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 its current epidemic rate. The law requires insurance companies to provide mental health coverage on 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 the 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.