Is Mental Illness Covered Under Disability Policies?

Millions of Americans live with a mental illness. According to the National Alliance on Mental Illness (NAMI):

• As of 2018, 1 in 5 adults in the United States experiences mental illness. Unfortunately, that’s more than 47 million people
• More than 11 million Americans experienced “serious” mental illness in 2018
• 17.7 million Americans experienced a major depressive episode in 2018, 48 million experienced anxiety disorders and roughly 9 million experienced PTSD of some type

These numbers are staggering, and they are even more haunting when compared with the number of people who actually receive treatment for these illnesses. The NAMI reports that in 2018 less than half of U.S. adults who suffer from a mental illness received treatment (43.3%) and only 64.1% of American adults with serious mental illness received any treatment.

When it comes to private disability insurance, many Americans are unsure if they have coverage for a mental illness. Private short-term disability insurance typically does not cover serious or chronic mental illness unless clearly set forth in the policy. The 6 months of payments typical short-term disability policies generally provide are reserved for claims involving physical ailments or accidents, except those suffered on the job. However, many health experts indicate that short-term disability coverage would be helpful in situations involving prescribed psychotropic drugs. If someone is taking such a drug for a mental illness, those drugs have potentially serious side effects, which could impair a person’s ability to work. Some psychotropic medications cause weight gain, which can lead to the onset of diabetes or hypertension. These medication side effects are physical conditions that short-term disability might cover.

Long-term disability policies also often include specific language that the disability be “physical” in nature which would exclude mental illness or reduce the length of mental nervous coverage to 6, 9, 12, 18 or 24 months.

An important factor to keep in mind is that some disability policies (long-term or short-term) could have exclusions for pre-existing conditions. If a woman becomes pregnant and suffers from post-partum depression that keeps her from working, an insurance carrier may treat that claim differently from someone who has taken medication for schizophrenia for a decade or two. Each insurer will utilize a different set of underwriting guidelines when it determines if an insured is eligible for coverage and whether pre-existing conditions or exclusions apply under the disability policy.

For those diagnosed with a mental illness, social security disability insurance (SSDI), paid family leave and unemployment compensation are alternatives.

Ultimately, an individual will have to review the individual or group disability policy language as well as state law to determine how mental health claims will be administered. Claimants should also consult with a disability attorney who understands the complexities of the law, insurance policies and how best to get justice for someone whose mental health disability claim has been delayed or denied.

Do You Have Questions About Your Benefits?

If you have questions about group short-term, long-term or individual disability insurance—as it relates to mental illness—contact us. Don’t wait.

The legal team at DarrasLaw is trusted nationally and experienced in dealing with group short-term and long-term as well as individual disability cases. There is no risk involved in contacting DarrasLaw. If you have short or long-term disability insurance questions of any kind our legal team is here to help. Call us at (800) 898-7299 or contact us online.