but not every carrier plays fair in how they apply this exclusion.

Don’t forget the carrier will do a file review months before the 24-month limitation runs. They will be looking in your medical records for continuing mental health problems so they can say, “Got you!”

Nancy Cavey will make sure your physical disability is well developed in your medical records and that your doctors properly comment that you are NOT disabled as a result of any mental conditions, including psychosis.

How Do I Get The Disability Insurance Benefits I Deserve?

It takes teamwork!

The various forms of psychosis can make it difficult, if not impossible, to do things around your home and work.  Psychosis, schizophrenia or bipolar disorder can damage and even destroy professional relationships and result in poor work performance.

If you no longer can work or your doctor has told you to apply for disability benefits, you should take steps before you apply:

  1. Obtain a copy of your disability policy. See how it defines “disability,” “occupation” and “self-reported conditions.” You’ll need to understand what you have to prove to get your benefits because of psychosis or any other mental or nervous condition.

Your policy can include a mental/nervous limitation that classifies your problem as a mental disorder, or the policy can be silent on the issue. You’ll want to know what your policy says before you apply for benefits. You’ll also want to know if the policy limitation applies if your mental nervous condition contributes to your disability in any way.

  1. Obtain a copy of your medical records. Review them to see if there is an objective basis for your diagnosis, what your records say about your report of symptoms and your restrictions and limitations. Psychological testing should be included in your records; if you have organic psychosis, the carrier will want to see neurocognitive testing.
  1. Obtain a copy of your personnel file to see if your psychosis, schizophrenia or bipolar disorder has affected your work performance.
  1. Obtain a copy of your job description. Create your own description of your physical duties with an explanation of how your symptoms impact your ability to do your occupation.
  1. Provide your doctor with the occupational description. Ask your doctor to prepare a report that explains the objective basis for your diagnosis, the objective basis of your restrictions and limitations, and the objective reasons you can’t perform some or all of the material and substantial duties of your occupation.
  1. Prepare a diary that explains and gives examples of how your symptoms interfere with your ability to do things on a daily basis and the side effects of your medication.

If you can’t prepare and keep the diary, ask a family member, friend or a co-worker to help you. This is important because the change in behavior as you have psychotic episodes is what makes you disabled. You may have difficulty performing your work or activities at home, become socially withdrawn, become overactive, get into altercations or do things that are just unusual for you.

  1. Hire Nancy Cavey to help you file your initial application. The application process is confusing and designed so you and your physician make mistakes that can result in a delay or even a denial of your benefits. Ms. Cavey knows how to prepare and file a winning shock and awe disability application that leaves the carrier little reason to question your claim.
  1. Hire Nancy Cavey to help you appeal a wrongful denial or termination of your disability benefits. Disability carriers are in the business of collecting premiums and not paying disability benefits for psychosis. Carriers routinely cut off benefits at 24 months and misapply the mental nervous condition limitations.

They’ll use any reason to deny your claim. The odds of getting your benefits on appeal are greater when you are represented by an experienced ERISA/private ID policy disability attorney.

Contact Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live

Psychosis, schizophrenia or bipolar disorder can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Nancy Cavey can review your policy and your medical records, and explain to you what your policy says and how to get your disability benefits.  Call today for a free consultation at 727-894-3188.