Mental Illness and the Mental Nervous Condition Limitation

Welcome to Season 4, Episode 24 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Mental Illness and the Mental Nervous Condition Limitation."

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses mental illnesses, and how they interact with disability claims. Disability carriers hate claims based on subjective conditions; unfortunately, most mental illnesses will fall into that category. Unsurprisingly, disability carriers are unashamed to continue upholding outdated societal traditions of downplaying the existence, severity, and disabling capabilities of mental illnesses. Most disability policies, regardless of carrier, will even include a clause called the "mental nervous condition limitation" which often states that any disability claim even partially contributed to by mental nervous conditions is subject to benefits for only two years. Today, your host, Nancy L. Cavey, will provide valuable insights into how to navigate mental illness disability claims, and combat the mental nervous condition limitation.

In this episode, we'll cover the following topics:

1 -  Understanding Mental Illness and the Mental Nervous Condition Limitation

2 - Mental Illness Claims and Getting the Benefits You Deserve

3 - An Overview of Disability Claims for Depression

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Speaker A [00:00:15]:
 Hey, I'm Nancy Cavey, national ERISA and individual disability attorney. Welcome to winning isn't easy before I get started, I've got to give you a legal disclaimer that this podcast is not legal advice. The Florida Bar association says, I've got to say this, so now I've said it. But I want to assure you that nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Today I'm going to be discussing mental illnesses and how they interact with the disability claims process. Disability insurance companies don't always make it easy for policyholders who have mental illness to get the disability benefits they deserve. And we're going to talk about why.
 
 Speaker A [00:01:05]:
 Specifically, I'm going to talk about understanding mental illness and the mental nervous condition limitations, mental illness claims and getting the benefits you deserve and an overview of a disability claims for depression. But before we get started, I want to take a break. And when we come back, I want to discuss with you a new mental health parity proposal that hopefully one of these days will become law. So let's take a break.
 
 Speaker B [00:01:33]:
 Have you been robbed of your peace of mind from your disability insurance carrier? You owe it to yourself to get a copy of robbed of your peace of mind, which provides you with everything you need to know about the long term disability claim process. Request your free copy of the book@kvlaw.com today.
 
 Speaker A [00:01:53]:
 Welcome back to winning isn't easy. Let's talk about understanding mental illness and mental nervous condition limitations and how disability carriers view these types of claims. Many claims are denied because the disability insurance company says there's no objective basis of the diagnosis, there's no objective basis for the restrictions and limitations, or there's no causal relationship between your mental illness and your restrictions and limitations, or your inability to do your own or any occupation. So those are the kind of basic reasons why claims get denied. But the definition of mental or nervous conditions in your policy is really key to how those three primary defenses are applied. Now, if you're lucky, there's no mental nervous limitation in your policy or plan. If you're disabled, then you're eligible for benefits for the life of the plan without consideration of the impact of mental illness. What is key is if you do have a policy or plan that has a limitation, we need to understand how the policy defines mental illness or nervous conditions because we need to understand what's considered to be a mental illness and we need to understand how that impacts how long you may be entitled to benefits.
 
 Speaker A [00:03:13]:
 Now, many policies will limit the payment of benefits to just 24 months, and there is a new legislative proposal that we think is going to be introduced in Congress in the future. Of course, depending on the politics, that will address the disparity in the treatment between someone who has a physical disability and a person who has a mental disability or a combination of them, because we know that many disability carriers and policies treat these claims completely differently, and by law, by case law, they are allowed to do so. Let's start out with the proposition that there is no uniform definition in a policy or plan for those terms, and many have been written very poorly. So let me give you an example of a gobbledygook definition of mental illness, and this is taken from a policy of one of our clients, and it says, any psychological, behavioral, or emotional disorder, any disorder found in the current Diagnostic standards manual of the American Psychiatric association. Other policies will not necessarily refer back to the AMA guides, but or have this large any emotional disorder kind of language, but they will actually list conditions they've decided are mental and nervous conditions, or they've listed conditions they've decided are not mental nervous condition limitations. So we got to start out with, you know, what is the definition of mental illness? Is it defined? Is it not defined? Or is it inclusive? Is it exclusive? Now, there's another factor that we need to consider after we've defined what the term mental illness or mental nervous condition means. That is the limitation that can apply to a disability that's involving mental illness. And there are different flavors of this term.
 
 Speaker A [00:05:22]:
 Now, there is what I call the plain vanilla mental nervous condition limitation that says, if your disability is caused by a mental nervous condition, as defined in the policy, benefits are limited to just two years. Then there is the more nuanced but broader Monty Python version of a mental nervous condition limitation. And it says, look, if your mental. If your disability is caused by a mental condition or is contributed to in any way, regardless of how small, benefits are limited to just two years. So you may have undergone back surgery and you've become anxious or depressed, and your benefits may be limited to 24 months. If your disability is contributed to by that depression caused by your back problems. Now, that's crappy, but those are the kinds of fights that we can have about these ambiguities. Of course, I've reached all sorts of different decisions about what mental nervous policy language means, and so it's crucial that you understand what's in your policy, what circuit, federal circuit, you're in.
 
 Speaker A [00:06:36]:
 So you have a sense of how a court may apply a mental nervous condition limitation as you are filling out that application or potentially dealing with a denial of termination of benefits. So let's expand on this. What mental conditions have limited pay periods? Well, this is some of the laundry list of conditions that I see, and again, it's policy specific, but it could be something like anxiety disorders, including generalized anxiety disorder, various phobic disorders such as simple phobia, social phobia and agoraphobia, panic disorders, obsessive compulsive disorders, post traumatic stress disorder, depressive disorders, including major depression, dysthymic disorder, psychotic depression, postpartum depression, seasonal affective disorder, and bipolar disorder. Now, I will tell you, there are some policies that say bipolar disorder is not a mental nervous condition limitation, but is considered to be an organic physical condition. So again, we got to go back to the policy and parse the terms. Now that I've set for the stage here, the definition of mental nervous condition, the potential limits on the time period. Let's talk about the games that carriers play and what they'll try to do is to characterize your physical problem as a mental problem. As I've just said, the carrier may say in the case of a person who has a back problem, will approve your disability claim because you're depressed because of your back problem.
 
 Speaker A [00:08:12]:
 But, you know, we're not really considering that herniated disc. So it's crucial that you understand the games that carriers play and how they're going to manipulate the mental nervous limitation to their advantage. Understand that the carrier is going to do a file review before the 24 month limitation runs, and they're going to be looking in your medical records for comments about continuing mental health problems. And they'll say, particularly if we've got the cause or contributed Monty Python clause, that we've got you. Your benefits are limited to just two years. So what you want to be doing is making sure that your physical disability is well developed in your medical records and that your doctors are properly commenting that you're not disabled as a result of any depression, for example, that has contributed to your disability. You can see that it takes teamwork to work around these types of mental nervous policy limitations. Got it? Let's take a break.
 
 Speaker A [00:09:45]:
 Welcome back to winning isn't easy. How do I get the discipline insurance benefits I deserve for mental nervous conditions? Now, I know that mental nervous conditions can make it difficult, if not impossible, to do things around your home and at work. They can damage and even destroy professional relationships, they can result in poor work performance. And if you are having any mental illness issues, psychological issues, and you can't work, then I think you should be considering applying for your disability benefits. But there are a number of steps that you should take before you apply for benefits. Stop work because some of these mistakes we can't fix. The first thing you need to do is to obtain a copy of disability policy and see how it defines the terms disability, occupation, self reported conditions. And we want to understand if there is a mental nervous policy limitation in the policy.
 
 Speaker A [00:10:45]:
 So you got to understand as you work your way through these definitions, what it is you have to prove to get your benefits and what limitations, if any, there might be on getting these benefits because of mental nervous conditions. Now, as I've said in blog posts and earlier videos, you can see a policy that's very expansive. You may see one that actually lists all the conditions that are considered mental disorders, or the policy can be silent and you've got to try to figure it out. It's really important that you understand, as I said, what that policy says so that you know how to pick your way through the potential claim denials or terminations that are going to be coming. Secondly, you need to get a copy of your medical records and you need to review them to make sure there's an objective basis of the diagnosis. Your doctor should be giving you some psychological testing to arrive at a diagnosis, and your records should also accurately report your symptoms. So, for example, if you're depressed, you may have a lack of interest in things, a lack of motivation. You might be isolating yourself and you need to be giving your doctor examples of not only what those symptoms are, but how your symptoms are impacting your ability to function.
 
 Speaker A [00:12:08]:
 And of course, your records should be commenting on your restrictions and limitations. The third thing I think you should do is get a copy of your personnel file to see if any of your psychological issues are impacting your work performance. You should also get a copy of your job description and create your own description, not only of your physical duties, but the psychological duties and cognitive duties. What do I mean by that? In these days, particularly when we're all dealing with zooming, if you will, we are interacting with people remotely, both by phone and by video. We also may be interacting with people on the phone. We may be interacting with people in person, but it's important that the doctor and the disability carrier understand the nature of your duties, both physically, emotionally, cognitively, intellectually, so that the doctor understands as you're explaining your symptoms what impact they may have on your ability to perform your occupation. So you want to give that information to your doctor. And ultimately your doctor is going to need to prepare a report or address any of the attending physician statement forms, basis of the diagnosis, your restrictions and limitations, and the objective reason why you can't perform some or all the material duties of your occupation.
 
 Speaker A [00:13:27]:
 You might even want to keep a diary of your symptoms. And if you're taking psychotropic medication and are having side effects, you should be discussing that in your medical records and documenting that. You want to make sure that the medical records are documenting trials of medication and your response to that medication so that your medical records are telling a story. Now, remember that many mental nervous policy limitations turn on the language in the policy, and there's no uniform language. It can be what I call the generic mental nervous limitation that says, if your disability is caused by a mental condition listed or unlisted in this laundry list, benefits are limited to just two years. Or it might be that expansive exclusion that says, hey, if you have a psychiatric condition that causes or contributes to, regardless of how small that contribution might be, benefits are limited to just two years. Obviously, these are completely different types of mental illness exclusions and limitations, and I find the cause and contributed language to be problematic. So let me give you an example.
 
 Speaker A [00:14:41]:
 In the case of George versus Reliance standard, it's a fifth circuit case. The policyholder George was a helicopter pilot who had flown over 20 years, and he had an amputation at the knee. Now, as time progressed, he could no longer wear the prosthetic device, and he couldn't operate the foot controls of the helicopter. He had severe pain at the amputation site. Ultimately, guess what? He was diagnosed with depression and post traumatic stress disorder. So George filled out a long term disability claim, and reliance standard policy had a mental nervous limitation that included anxiety disorders and mental illness. And it was so, so, so broad that it limited coverage to just two years for those disabilities caused or contributed to by a mental nervous condition. So guess what? Reliance found that George's depression and post traumatic stress disorder contributed to his impairment.
 
 Speaker A [00:15:32]:
 And guess what? His claim was denied. This case ultimately goes up to the federal court, the Fifth Circuit. And the Fifth Circuit considers whether his physical disabilities alone were sufficient to render him totally disabled. Now, in this instance, the court reversed, saying, look, George's physical disability was in and of itself sufficient to render him totally disabled. And the question, according to the court, was whether the physical disability alone totally disabling. Now, I will tell you that not all circuits take this approach. And again, it depends on the language of the particular policy or plan and what the medical records have to say. So before you stop work and apply for your disability benefits as a result of mental illness, and even before you stop working, apply for benefits because of any physical organic issue, you should be getting a copy of that policy, reading it cover to cover so you understand what the game plan is and the limitations are.
 
 Speaker A [00:16:31]:
 Got it? Let's take a break.
 
 Speaker B [00:16:33]:
 Are you a professional with questions about your individual disability policy? You need the disability insurance claim survival guide for professionals. This book gives you a comprehensive understanding of your disability policy with tips and to dos regarding your disability application that will assist you in submitting a winning disability application. This is one you won't want to miss. For the next 24 hours, we are giving away free copies of the disability insurance claims survival guide for professionals. Order yours today@disabilityclaimsforprofessionals.com. dot.
 
 Speaker A [00:17:29]:
 Hey, welcome back to winning isn't easy I'm going to talk about the disability claims for depression. I'm going to give you an overview. So the question becomes, what happens if you have a claim for disability benefits as a result of depression? Now, disability carriers and plans don't make it easy for those who have depression to get the benefits they deserve. And many times the disability carrier plan is going to say that there isn't an objective basis of the diagnosis. The doctor is just repeating and parroting your complaints and there isn't an explanation in the medical records as to how the doctor got to the diagnosis. Then the disability carrier might say, look, the restrictions and limitations assigned by the doctor are really subjective in nature. There isn't any objective basis. The doctor is relying on your subjective complaints.
 
 Speaker A [00:18:33]:
 And by the way, we think that you can do more than your subjective complaints allow. Or the disability carrier may say, look, your depression may have been severe, but you're getting treatment and this medication is working and we don't care that your doctor doesn't think you can go back to work. And so we just don't think your depression is severe enough to make you eligible for your benefits. Another game that they may play is they'll get a copy of your personnel records and they'll be looking for conflict that you might have with supervisors or co workers. And what they'll say is that this isn't a disability insurance claim, this is an employment claim because you're a disgruntled employee, you're having all of these issues, and now that you're not working with your employer anymore, you shouldn't be having these particular problems. So you need to understand that there are lots of games that disability carriers may play in the context of a claim for depression and that information in your medical records, the information that's in your personnel file, can make or break your claim. So before you stop work, I suggest that you get a copy of your disability policy or plan. Read it cover to cover.
 
 Speaker A [00:19:49]:
 What's the definition of disability? What's the definition of occupation? Is there a mental nervous limitation? Is it just a vague mental nervous limitation? Or is it one that's got specific listed conditions? Does your disability psychological diagnosis fall within one of those listed conditions? Do we have a two year caused or contributed issue? Do we have an argument that might be made that you are getting better, that you go back to work? Is there going to be an argument that this is all an employment issue? Because you got to anticipate what the disability carrier is going to do when you apply, and if there's that mental nervous limitation, the fact that at about 16 months, maybe 18 months in, they're going to be looking for a reason to deny this claim based on the mental nervous condition limitation. If you have any of these types of issues, you really should be consulting with an experienced ERISA disability attorney now, not later, because it's really hard to change or amend correct medical records, particularly from a psychological standpoint. I hope you have enjoyed this week's episode. If you have any questions, give us a call at 727-894-3188 but if you have enjoyed this episode, I really would appreciate it if you would subscribe to this podcast. That way you're going to get notification and also leave us a like, okay, talk to you next week.