Long-Term Disability: 4 Mental Disorders That May Qualify
- By Admin
- •
- 13 Nov, 2019
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Many employers offer long-term disability coverage. This is beneficial for employees who get injured or who suffer an illness that renders them unable to work for a period of time. In some cases, long-term disability pays up to 70% of an employee's salary if they are unable to work. Some long-term disability policies provide coverage for 5 to 10 years.
Other policies provide coverage for as long as the employee is disabled or until they turn 65. Some of the most common diagnoses for long-term disability claims are musculoskeletal and connective tissue disorders, nervous system disorders, cardiovascular disorders, and cancer.
Since mental health issues can also inhibit one's ability to work, certain mental disorders are another common reason employees file for long-term disability. Here are four specific mental disorders that may qualify for long-term disability.
1. Affective Disorders
Affective disorders are commonly referred to as mood disorders. People who have affective disorders have a general emotional state that is inconsistent with their circumstances. This type of disorder commonly interferes with a person's ability to function, including in the workplace.
Common examples of affective disorders include:
- Major depressive disorder
- Bipolar disorder
- Persistent depressive disorder
Affective disorders often affect more than a person's mood. Their sleep, behavior, weight, and cognitive function are also usually affected. In order to qualify for long-term disability, employees with mood disorders need to prove that they cannot function in the workplace even while receiving treatment.
2. Anxiety Disorders
Anxiety disorders are conditions in which a person has repeated episodes of feeling intense anxiety. They may feel panic, terror, or fear, even in normal situations. Common symptoms of anxiety disorders include having a sense of doom, increased heart rate, rapid breathing, sweating, trembling, and trouble concentrating.
The five major types of anxiety disorders include:
- Obsessive-compulsive disorder (OCD)
- Social anxiety disorder or social phobia
- Post-traumatic stress disorder (PTSD)
- Panic disorder
- Generalized anxiety disorder (GAD)
To qualify for long-term disability, an employee with an anxiety disorder needs to prove that their symptoms prevent them from functioning in a typical work or social environment.
3. Personality Disorders
For most people, their personality stays the same over time. For people with this type of disorder, their personality changes based on experiences or their surroundings. Some of the most common types of personality disorders include:
- Paranoid personality disorder
- Antisocial personality disorder
- Borderline personality disorder
- Avoidant personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
- Obsessive-compulsive personality disorder
Any of these types of personality disorders can prevent one from being able to function in the workplace.
An employee with a personality disorder who is seeking long-term disability benefits needs to prove they have certain symptoms including autistic thinking, seclusion, inappropriate hostility, aggressiveness, or constant mood disturbances.
4. Psychotic Disorders
This type of severe mental disorder causes abnormal thinking and perceptions. People with psychotic disorders lose touch with reality. Examples of psychotic disorders include:
- Paranoia
- Delusional disorder
- Schizophrenia
Those who get diagnosed with psychotic orders have hallucinations, delusions, and off-the-wall or disorganized behavior.
Psychotic disorders are also characterized by incoherent and chaotic speech. People with these disorders may say things that are inappropriate. In order to qualify for long-term disability benefits, employees must be able to prove that the symptoms of their psychotic disorder interfere with work.
Other mental disorders that may qualify employees for long-term disability benefits include organic mental disorders, somatoform disorders, attention deficit hyperactivity disorder (ADHD), Asperger's syndrome, chronic insomnia, and eating disorders.
If you are suffering with a mental disorder and have been denied by your insurance company for long-term disability, there is still hope. Contact Scott E. Shaffman Attorney At Law. Attorney Shaffman has successfully represented clients on long-term disability claims for over 35 years.
The language in a disability policy can vary from one insurance company to the next. This can make it difficult to determine exactly what your disability benefits are when you have sustained a serious injury.
Two common areas of confusion in long-term disability policies are the definitions of occupation and job duties. Legal arguments in long-term disability claims often center on the definitions of occupation and job duties, so you need to be able to understand the language in your policy if you want to know your rights.
Own-Occupation vs. Any-Occupation
When it comes to defining a disability, most policies will provide benefits for either an own-occupation disability or an any-occupation disability. If your disability policy can be classified as an own-occupation policy, you will be able to obtain benefits if you sustain an injury that prevents you from performing the duties associated with your current occupation.
This means that even if you are able to obtain a position in another occupation, you can still apply for disability benefits because of your inability to continue to work in your chosen field.
Many long-term disability policies are categorized as any-occupation policies. If the language in your policy refers to any-occupation coverage, you will only be able to access benefits if you are unable to work in any capacity.
You may need to work with your attorney to have the court qualify your policy to require the insurer to provide you with benefits if your injuries prevent you from obtaining a job for which you have sufficient education, training, or experience.
The level of disability required to obtain benefits differs between an own-occupation and an any-occupation policy, so you should know which type of language is used in your policy before you file a claim.
Material Duties vs. Substantial Duties
Long-term disability insurance policies will often state that benefits can only be obtained when a claimant is unable to fulfill the material and substantial duties of their occupation. Though it sounds like these duties are lumped together, many insurance companies evaluate them on an individual basis.
Material duties are categorized as those tasks that must be done as part of an occupation. In other words, if you couldn’t complete the material duties of your job, it would be impossible to do your job the right way.
Substantial duties are important to job performance but don't encompass the entire job description. For example, if you were a sales representative who had a stroke and lost the ability to speak, you would be unable to perform the substantial duties of your job. You may still be able to interact with clients via email, however, so not all aspects of your occupation would be impossible.
There is a lot of overlap between material and substantial duties. Your attorney should be able to establish the specific duties that you fulfill at work each day if you file a disability claim. Showing how your workday differs from a watered-down and generalized job description will help you prove your claim more effectively.
The outcome of a disability claim depends, in large part, on the specific language used in the claimant's insurance policy. Occupation descriptions, essential job duties, and what defines a disability can vary from one policy to the next.
An attorney can help you better understand whether your policy uses own-occupation or any-occupation language, and whether or not your disability limits your ability to complete material duties, substantial duties, or both.
Contact Scott E. Shaffman, Attorney At Law to schedule a free consultation so you can learn more about the specifics of your long-term disability policy.
