ERISA and Disability Benefits for Mental Disorders

September 16, 2015 | J. Price McNamara
ERISA and Disability Benefits for Mental Disorders Last week, we discussed the sad realities of student loans, and how millennials will need to take extra measures to save up for retirement. Today, J. Price McNamara is blogging from his Houston, TX firm to discuss how ERISA affects your claim if you’ve lost your job because of a mental illness. You’re probably already aware that you can collect long term disability for debilitating physical conditions. But what about debilitating mental illnesses? It can be difficult to keep a job if you’re suffering from cognitive, emotional, psychological, or psychiatric problems. Unfortunately, the majority of long term disability policies covered by ERISA only allow benefits for one or two years for disabilities caused by mental illness. Some policies don’t interpret mental illness at all - and others define the term loosely to limit the amount that can be collected for mental disorders.

The Stigma of Mental Illnesses

Biased company insurance company policies stem from an even bigger problem in America of stigmatizing of mental illnesses. Research shows that people with mental illnesses have the ability and drive to work. However, they’re unable to secure jobs. In fact, the unemployment rate in people suffering from mental illnesses is 3-5 times higher than nondisabled people. Studies have found that employers are more likely to hire someone with a physical disability over a mental disability. Polls of US employers revealed that over half are unwilling to hire someone with a history of taking antipsychotic medicine. This research is stunning, considering that the Americans with Disability act actually requires employers to accommodate people with mental disabilities. Employees suffering from mental illnesses also received discrimination from their coworkers once the illness became known about. Workers who return to jobs after a stint with mental illness reported that their responsibility was reduced and supervision was increased. They also felt sidelined from coworkers, receiving negative comments and mean behavior.

How Disability is Outlined in Policies

There's no doubting that company disability policies are biased against mental illnesses. They vaguely define eligibility and use "beat around the bush" language to show what you're eligible for. An example of how the language in policies would be the following: “Any loss caused by, contributed to, or resulting from a mental disorder beyond 12 months if it is due to a mental disorder is limited to 12 months during your lifetime if you are disabled due to a mental or nervous disorder or disease. Unless, the disability results from schizophrenia, bipolar disorder, dementia, or organic brain disease. The company will pay monthly benefits for no more than 24 months during an employee’s lifetime for disability caused by the following conditions: alcoholism, drug addiction, bipolar disorder, schizophrenia, delusional disorders, psychotic disorders, depressive disorders, anxiety disorders, somatoform disorders, eating disorders, and dementia.” You can probably already tell, this policy is roughly worded. Some of the illnesses listed will debilitate you way longer than 24 months. For instance, if someone whose job requires memory and brain function suffers from early onset dementia, then they'd only be eligible for 24 months of disability. This is crazy, especial since dementia is a decline in memory that can progress to a state where the sufferer can’t even speak. How do insurance companies expect these people to take care of themselves if they can’t work and aren’t receiving benefits? Instances like this are why it’s important that you know your policy, especially if your illness causes you to miss substantial work. You might be able to get more money than your policy explicitly defines. For example, most policy limitations for mental illness don’t apply during the period you’re confined to a hospital. So, say you’re in the hospital for a month recovering from anorexia, your policy might try and count this month towards your 12 month period. In actuality, this month would roll over, so you would be eligible for 13 months of disability.

Trying to Define Mental Illness

Most companies add definitions for the term “mental illness” in the policies, which in itself is absurd, considering that the American Psychiatric Association has over 450 different definitions of different kinds of mental illnesses. Not to mention, every mental illness is unique and some are more impairing than others. What’s even more exasperating is that policy definitions are incredibly vague, so companies are able to pay at their own discretion. Fortunately, courts will use 3 approaches to determine the amount of disability you’re eligible for based on your symptoms, the causes, and methods of treatment. Cases get even more complicated when there is an interaction between a mental and physical condition. For instance, a plaintiff who tries to claim disability because she can’t work due to anxiety. Say she claims that she suffers from symptoms like being unable to concentrate, vomiting at work, or uncontrollable emotional outbursts. She might lose the case because of the policies rules towards her disorder. Say that she later receives a diagnosis of fibromyalgia, in which case she would be eligible for long term disability benefits.

See J. Price Macnara, know your policy, see results

If you have questions about ERISA, consult with the ERISA master, attorney J. Price McNamara in Houston, TX.  At J. Price McNamara ERISA Insurance Claim Attorney, we’re ready to help you find the consolation and results you deserve with your ERISA case.
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J. Price McNamara


Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!

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