Long-term disability claims based on mental illness are some of the most common types of claims. Nonetheless, it is quite common for long-term disability insurance policies to contain limitations on the payment of benefits for mental/nervous conditions.

For example, one common mental/nervous limitation is to restrict the payment of benefits for mental illnesses to 24 months of benefits. In some cases, the mental limitation may restrict benefits to 24 months for disability due solely or in part to the mental condition. In other cases, the mental limitation similarly restricts benefits for disability “caused by,” “resulting from,” or “contributed by” a mental condition. Therefore, the language of the mental limitation can be extremely important in determining whether the limitation applies to a particular case.

Insurance companies often will try to ignore a physically disabling condition in favor of awarding benefits based on a mental health diagnosis, so that they will be limited to paying only 24 months of benefits. Alternatively, they may try to conflate a physical condition into a mental condition, also to invoke the mental limitation in the policy.

Cal. Ins. Code § 10110.6 provides that any discretionary clauses contained within disability insurance policies, which are clauses in which the insurer reserves discretionary authority to determine eligibility for coverage, interpret the terms of the policy, or provide standards of interpretation that are inconsistent with California law, are void and unenforceable. In order to be enforceable under the law, the mental limitation should specifically define mental illness or condition.

If the disability insurance policy in question does not provide a clear definition of “mental illness” or “mental health,” but instead leaves that determination to the discretion of the insurance company, a court may find the provision to be ambiguous under this law and thus construe it in favor of the claimant. Many federal courts have invalided mental/nervous limitations in long-term disability insurance policies for this reason, including some in California.

At Bonnici Law Group, we offer you client-centered representation at all stages of the long-term disability benefit claims process. When you need the kind of help that only an experienced long-term disability benefits attorney can offer you, contact Bonnici Law Group at 858-261-5454 or help@bonnicilawgroup.com.