I have seen denial letters where individuals with a physical disability are said to have a mental disability by the insurer. Why would they do that?

The answer is simple and in my opinion in bad faith - most group long-term disability insurance policies have a clause limiting benefits for mental health disorders.  The period in some policies for so-called “mental/nervous conditions” is usually 2 years or less. Although these disabling mental disorders last longer than 24 months, the ERISA LTD insurance carrier will not pay benefits beyond what the policy says.

So, some insurance companies want to use this limitation to their advantage. They will try to apply the mental health limitation when a physical disorder produces disabling symptoms such as anxiety, depression, confusion or cognitive decline.

This is a sneaky and underhanded tactic for insurers to deny claims for other alleged subjective disorders, such as complex regional pain syndrome or fibromyalgia, where there are few diagnostic tools to definitively diagnose the disease.  Proof in these cases must be in the form of clinical exams, patient history, and other assessments.

No matter what your disabling physical condition may be, you have the right to fight back when the insurance company wrongly labels it as a mental disorder as a way to reduce your benefit payout.

If this is the case in your claim, you will need to fight hard to overturn the insurer’s misrepresentation. Working with your doctors and medical evidence, you will need to establish that the medical conditions causing your disability are physical, not mental.

Mental Health Disorder Is Secondary to Physical Disorder

Long-Term Disability: Physical vs Mental Disability

Sometimes mental issues are the result of an underlying physical disorder. This is common in my experience due to the significant life changes and/or chronic pain, fatigue, or other symptoms caused by most physical impairments.

If you suffer from cancer, degenerative disc disease or nerve damage, and deal with severe pain from the time you wake up to the time you go to bed (and you don’t sleep well because of the pain), it is not uncommon to experience depression or anxiety. Unfortunately, insurance companies try to take advantage of this situation by saying that your prescriptions for depression or anxiety medications or your visits to a psychiatrist/psychologist mean you have a mental impairment subject to the limitation.

Another tactic seen sometimes is classifying side effects from narcotic pain meds or sedatives, such as confusion or cognitive impairment, as a mental health disorder – all so that benefits will only be paid for 24 months, and not to age 65 or more.

These symptoms are not a disorder of the mind, but instead, they are a complication of a painful and lasting physical condition.

Another underhanded tactic is when the disability insurer provides you a representative for your Social Security Disability claim and that representative makes a good case for a mental impairment, and then SSA actually finds you are disabled due to this mental impairment.  It is my opinion that these SSA representatives paid by the LTD carrier have specific instructions to try to push the mental health aspects of a claim over physical aspects – although I do not have direct proof.

The Insurance Company Should Not Misrepresent Your Physical Disability as Mental

Most insurance companies play by the rules. Sometimes, however, they don’t and you must have an experienced disability attorney who is prepared for the ones who do not.

Claim reviewers may be coached to discretely push claims as being due to mental disorders rather than the actual physical condition, all for the purpose of limiting benefits – and saving money for the insurance company!

LTD companies sometimes argue that you can return to work with your physical impairment and that it's only your mental or nervous condition that keeps you from working!

Our Disability Team Can Help You Now

If you are struggling with a disabling physical condition, the anguish added by an insurer’s unfair denial is probably overwhelming. I believe it is wrong to exploit someone’s depression/anxiety by mischaracterizing a physical disability as a mental disorder in order to limit disability insurance coverage!

Have questions or concerns about your long-term disability claim?  Give Louisiana Disability Law a call right now at 985-240-9773.  The call is free and we can help you determine quickly if we can help with your claim.

Loyd J. Bourgeois
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Accident, injury, and disability lawyer serving Luling, Metairie, New Orleans, and South Louisiana
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