Some employees are unable to continue working because of disabling mental health conditions. They might fail at their jobs because of the way their mental health conditions interfere with their ability to perform the tasks of their jobs. Some people suffer from chronic mental health conditions that prevent them from returning to work on a long-term basis. If you have a behavioral health condition that prevents you from working either on a short- or long-term basis, you might be eligible for short- or long-term disability benefits through your employer-provided benefits. While not all employers offer short- or long-term disability benefits to their employees, many do. Here is what you need to know about qualifying for benefits based on a mental health condition from the employment lawyers at Swartz Swidler.
Mental Health Conditions and Disability Benefits Claims
While mental health conditions are hidden and do not show obvious physical signs, they can be just as disabling as serious physical injuries or other illnesses. Anxiety, depression, post-traumatic stress disorder, and other mental health conditions can interfere with employees’ ability to concentrate, focus, maintain attention, and perform the duties required of them at work. Similarly, employees with substance use disorders tend to have higher rates of absenteeism and show poor performance at work. They should be allowed to take time away from work to undergo necessary treatment so they can recover.
Disability Benefits Claims Process
Employer-provided disability benefits are governed by the Employee Retirement Income Security Act (ERISA). Since these benefits are governed by ERISA, employees must go through the administrative process before they can file claims in court. Employers are also prohibited from interfering with an employee’s attempt to use the employer-provided benefits or retaliating against employees who use them. If your employer has 50 or more employees, and you have worked for your employer for 12 months or longer for at least 1,250 hours, you might also be eligible to take time off from work to care for your serious mental health condition under the federal Family and Medical Leave Act (FMLA) at the same time that you use your short-term disability benefits.
You will need to have a medical professional certify that your condition is serious and verify that your symptoms are severe enough to prevent you from working. Your condition must have been diagnosed by a qualified mental health professional, and you must be undergoing treatment to assert your benefits claim.
You will file your short- or long-term disability benefits claim with the insurance company through which the benefits are provided together with supporting documents. If your initial claim is denied, you must exhaust the administrative remedies within the insurance company first before you can file a claim in court. Working with an experienced attorney who works in the area of employment law and understands the ERISA claims process requirements might help you to win your claim internally without having to file a lawsuit in court.
Insurance companies review claims and supporting documents to look for key information about the condition, including mental status examination results. It is important for you to regularly see your mental health professional and follow all treatment recommendations. Take any psychotropic medications that you are prescribed. Regular appointments with your mental health professional together with prescribed medications can help you to demonstrate the severity of your condition. Other factors, including hospitalizations and detailed documentation about your symptoms, can also be helpful with your claim.
The insurance company investigators will likely contact your treating psychologist, therapist, or psychiatrist for additional information. The insurance company might also retain a consultant to examine you and opine about your functional limitations. If you are approved for short- or long-term disability benefits based on your mental health condition, you will receive a percentage of your regular income until you can return to work. There will be a short waiting period before your benefits begin.
Disability Claims for Mental Health vs. Disability Claims for Other Illnesses/Injuries
State and federal mental health parity laws require health insurers to provide equal benefits to people with mental health conditions and other medical conditions or injuries. However, these parity laws do not apply to short- or long-term disability insurance. Most disability insurance plans discriminate against people with mental health conditions by restricting the duration of available benefits. Payments for psychiatric disorders might be limited to a maximum of 24 months under most long-term disability benefits plans. By contrast, long-term disability benefits for physical injuries and other medical conditions might continue until age 65 if they permanently prevent you from returning to work.
If you have a disabling mental health condition that prevents you from returning to your job, you need to understand your employer-provided disability benefits and the coverage that might be available to you. While your benefits only remain in effect during employment, your right to file a claim will not automatically end if you are terminated. This is especially true if you were terminated because of your mental health condition. If your employer offers a severance package to you through which you would release your employer from liability, you should be cautious if you could potentially file a claim for disability benefits.
Speak to Swartz Swidler
If you have a behavioral health condition that interferes with your ability to perform your job, you might be entitled to short- or long-term disability benefits through your employer-sponsored disability benefits plan. Contact the attorneys at Swartz Swidler for help with filing your claim by calling us at (856) 685-7420.
