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What Those With Mental Health Concerns Should Know About Group Short-term Disability

Mental Health Disability Attorney California

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 or long-term disability insurance provides 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 short-term 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 other income protection.

What about temporary acute mental health episodes?

Private short-term disability insurance does not cover temporary acute mental health episodes. That’s because these issues are considered to be the sort of emotional disorders specifically excluded by policy language.

A temporary acute mental health episode includes everything from anxiety and depression to situational stress.

Does this mean a person with mental health concerns can’t ever look to short-term disability?

Not necessarily. Experts indicate that short-term disability coverage may be helpful in situations involving psychotropic drugs. Many drugs have potentially serious side effects that could impair a person’s ability to work.

Consider how some psychotropic medications cause weight gain, which can lead to the onset of diabetes or hypertension. These medication side effects are physical conditions that short-term disability might cover.

It’s important to note that the size of a policy may have to be smaller. The reason is that the more coverage sought, the more complete the underwriting process and the higher the premiums.

Short-Term Disability When The Mental Health Condition Is Related To Physical Injury

Another circumstance in which an employee can use group short-term disability for mental health conditions is when the condition was the direct result of a physical injury.

For example, if a person is in a car accident that causes chronic pain. The injured individual cannot participate in activities they previously enjoyed and numerous other activities that result in depression. Because the depression directly resulted from a physical injury, it should not trigger the denial of benefits as it would if it were a stand-alone condition.

Mental Health Conditions and ADA Requirements

The Americans with Disabilities Act (ADA) covers certain mental health conditions, which means that an employer must provide reasonable accommodations to enable disabled workers to perform the important tasks of their occupation.

Reasonable accommodation can include longer breaks as well as a modified work schedule. Reasonable accommodations can be made for any disability that substantially limits the worker’s ability to concentrate, eat, sleep, practice self-care, interact with others, or perform any major life activity. The condition does not need to be permanent or even severe to result in a condition that is substantially limiting.

To request a reasonable accommodation for a mental disability, an employee should:

  • Inform their supervisor, human resources department, or applicable employee resource that they require disability accommodation. It should be noted that the sooner the employer is informed about the disability and the need for modifications to the work schedule, the better. Employers do not have to retain employees who have exhibited poor job performance, even if that performance was impacted by a disabling condition if no request was made.
  • The employer can ask the employee to put the request in writing and can even require documentation of the mental health condition from their health care provider. The employee does not have to state their diagnosis when requesting the accommodation but can instead describe the general impacts.
  • The employer can ask the worker’s health care provider if a modified schedule would accommodate the particular needs of their condition.
  • It should be noted that an employer must give you a reasonable accommodation when requested, provided it can be shown that this accommodation will likely help with your job, and will not pose a significant difficulty or expense for the company. If the condition prevents an employee from performing the tasks of the job, even with an accommodation, there may be an opportunity to seek unpaid leave as a reasonable accommodation, if it is believed that this leave would allow the employee to regain the ability to perform the tasks of the job.
  • An employer cannot fire or otherwise penalize an employee for asking for a reasonable accommodation for a mental health condition.

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 assists 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 characterizes 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 the manifestation of the disorder before age 22.
  • Anxiety and obsessive-compulsive disorders. Excessive anxiety, worry, apprehension, fear, or 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, 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:

Unemployment Compensation

Eligibility requirements for unemployment compensation will vary by state. Each state, however, imposes three basic guidelines for receiving unemployment compensation. Individuals must be:

  1. Physically able to work
  2. Actively seeking a new job
  3. Willing to accept suitable offers

Serious illnesses are consistently recognized as valid reasons for stopping 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.

The “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 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 short-term policy language.

What To Do if You Cannot Work Due to A Mental Illness

As you can see, there is a lot to consider if you have a mental illness that prevents you from working. While this can be overwhelming, it is important to remember that there are steps you can take to protect your mental and financial well-being.

Ensure Your Health and Safety First

Often, people suffering from mental illnesses or conditions feel unseen for their struggles. If you need crutches or a wheelchair, your employer and coworkers likely would have sympathy for your condition. However, when your health condition is invisible, it can be significantly more challenging for your employer to understand why you struggle to perform the essential functions of your occupation as you customarily would.

Sometimes, it can be easy to think that a mental illness is simply a sign of instability. However, it is important to remember that these are diagnosable medical disorders due to chemical imbalances, trauma, or other very real and unavoidable circumstances. If you are facing challenges at work due to your mental illness, you want to ensure that you take care of your physical and mental health first.

You should make appointments with your general physician, who can promptly refer you to the proper mental health specialist. In some cases, obtaining the correct diagnosis and treatment plan can require second – or even third – opinions. Be patient and speak up if you believe that your symptoms are persisting or worsening despite treatment. You might need an adjustment in your medication or more frequent prescribed treatment.

In addition to addressing your mental health, always ensure that your doctors are on top of your physical health.

Several physical conditions can manifest as a co-morbid or correlating condition to mental illnesses, including:

  • Sleep disorders, including insomnia or nightmares that can lead to extreme fatigue, lack of focus and diminished executive functioning.
  • Migraines and chronic headaches that can disable you at any time of the day and without warning leaving you depleted, depressed and fatigued.
  • Irritable bowel syndrome (IBS) and other intestinal disorders that can cause diarrhea, pain, bloating, and other chronic distress
  • Fibromyalgia, which can result in pain throughout your entire body

In addition to the above chronic conditions that can accompany anxiety disorders and other mental illnesses, people with mental health diagnoses can be at a higher risk of developing severe and debilitating health conditions.

These include:

  • Infections
  • Pneumonia
  • Heart disease
  • Tuberculosis
  • Osteoporosis
  • Cancer
  • Diabetes
  • Pregnancy problems

You need the proper preventative treatment for these often life-threatening conditions, as well as a prompt diagnosis if you develop one or more of them.

While your financial concerns are important, your mental and physical health should come first. Once you have a complete picture of your mental and physical diagnosis, you should then move forward to find solutions for your employment challenges.

Discuss the Matter with a Disability Attorney

Your best resource for exploring your financial solutions if you are struggling to perform your occupational duties is an experienced disability attorney from DarrasLaw. First, our stellar legal team of experts can review other possible options – such as paid leave Social Security or state disability – with you to see if any are appropriate for your situation.

In some cases, you might be asking about short-term disability benefits from your group insurer when, in reality, you should also be considering whether you can seamlessly transition to receive long-term disability benefits. While obtaining long-term disability for mental illness is also challenging, most policies do not exclude mental conditions like short-term policies usually do.

Some people can successfully prove their disabilities stemming from mental illness and receive long-term benefits for 12, 18, or even 24 months. While this support is still limited in scope, it can provide the financial assistance you need while you get treatment and recover.

Our disability insurance attorneys can evaluate whether you might be eligible for long-term disability insurance benefits.

Some common mental conditions that can lead to long-term disability include:

  • Post-traumatic stress disorder (PTSD)
  • Schizophrenia, paranoid schizophrenia, Bipolar 1 and Bipolar 2
  • Eating disorders
  • Major depressive disorder
  • Social anxiety disorder
  • Agoraphobia
  • Panic attacks
  • Major depression

Even with regular and proper treatment, your symptoms might be so debilitating that they prevent you from performing the required functions of your occupation. For example, while you are undergoing treatment for PTSD, you might still have irrational fears, flashbacks, or other symptoms, and certain conditions at work might trigger these symptoms.

In addition, if your mental health condition comes with physical manifestations, such as daily migraines that require a quiet, dark room each afternoon or chronic pain from fibromyalgia, you might qualify for long-term disability based on your physical symptoms.

An experienced disability insurance attorney can determine what type of subjective and objective medical evidence you need for your policy to file a successful claim. We can review the terms of your individual or group disability policy and advise whether it is worth it to move forward with the claim process.

At DarrasLaw, we work with clients who need assistance building a bullet-proof claim for disability benefits based on mental illnesses, as well as a wide range of physical conditions. If we believe you have a valid claim for short or long-term benefits, we can assist you in getting the process started so you can get the benefits you need.

You Have Options for Financial Support

When you learn that you will not be eligible for short-term disability benefits following a diagnosis of a mental illness, do not give up hope. If you cannot continue performing your occupational duties for some time, there are options available. The right legal disability advocate can advise you of the best course of action for financial support in your specific situation.

If you are searching for solutions, you want the top-rated disability attorneys in the nation by your side. Our seasoned and experienced legal team at DarrasLaw can review your short and long-term disability policies through your employer and determine whether monthly insurance benefits are available. If not, we can guide you in the right direction to obtain financial support while you need to take time away from your usual occupation. Even obtaining long-term benefits for a limited time (such as 24 months or shorter) can help keep you and your family afloat so you can focus on your recovery.

Do You Have Questions About Your Benefits?

Attorney Frank Darras
Attorney, Frank Darras

If you have questions about group short-term disability insurance—as it relates to mental illness—contact us. Don’t wait.

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If you have short or long-term disability insurance questions, our award winning legal team is here to help.

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