Mental health is the new battleground in disability claims

At a time when more people are dying by suicide or overdose, those seeking treatment for mental health issues and addiction face major barriers. Namely, insurance companies are deploying many tactics to deny or limit mental health coverage.

This includes professionals and others who have long-term disability insurance. Mental health claims are denied or downplayed by insurers at a greater rate than medical claims, despite federal legislation.

Mental illness is a disability too

Congress passed the Mental Health Parity and Addiction Act in 2008, well before the opioid crisis and spiraling suicide rate had reached their current epidemic rate. The law requires insurance companies to provide mental health coverage on a par with medical coverage. Over a decade later, insurance companies are still finding ways to avoid their legal obligations.

Mental health claims under long-term disability and short-term disability policies are routinely denied, even when policyholders have faithfully paid their premiums on time for years. Sometimes it’s in the fine print. Sometimes claims are turned down without justification. Some insurers are actively discouraging claims:

  • Insurers often provide a list of mental health providers who are in-network (covered by insurance), yet many of those providers are no longer practicing or aren’t taking new patients.

  • Some insurers pay lower rates to mental health providers, in direct violation of the parity legislation.

  • Some LTD policies expressly exclude mental health conditions.

  • Some policies limit benefits to two years, which may not be long enough for those fighting serious depression, anxiety or addiction.

  • Claimants are required by insurers to submit to an Independent Medical Exam, and those IME doctors contradict the diagnosis.

No incentive for insurers to adhere to the parity law

Insurance companies such as United HealthCare have been sued repeatedly for differential payments to mental health providers. Underpayment discourages mental health professionals and forces claimants to pay more out of pocket for treatment. But when long-term disability policies are provided through an employer, they fall under jurisdiction of ERISA (federal law). Not only do the ERISA regulations favor insurance companies but the law does not allow for punitive damages. So even when plaintiffs win, the insurance companies write off the judgments as a cost of doing business.

What rights to disability policyholders have?

The law says disabling mental health conditions must be treated comparably to orthopedic injuries, cancer and other medical maladies. With the right lawyer, you can appeal a denied claim or termination of benefits. If your disability appeal is in state court, California laws are much more favorable to individuals. If your disability policy is governed by ERISA, it is a much tougher fight. But our attorneys have prevailed against the largest insurers in the country, including appeals of mental health claims.

No Comments

Leave a comment
Comment Information
Email Our Attorneys

Our Insurance Lawyers Can Help

Bold labels are required.

Contact Information

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.


Privacy Policy

  • American Board of Trial Advocates
    American Board of Trial Advocates A prestigious national association of experienced trial lawyers and judges. Membership is by exclusive invitation only. All members shall have completed 10 civil jury trials to jury verdict or hung jury as lead counsel.
  • Best Lawyers
    Best Lawyers The oldest and most respected peer-review publication in the legal profession. A listing in Best Lawyers is widely regarded by both clients and legal professionals as a significant honor, conferred on a lawyer by his or her peers.
  • AV | PeerReviewRated | Martindale-Hubbell | For Ethical Standards and Legal Ability
    Martindale-Hubbell Peer Review Ratings An objective peer review rating indicator of a lawyer's high ethical standards and professional ability, generated from evaluations of lawyers by other members of the bar and the judiciary. Pillsbury & Coleman founding partner Philip L. Pillsbury Jr. is rated “AV Preeminent.”
  • Super Lawyers
    Super Lawyers A peer-review rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievement.
  • Best Lawyers | Best Law Firms | U.S.News & World Report | 2019
    Best Lawyers Best Law Firms U.S. News 2019
  • American Association for Justice | Formerly the Association of Trial Lawyers of America (ATLA)
    American Association for Justice (AAJ) Founded in 1946, AAJ is the world’s largest trial bar and supports the work of attorneys to ensure that injured plaintiffs can obtain justice.
  • American College of Coverage Counsel
    American College of Coverage and Extracontractual Counsel Composed of preeminent insurance coverage counsel in the United States and Canada, representing the interests of both insurers and policyholders. The minimum membership requirement is the practice of insurance law for at least fifteen consecutive years.
  • Association of Business Trial Lawyers | abtl
    Association of Business Trial Lawyers Founded in 1972, ABTL is dedicated to connecting litigators and judges to address issues important to trial lawyers.
  • Consumer Attorneys of California
    Consumer Attorneys of California The only California-wide unified trial bar for plaintiffs lawyers who represent consumers harmed by powerful foes such as insurance companies, pharmaceutical companies, automobile manufacturers and banks.
  • SFTLA | San Francisco Trial Lawyers Association
    San Francisco Trial Lawyers Association For over 60 years, this prestigious bar association has educated and trained trial lawyers and supported and passed critical legislation to protect and advance individuals’ rights.
  • United Policyholders | Empowering the Insured
    United Policyholders A non-profit group dedicated to providing trustworthy and useful information and an effective voice for insurance consumers in all 50 states.
  • America's Top 100 High Stakes Litigators | 2018 | Top 100
    ACCEC | American College of Coverage and Extracontractual Counsel | Fellow