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How Benefits for Psychiatric Conditions Can Be Limited

Tue Jul 31st, 2018 on     Disability Insurance,    

Disability insurance coverage can surprise many policyholders who put too much trust in their insurer to “do right” by them.  All too often, disability insurance policyholders believe that they are well-protected by their private policy, only to find that their insurer is taking steps to avoid or minimize the payout altogether.

In many cases, the insurance contract itself includes language that could expose the policyholder to a dispute down the line, when they have actually been disabled.  It is increasingly common for insurers to include a limitation on benefits for disability claims that are premised on psychiatric conditions (i.e., mental disorders) — this limitation is commonly referred to as the “mental and nervous” provision.

Let’s briefly consider the fundamentals.

How the Mental and Nervous Provision Works

Claimants may be initially confused by the application of the “mental and nervous” provision in their insurance policy, but it’s rather simple in effect.  The provision essentially limits the duration of benefits payments for disability claims where the cause of the disability at-issue is based exclusively on a psychiatric condition.

Generally speaking, only the length of payments are limited, not the amount.  For example, if you have been suffering from a substance abuse condition (say, alcoholism), and the addiction is so serious that it has effectively rendered you disabled and unable to work, then you may be entitled to benefits, but only for a limited period of time — perhaps a two-year period.

Insurance policies can vary quite a bit, but as a general rule, disability insurance policies that include “mental and nervous” provisions don’t apply the limitation on benefits to certain exceptional conditions such as bouts of dementia that can be traced back physical injuries or specific neurological conditions (i.e., Alzheimer’s disease and Parkinson’s disease).  Most other psychiatric conditions — such as depression, drug abuse, and anxiety — fall under the limitation, however.

It’s important to note that if the psychiatric condition is not the “exclusive” cause of the disability, then the limitation on benefits will not apply.  Thus, if you can show that your disability has resulted from a combination of factors, some physical and some mental in origin, then you may still qualify for full benefits.

Contact Our Team of Disability Insurance Lawyers for Assistance

If you have had your claim for disability benefits denied, undervalued, delayed, or otherwise adversely handled by your insurer, then you may be entitled to challenge the determination of the insurer, or even to bring an action for damages in a court of law.

Here at Ver Ploeg & Marino, P.A., our attorneys have decades of experience handling a range of insurance disputes, including disability insurance disputes that center around the issue of psychiatric conditions.  We understand the contours of insurance litigation and how to counter the insurer’s various strategies, and over the years, our commitment to thorough, effective legal representation has earned us many successes.  We have secured numerous multimillion dollar verdicts and settlements on behalf of our policyholder-clients.

Call (305) 577-3996 or submit an online case evaluation form today to get connected to our team of Miami disability insurance lawyers.

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