• Beware of Mental Nervous Limitations in Long Term Disability Benefit Policies?

Disability Companies Are Wrongfully Using the 24 Month Mental Nervous Limitation

Every person that experiences pain also has a secondary dysfunction of their mental state. How could a person be in good spirits when he or she is suffering from a painful medical condition and unable to work? In this video, disability insurance lawyers Gregory Dell and Stephen Jessup discuss how disability insurance companies are manipulating the mental nervous limited pay period provision in order to deny long term disability benefit claims. We welcome your comments and feedback on this issue which we battle for claimants on a daily basis.

Comments (2)

  • Steve,

    First and foremost, contact your HR department to secure a copy of the long term disability policy. If your policy does contain a 2 year mental health limitation and your condition does not fall into any exception (if any), then it may in fact be limited to the 24 months. That being said, just because your claim has been approved it does not mean that it will continue to be approved for the full 24 months as disability is a month to month analysis. Your policy will require you to be under the appropriate care of a physician/treatment provider- if your doctor wants you to come every couple months it is arguable you will satisfy the appropriate care provision. However, with mental health claims Sedgwick will certainly expect that you have monthly if not bi-weekly visits if your condition is to be deemed severe enough to qualify for disability. Please feel free to contact our office should you have additional questions.

    Stephen Jessup Nov 14, 2014  #2

  • Hello Mr. Dell,

    I have been on disability for about 15 months. I was sent to an independent medical examiner and afterwords I received notification that my long-term disability was approved.

    Will my claim most likely be closed once the 24 month period hits because it is mental health? I noticed on my online claim information that it says RTW and then the date just happens to be at the 2 year mark.

    How can I obtain my employers group disability policy rules that Sedgwick follows?

    Since my long-term disability was approved does that mean I am approved at least up until it hits 24 months? Or will it be an ongoing approval type system like in the beginning of the claim process?

    Is there a certain limited amount of time that can pass in between doctor visits? A couple months or possibly longer?

    Any advice that you have is greatly appreciated.

    Thank you,
    Steve

    Steve Nov 13, 2014  #1

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Craig (California)

Cesar and Michal helped me through my case against Prudential. That only touches the surface. I suffered a bad injury which made me a challenge as I often didn’t recall what was said and to whom.

Cesar took the leap of faith to help me but he didn’t treat me like a client but more as if I was part of your family. I don’t know how you were able to get transform the team to have such a great attitude but by far I must say I am treated well from the moment I called, retained your firm it helped me through the minute I faced IME’s. Cesar demonstrates empathy and cares for his clients. I know that I made the right decision to select your firm and am fortunate that firms such as yours are around to help go up against big companies.

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The first and most important matter you have at hand is to take care of your health and let your retained lawyers handle the information needed to not only be approved for long term disability but also to make sure that your claim is managed for the duration of your disability. The disability is a matter that may last a lifetime.

A thorough online yelp review was held prior to conversations with Cesar Gavidia Esq. and Michal Mizrahi from the firm of Dell & Schaefer. I decided to retain them to handle my disability claim. The law-firm has an elaborate web page that demonstrates their ability to go up against all the largest insurance with a stellar track record.

The ERISA law is complex and if you decide to battle the insurance company without representation the odds will be stacked against you. An insurance company has one goal alone and that is to generate profits. The representation of Cesar Gavidia Esq. and Michal Mizrahi were responsible for the successful appeal and approval of my case.

An insurance company typically will deny or delay the claim as the penalty for denial or delay is non-existent. In my case, I was prepared with retained council Cesar Gavidia Esq and Michal Mizrahi who prepared and submitted the ERISA appeal. The document was complete and included information to demonstrate that I was disabled and overturned a previous denial from Prudential.

I’m not only happy to say that I picked the right firm but that I have developed a trusting relationship with combination of Cesar Gavidia Esq. and Michal Mizrahi from the firm of Dell & Schaefer.

Cesar Gavidia Esq. or Michal Mizrahi will pick up calls and take the time to explain what is being done by the insurance company or return the call in a timely basis if they were busy. This was after I had signed to be represented.

I never met Cesar Gavidia Esq. or Michal Mizrahi in person but I consider them my friends versus just attorneys that have been hired.

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