Individuals suffering from bipolar disorder can experience many difficulties in life. Sufferers of bipolar disorder will experience feelings of depression that alternates with episodes of mania. The symptoms associated with bipolar disorder can render an individual incapable of working and can include hyperactivity, impulsive decision-making, distractibility, trauma, racing thoughts and depression.
If work in no longer possible, and the worker has access to long-term disability (LTD) benefits through their employer or under a separately purchased insurance policy, the pursuit of such a claim can be a real uphill battle.
LTD insurers can be very hesitant to approve claims for benefits based on a diagnosed condition of bipolar disorder. This can be true even if the treating psychologist or psychiatrist has rendered very clear opinions about the individual’s diagnosis, symptoms, treatment plan, prognosis and ability to function in the work place. We find that bipolar disorder claims are often denied by long-term disability insurance companies. Fighting back against an insurance company can be a daunting task for individuals suffering the symptoms of bipolar disorder.
Policy and Limitations for Mental and Nervous Disorders
Most long-term disability insurance policies limit the amount of time benefits are potentially payable for mental and nervous disorders. The most common limitation is 24 months. In our experience, this mental and nervous limitation exists in nearly every employer-provided (and thus ERISA-governed) LTD plan and insurance policy. Such a limitation provision may also exist in an individual disability income replacement policy.
However, even though such a limitation provision exists and you may have experienced a denial or termination of your claim after 24 months, with the insurance company claiming that your benefits are limited by such provision, the denial may not be correct. Most all limiting provisions contain exceptions which might be applicable. Other limiting provisions may have ambiguously defined ‘mental illness’ such that the denial may be unsupportable.
Although these claim determinations can be difficult to overcome at times, it may be worth your time to have your situation reviewed by an experienced long-term disability attorney. Such consultation should take place as soon as possible after your receipt of a termination letter. Your termination letter likely provides you with an opportunity to submit an internal review request to the same insurance company. This may be your only time to submit evidence in support of your claim. This is especially true if your long-term disability claim is governed by the federal ERISA laws (a.k.a. the Employee Retirement Income Security Act of 1974). This internal appeal process cannot be taken lightly. We believe it is the most crucial stage of your claim and is likely a prerequisite step in the process, meaning it must be completed in a timely and complete manner before you have the legal ability to pursue a lawsuit against the insurance company or employer plan.
To find out more about submitting an ERISA LTD appeal, please click here. Please do not hesitate to contact a Denver ERISA lawyer at McDermott Law if you have any questions or you are seeking a review of a terminated claim.