What Those With Mental Health Concerns Should Know About Group Short-term Disability
On behalf of DarrasLaw, posted in Disability Insurance on Wednesday, June 7, 2017.
When many people think of disabilities—and even disability insurance—physical disabilities come to mind. While physical injuries and chronic pain conditions surely qualify as disabilities under certain circumstances, they are not the only ones. Mental illnesses may also fall under the provisions of many individual and group disability insurance policies.
Statistics provided by the National Alliance on Mental Illness (NAMI) reveal that mental health conditions are far from uncommon. In fact, NAMI has made the following, eye-opening determinations concerning the prevalence of various mental health issues in the United States:
1 in 5 (18.5 percent) U.S. adults experience mental illness in any particular year, and 1 in 25 (4.0 percent) U.S. adults experience a serious mental illness that interferes with one or more major life activities
3.7 percent of U.S. adults live with schizophrenia or bipolar disorder
25 percent of U.S. adults experienced either one (or more) major depressive episodes last year or currently experience anxiety disorders
Of the adults in the United States who have experienced a substance-abuse disorder, 50.5 percent of those people—roughly 10.2 million U.S. adults—have a co-existing mental illness
Unfortunately, nearly a third of NAMI survey respondents reported that private insurance companies denied authorizations for mental health care benefits, because insurers deemed the care unnecessary medically.
Given the staggering, and even frightening, numbers above, questions about whether short-term disability insurance provide mental health coverage for people with episodic or long-lasting mental illnesses.
Do Short-Term Disability Individual or Group Insurance Cover Chronic Mental Illness?
Group short-term disability insurance does not typically cover mental illness. Most policies even include language that categorically excludes mental or emotional disorders of any kind. For example, a typical group short-term disability-insurance policy might contain the following language:
“Benefits will not be paid for losses caused by or resulting from mental or emotional diseases or disorders of any kind.”
Those with chronic mental-health conditions—such as clinical depression, bipolar disorder, or schizophrenia—should consider looking beyond group short-term disability insurance for income protection.
What Other Options Are There?
People diagnosed with a mental illness can look to the following resources for income assistance. No option is guaranteed to provide income, but each of the following resources provides assistance to qualifying individuals with mental health-related disabilities under certain circumstances. Generally, the Social Security Administration (SSA) is most helpful.
Social Security Disability Insurance
The Social Security Administration provides a great deal of information regarding its disability claims evaluation criteria. Under its guidelines, Section 12—a newer section—deals with mental disorders.
According to the information provided there, Social Security Disability benefits cover nine categories of mental illness:
Neurocognitive disorders. A clinically significant decline in cognitive functioning characterize these disorders.
Schizophrenia spectrum and other psychotic disorders. People with these disorders suffer from delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior, causing a clinically significant decline in functioning.
Depressive, bipolar, and related disorders. Patients who suffer from these disorders experience irritable, depressed, elevated, or expansive moods, or lost interest or pleasure in all or almost all activities, causing a clinically significant decline in functioning.
Intellectual disorders. These disorders cause significantly sub-average general intellectual functioning, significant deficits in current adaptive functioning, and manifestation of the disorder before age 22.
Anxiety and obsessive-compulsive disorders. Excessive anxiety, worry, apprehension, and fear, or by avoidance of feelings, thoughts, activities, objects, places, or people characterize these disorders.
Somatic symptoms and related disorders. These disorders result in physical symptoms or deficits that patients do not intentionally produce or feign, and that, following a clinical investigation, doctors cannot fully explain as a general medical condition, another mental disorder, the direct effects of a substance, or a culturally sanctioned behavior or experience.
Personality and impulsive-control disorders. These disorders cause enduring, inflexible, maladaptive, and pervasive patterns of behavior.
Autism-spectrum disorder. These disorders cause qualitative deficits in the development of reciprocal social interaction, verbal and nonverbal communication skills, and symbolic or imaginative activity; restricted repetitive and stereotyped patterns of behavior, interests, and activities; and stagnation of development or loss of acquired skills early in life.
Neurodevelopmental disorders. These disorders emerge during the developmental period—that is, during childhood or adolescence—although sometimes doctors don’t diagnose them until adulthood.
For each of these nine categories, the Social Security Administration provides explicit information regarding what applicants must show to receive disability benefits.
To find this information, click here. Once on the site, click on the disorder category in which you think you fall to find information regarding successfully filing and documenting a mental disorder claim. (Click the actual words—which should be in blue.)
Paid Family-Leave Programs
The Family and Medical Leave Act of 1993—and similar state-labor laws—require that covered employers provide employees with protected time off (or leave) for qualifying family and medical reasons. Though even the idea of FMLA was a progressive leap in 1993, FMLA leave remains unpaid. This may mean that you can take significant time off for mental health related issues while remaining employed (as long as 12 weeks), but income protection will remain a valid concern.
Few states have taken any real steps to extend state labor laws to include paid family and medical leave. That said, four states—and the District of Columbia—have started making this leap: California, Rhode Island, Washington state, New Jersey, New York, and Washington D.C. have laws that provide paid family-leave for employees who require time off for FMLA-related reasons. If you reside in one of these five areas, paid family leave may provide an option for you.
For more information, check out the applicable links below:
California Paid Family Leave
California was the first to provide paid family and medical leave, in 2004.
Washington Family Leave Insurance
Washington was the second state to pass a paid family leave law, in 2007.
New Jersey Paid Family Leave
New Jersey has provided employees with partial pay for family and medical leave since 2009.
Rhode Island Temporary Caregiver Insurance
Rhode Island has also provided partial pay for family and medical leave since 2014.
New York’s Paid Family Leave Law
New York will provide partial pay for family and medical leave, beginning in 2018.
District of Columbia Paid Family Leave Law
For qualifying reasons, D.C. employees may receive paid family and medical leave benefits starting in 2020.
Eligibility requirements for unemployment compensation will vary by state. Each state, however, imposes three basic guidelines for receiving unemployment compensation. Individuals must be:
- Physically able to work
- Actively seeking a new job
- Willing to accept suitable offers
Serious illnesses are consistently recognized as valid reasons for quitting work—a prerequisite for receiving unemployment benefits (other than being laid off). Unfortunately, one’s ability to work is a requirement for every state’s unemployment benefits. This means that you must, first, recover before you qualify for unemployment.
As is obvious, this “able to work” requirement presents a significant difficulty for people with chronic mental health disorders. Look here for a table providing state-specific unemployment benefit information—and talk to an experienced attorney if you have questions about unemployment benefits.
What About Temporary-Acute Mental Health Episodes?
Acute—and, by their nature, temporary—mental health episodes require immediate treatment for significant and distressing symptoms. Sometimes, they are the first mental illness symptoms a patient experiences. Other times, these episodes are just one in a series of episodes or the worsening of a related chronic mental illness. Acute mental episodes generally respond to immediate, full-time treatment. This, however, requires missing work for a set period of time. Income protection during these times is a real concern.
Group short-term disability insurance does not typically cover temporary-acute mental health episodes. This is because temporary-acute episodes are considered the sort of emotional disorders specifically excluded by typical policy language.
Do You Have Questions About Your Benefits?
If you have questions about group short-term disability insurance—as it relates to mental illness—contact us. Don’t wait.
The legal team at DarrasLaw is experienced in dealing with group short-term and long-term disability cases. There is no risk involved in contacting DarrasLaw. If you have short or long-term disability insurance questions, our legal team is here to help. Call us at (800) 458-4577 or contact us online.