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Long Term Disability Insurance Policy Limitations

Long term disability insurance policy limitations have been used and abused by insurance companies for a long time. This common tactic is often applied to disability policies that contain a mental health or nervous disorder limitation (“MNL”). Generally, this limitation reduces the amount of long term disability insurance policy benefits available if the insurance company finds that a disability is related to a mental health condition or a nervous disorder.

In a recent appellate case, the court considered whether the insured, Patti Okuno, physical ailments were enough on their own to render her totally disabled. Additionally, Ms. Okuno suffered from depression and anxiety. She applied for long term disability benefits through her employers’ policy with Reliance Standard Life Insurance Company. Reliance Standard approved her benefits, but only for 12 months. They relied on the mental or nervous disorders limitation in the policy to deny further benefits.

Ms. Okuno appealed their decision, arguing that her physical conditions alone were enough to establish her total disability. She argued that the mere presence of a mental condition does not justify application of the limitation. The court agreed, citing another case covering the MNL which held that the MNL excludes or limits coverage only when the person’s physical disability was insufficient to render him or her totally disabled. Ms. Okuno thus won her appeal and was awarded the benefits she was due.

When physical conditions and mental health conditions both contribute to a person’s total disability, the insurance company cannot simply choose between them for their financial gain. They must first look to see if the physical conditions themselves cause total disability. If they do, the mental health limitation cannot apply even if the person suffers from mental health conditions.

If you have suffered from physical and mental conditions and feel that your insurance company is improperly applying the mental and nervous disorder limitation in your policy, we may be able to help you. Contact one of the experienced long term disability insurance attorneys at Dabdoub Law Firm for a consult on your case to ensure you get the most out of your claim.