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Can a Mental Health Condition Qualify for Disability?

Most people are aware that, if they’re injured at work, they have insurance coverage (often through a workers compensation program).

Workers may also have some kind of short- or long-term disability coverage if they’re hurt on the job, meant to make sure ongoing medical expenses will be taken care of and that they’ll receive at least partial compensation for lost wages and income while they recover (or, in the most serious cases, coverage to help meet expenses if an injury leads to permanent disability).

But what about mental health coverage? The answer is complicated. Many policies include limited mental health coverage, but a minority provide ongoing disability coverage for mental health issues. The conditions that qualify and the length of time for which coverage applies can also be limited.

Qualifying Conditions

Mental health conditions affect far more people than most Americans realize, and not treating them costs everyone greatly. Many conditions are related to work or can result from work injuries, but there’s no strict list of conditions that do and don’t qualify for disability coverage.

Most policies determine coverage using conditions that are listed in the DSM-IV or DSM-5, standard diagnostic manuals used by mental health professionals. Unrecognized conditions might be excluded.

Coverage also may be different based on how a condition developed. For example, when a condition is a secondary effect of an injury or infection, such as a head injury that leads to a mental or nervous problem, it might be covered in the same way as a physical injury. However, when the condition is purely psychiatric, it might not be covered or coverage might be limited.

Restrictions, Limitations, and Documentation

Disability claims are governed by federal rules known as the Employee Retirement Income Security Act of 1974 (ERISA). These provisions allow insurers to limit disability claims for mental health issues to twenty-four months in many cases.

While this is appropriate for some conditions, disability insurers often try to limit the amount they pay out in claims. There have been many cases in which insurers have tried to categorize claims in ways that allow them to limit the amounts paid to claimants (or deny them altogether).

That’s just one reason why it’s helpful to work with an experienced disability attorney when you are considering making a claim. You need to be certain that your claim is documented properly, which may require having the right kind of medical examination and completing the right paperwork.

You also need someone on your side who understands what is involved in every contact and request from an insurer. An “independent” medical examination required by an insurer, for instance, might not be independent; sometimes, it might not even be a real examination, but simply a review of previous records by someone chosen by the insurer.

Los Angeles Disability Lawyer

We often hear questions about mental health coverage. When you choose us to help you with your claim, you can be certain that the team at Haffner Law is knowledgeable and experienced when it comes to all aspects of disability law—and that we’ll fight for you every step of the way.

We offer every client a free, no-obligation consultation, so you have nothing to lose. To schedule an appointment, just pick up the phone and give us a call at 1-844-HAFFNER (423-3637) or fill out the contact form below.

(This is an attorney advertisement by Joshua Haffner)

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