Long-term disability (LTD) insurers are generally reluctant to approve claims for benefits based on mental illnesses such as depression or bipolar disorder. Even if you're receiving regular treatment from a psychologist or psychiatrist who supports your disability claim, your LTD carrier is likely to deny your initial application and force you to plead your case on appeal. In these difficult cases, it is critical to hire an experienced disability attorney who can guide you through the appeals process and, if necessary, file a lawsuit against your insurer.
Clinical depression is a mood disorder marked by persistent feelings of sadness, isolation, and agitation that interfere with one's daily life. Depression may also be manifested in physical symptoms that include fatigue, sleeplessness, and changes in appetite. Those with severe depression may experience crying spells, hallucinations, delusions, and suicidal thoughts or actions. The causes of depression are not exactly known, but are thought to include chronic pain, stress, substance abuse, and genetic factors. Treatment usually consists of talk therapy and/or medication.
Individuals with bipolar disorder, also called manic-depressive disorder, experience feelings of depression alternating with episodes of mania. During a less severe "hypomanic" episode, individuals may be highly energetic and productive, while more severe "hypermanic" periods might feature racing thoughts, hyperactivity, sleeplessness, impulsive decision-making, or irritability.
Those with acute forms of bipolar disorder may experience psychotic symptoms, including delusions and hallucinations. Depression and manic episodes can cycle back and forth rapidly, over a period of a few hours, or slowly, over weeks or even months. People who experience mania and depression at the same time are said to be in a "mixed state." Treatment for bipolar disorder often consists of a combination of counseling and mood-stabilizing or antidepressant medications.
It is increasingly common for LTD insurers to limit payments for mental and nervous conditions to two years. This provision appears in virtually all employer-provided group plans (ERISA-governed LTD plans) as well as many LTD individual policies, though individual policyholders may be able to purchase a rider that will remove this term in exchange for a higher monthly premium.
A typical limitation might read as follows:
Disabilities, due to illness or injury, which are based primarily on self-reported symptoms, and disabilities due to mental illness, alcoholism, or drug abuse, will be limited to 24 months of benefits.
Self-reported symptoms are defined as "manifestations of your illness which you report to your doctor, including pain and fatigue, that are not verifiable with objective tests or clinical examinations."
Note that many policies exempt certain mental illnesses from the two-year limitation, most often schizophrenia, Alzheimer's Disease, organic brain disease, dementia, and occasionally bipolar disorder. If your policy exempts these disorders from the two-year limitation, you may be able to collect LTD benefits indefinitely, for as long as you remain disabled. The two-year limitation almost always applies to depression.
If you suffer from another disabling condition (such as chronic back pain) to which the two-year limitation does not apply, you should continue to receive benefits for as long as you remain unable to work due to that condition.
It is essential to receive consistent treatment from a mental health professional, preferably a psychologist or psychiatrist, to have any chance of prevailing on a claim for depression or bipolar disorder. Make sure that your insurer carrier has requested and received all the medical records related to your condition, including those from your treating doctors and any hospitals or psychiatric facilities where you've received treatment. Don't simply rely on your LTD carrier to solicit all the evidence it needs to make an informed decision in your case.
While your LTD carrier will likely contact your treating physician for an opinion about the functional limitations caused by your condition, the insurer's paperwork may be less than thorough than you would want, or may be designed to elicit responses unfavorable to your claim. To help your case, you should make sure that detailed findings from your treating doctor about your vocational limitations get into your record. In particular, you should ask your doctor to submit information to the insurance company discussing any limitations you have in the following areas:
To do this, your doctor may either complete a Residual Functional Capacity (RFC) form supplied by your lawyer or write a letter addressing your abilities in the areas listed above. Finally, your doctor should indicate if he has restricted you from working as part of your treatment.
While insurers tend to rely largely on medical records and opinions in making their decisions, you may wish to submit statements from third-parties, including former colleagues or supervisors, that discuss their observations of any difficulties you've had while working.
Receiving LTD benefits for bipolar or depression is just as difficult, if not more so, than receiving Social Security disability (SSDI) benefits. The major difference is that Social Security does not put any time limitation on the receipt of benefits for mental illnesses; if you are approved, your SSDI benefits won't be cut off after two years, although you may be subject to Continuing Disability Reviews. In general, your chances of receiving LTD or SSDI based solely on a mental illness are roughly similar, but your LTD insurer is much more likely to terminate your disability benefits after you've been approved. Find out more about LTD benefits and SSDI benefits.
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