What You Should Know Before You Read:
- Many long-term disability policies limit benefits for mental health conditions to twenty-four months of paid LTD benefits
- Disability insurers often try to apply this mental health limitation even when a claimant’s primary disabling condition is physical, not psychological.
- This tactic can cause unnecessary frustration and disruption to your LTD claim.
- Dabdoub Law Firm focuses exclusively on disability insurance claims, representing clients nationwide with a proven record of success in federal court. Our firm was built to win disability insurance cases.
Understanding the Mental Health Limitation in LTD Policies
Most group long-term disability policies contain a clause that restricts benefits for mental health conditions to a maximum of twenty-four months. This is often called the mental health limitation or the mental nervous disorder limitation. It typically applies to conditions such as depression, anxiety, bipolar disorder, and other psychological diagnoses.
However, many individuals with serious physical impairments also experience secondary psychological symptoms. It is certainly understandable, and even expected, that someone dealing with a life altering medical condition would experience anxiety or depression. over the difficulties they are facing. Despite knowing this, disability insurers often try to recast a physical disability as a mental health one to shorten the claim and limit their liability
This is one of the more common and problematic tactics used by disability insurance companies. It is also one that courts have repeatedly criticized when the disabling condition is clearly physical.
How Insurers Misuse the Mental Health Limitation
Insurers do not need extensive evidence to attempt to apply the mental health limitation. They simply need a basis, however weak, to claim that a psychiatric condition contributes to the disability. The most frequent scenarios include the following.
1. Putting a Secondary Mental Health Issue Above a Primary Physical Condition
If you suffer from a physical illness such as multiple sclerosis, cancer, chronic fatigue syndrome, back pain, or fibromyalgia, you may also experience anxiety or depression related to your condition. Insurers sometimes focus on a single mention of anxiety in your chart and use it to argue that your disability is psychiatric in nature, even when your physical symptoms are the main cause of your long term disability claim.
2. Cherry-Picking Physician Notes
Long term disability insurance companies often comb through medical records to find isolated references to mental health complaints like low mood or anxious feelings. . Even if your physician clearly states that your disability is caused by a physical condition, the insurance company may cherry-pick the one sentence that mentions depression and claim it is the reason you cannot work, while ignoring all the physical symptoms.
3. Relying on Hired Medical File Reviewers
Many long term disability terminations are based on file reviews by insurance-paid psychiatrists, psychologists, or behavioral health nurses who have never met you. These reviewers frequently claim that mental health symptoms are the cause of your disability, even when the treating physicians disagree.
4. Mischaracterizing Physical Disorders as Psychiatric
Disability insurance companies are quick to mischaracterize conditions like long COVID as a mental health condition because they involve subjective symptoms. People suffering from long COVID often report symptoms such as overwhelming fatigue, cognitive impairment or “brian fog,” and respiratory issues as the basis for their disability. But the same people also report depression and anxiety as part of the disability.
And somehow insurers turn that around to say that long COVID is psychological and thus subjected to the mental health limitation despite having objective physical findings. They may argue that the disability is caused by “pain behavior,” “symptom magnification,” or “somatic focus,” even when objective physical findings exist.
Why This Approach Is Wrong Legally and Medically
Courts have consistently held that insurers cannot apply the mental health limitation when a physical condition is the primary cause of disability. The presence of depression or anxiety does not eliminate the existence of an underlying physical illness, nor does it negate the functional limitations caused by that illness.
A proper claim evaluation should ask:
Are the physical conditions and symptoms alone disabling?
If the answer is yes, the mental health limitation does not apply.
Additionally, most treating physicians specifically document the physical basis for disability. When the insurer disregards these findings and replaces them with its own psychiatric interpretation, it often violates the policy and applicable ERISA standards.
Warning Signs That Your Insurer Is Preparing to Misapply the Limitation
You may be at risk of an improper mental health limitation termination if you notice any of the following:
- Requests for mental health records when your disability is physical
- New questionnaires focusing on mood or emotional state such as a behavioral health assessment
- A psychiatric IME scheduled without previous discussion
- File reviews by psychiatrists or psychologists despite physical primary conditions
- Claims representatives reframing your physical diagnosis as behavioral
These steps almost always signal the insurer is preparing to argue that your disability falls under the mental health limitation, even if that is medically inaccurate.
What To Do If your Long Term DisabilityInsurer Applies the Mental Health Limitation
If your LTD insurer insurer has sent you a termination letter based on the mental health limitation, you must act quickly. You typically have one hundred eighty days to appeal under ERISA, and this appeal is the most important part of your case.
1. Request Your Entire Claim File
You have the right to obtain the insurer’s full file, including internal notes, medical reviews, vocational reports, and communications. This file often reveals the weaknesses in their reasoning.
2. Work With Your Treating Physicians
Your doctors can provide updated explanations, physical examination findings and objective evidence clarifying that your disability is physical, not psychiatric, and remains disabling regardless of any secondary mental health symptoms.
3. Add Strong Medical Evidence
Updated imaging, lab results, functional assessments, and specialist opinions can help demonstrate your disability is physical in nature.
4. Address the Insurer’s Misstatements
Many termination letters contain selective quotes from your medical records or a misrepresentation of your symptoms or reported activities. These need to be addressed and clarified in writing through the appeal.
5. Consult a Disability Insurance Attorney Immediately
Because federal courts generally cannot consider new evidence during litigation , submitting a thorough appeal is crucial. An experienced disability attorney knows how insurers misuse the mental health limitation and how to challenge the tactic effectively.
How Dabdoub Law Firm Can Help
Misapplying the mental health limitation is one of the most common ways insurers try to cut off long-term disability benefits early. Dabdoub Law Firm knows these tactics well. Our practice was built to win disability insurance cases, and we apply that experience every day for clients across the country.
We help with:
- Claims involving complex physical conditions and mixed symptoms
- Appeals of terminations based on mental health limitations
- Countering biased psychiatric reviews and IMEs
- Preparing strong administrative records under ERISA
- Litigating unfair terminations in federal court
- Negotiating lump-sum settlements when appropriate
We represent clients nationwide against every major disability insurance company and have a proven record of success in federal court. Because most claims fall under federal law, we can handle your case no matter where you live.
If your insurer has wrongly applied the mental health limitation to your physical disability, contact Dabdoub Law Firm at (855) 276-3760 for a free consultation. You pay no fees or costs unless you receive benefits.