CALL NOW TO SPEAK TO AN ATTORNEY

1-844-HAFFNER

Recent California Case Addresses The Mental Health Limitation In ERISA Policies

Many disability policies have a limitation on the amount of time, usually two years, that they will pay policy benefits for a disability caused by mental illness.  Issues regarding the scope and applicability of the mental illness exclusion can arise where a physical injury or illness also results in mental incapacity which contributes to the inability to work.  Common examples of mental health issues associated with a physical injury or illness are depression and anxiety.

On March 27, 2017, a California federal court in Los Angeles ruled that, under an ERISA policy, where mental issues are caused by a physical injury or illness, the 24-month mental illness limitation is inapplicable.  In Doe v. Prudential Ins. Co. of America (2017) WL 1156725, the federal district court addressed a disability policy which limited benefits to 24 months when the disability is caused “in whole or part [by] mental illness.”  (Id. at *1.)  The insured submitted a disability claim for “HIV infection, pain, fatigue, osteoporosis, and severe depression.”.  (Id. at *4.)  Prudential, the disability insurer, approved the claim, but stated that the insured’s disability was caused by his depression and anxiety, not the physical ailments.  (Id. at *5.)  The insured had a history of depression since 1997.  (Id.)  Upon reaching the 24 months, Prudential terminated the insureds benefits.  (Id. at *7.)

The court in Doe v. Prudential Ins. overturned the denial, holding that the insured suffered “disabling cognitive impairments that have a physical etiology.”  (Id. at *14.)  The court stated that the mental illness must be the “but-for” cause of the insureds disability to trigger the mental illness limitation.  (Id. at *12.)  The court emphasized that the insured’s cognitive impairments had a physiological etiology.  (Id. at *14.)  The Court noted that “if Plaintiff’s mental health issues were suddenly resolved, he would still” be disabled.   (Id. at *15.)  The court held that the mental illness limitation did not apply because the insured’s HIV diagnosis, a physical condition, was the but-for cause of his disability.

Along with other courts, Doe v. Prudential adopts a but-for analysis regarding whether a mental illness “in whole or in part” causes a disability, and thus falls under a mental illness limitation.  Insureds who have been subjected to a mental illness limitation in connection with a disability claim may be able to use Doe v. Prudential, and its analysis, to challenge a mental illness limitation.

Click below to share this article:
Facebook
Twitter
LinkedIn

FILL OUT THE FORM BELOW FOR A FREE CASE REVIEW

Sidebar Form
I've been injured...

Recent Posts

RESULTS

$15,000,000
PROPERTY DAMAGE / BAD FAITH
$97,284,817
Class Action / Rest Break
$10,000,000
Bad Faith
$8,820,000
Brain Injury
$7,500,000
Medical Malpractice
$8,250,000
Wrongful Death / Accident
$1,000,000
Construction Defect

INJURED ? CALL (213) 212-6946

or

FILL OUT THE FORM BELOW FOR A

FREE CASE REVIEW

THE USE OF THE INTERNET OR THIS FORM FOR COMMUNICATION WITH THE FIRM OR ANY INDIVIDUAL MEMBER OF THE FIRM DOES NOT ESTABLISH AN ATTORNEY-CLIENT RELATIONSHIP. SENDING TIME SENSITIVE MATERIAL TO THE FIRM VIA THIS MESSAGE, WILL NOT BE THE RESPONSIBILITY OF THE FIRM. PROCEED IF YOU’VE READ THIS DISCLAIMER.
Footer Form
I've been injured...

RESULTS

$15,000,000
PROPERTY DAMAGE / BAD FAITH
$97,284,817
Class Action / Rest Break
$10,000,000
Bad Faith
$8,820,000
Brain Injury
$7,500,000
Medical Malpractice
$8,250,000
Wrongful Death / Accident
$1,000,000
Construction Defect

INJURED ? CALL (213) 212-6946

or

FILL OUT THE FORM BELOW FOR A

FREE CASE REVIEW

THE USE OF THE INTERNET OR THIS FORM FOR COMMUNICATION WITH THE FIRM OR ANY INDIVIDUAL MEMBER OF THE FIRM DOES NOT ESTABLISH AN ATTORNEY-CLIENT RELATIONSHIP. SENDING TIME SENSITIVE MATERIAL TO THE FIRM VIA THIS MESSAGE, WILL NOT BE THE RESPONSIBILITY OF THE FIRM. PROCEED IF YOU’VE READ THIS DISCLAIMER.
Footer Form
I've been injured...