When our client initially contacted Attorneys Dell and Schaefer his claim for long term disability benefit had already been approved by Unum. However, in approving his claim for benefits Unum determined that the underlying cause of his personality change, cognitive difficulties and symptoms of paranoia, depression and anxiety, which were preventing him from being able to work, were a result of a mental health condition. In doing so, his benefit would be limited to twenty four (24) months of benefits due to the limited pay period for mental health conditions contained in the Unum policy, a limitation common to most group long term disability policies. Complicating the matter even further was the fact that at the time he contacted our Office his monthly benefit was set to end in a month. Time was quite literally of the essence and not a moment was wasted as Attorneys Stephen Jessup and Gregory Dell set to work to prove to Unum that the underlying causes of our client’s conditions were not related to a mental health condition but rather a brain condition.
Mental Health Disability Claim vs. Organic Brain Conditions
As noted above, the vast majority of ERISA disability policies contain a 24 month limitation for mental health conditions. In turn, symptoms (such as cognitive dysfunction/deficits, depression and anxiety) are often viewed by the disability company as being the result of a mental health condition. Often times many people receive indication from their carrier as to same and do not question the matter further. Had our client done same he would have jeopardized his monthly benefit and financial security.
It is not uncommon that the manifestation of such symptoms as depression, cognitive dysfunction, stress, anxiety, paranoia or suicidal ideations actually stems from a physical abnormality in the brain. When this happens there is a strong argument to be made that a claim should not be limited to 24 months under a mental health limitation.
Attorney Jessup set to work collecting and reviewing all of our client’s medical records. During the process and in speaking with the client, Attorney Jessup learned that he had suffered multiple concussions and instances of being knocked unconscious in the past. “Through our experience of working with former NFL players, we are very familiar with the cognitive difficulties that develop from a history of brain trauma.” Armed with objective medical evidence by way of MRIs that noted atrophy in portions of our client’s brain and neuropsychological testing supporting cognitive dysfunction, Attorney Jessup argued to Unum that our client’s medical history, MRIs, and neuropsychological testing supported that the root cause of his disability was not depression or a mental health condition, but rather cognitive deficits as a result of a brain injury and that any change in personality or depression was a byproduct of the physical changes to our client’s brain.
Faced with the overwhelming medical evidence supporting this conclusion, Unum notified Attorney Jessup that it had determined that our client’s claim was not subject to the 24 month limitation for mental health conditions and that his monthly benefit would continue to be paid.
Is your Insurance Company trying to limit your monthly benefits?
Limited benefit periods for Mental Health conditions are commonplace in disability policies. If your insurance carrier can reasonably lump your claim into this limitation they most certainly will. It is not uncommon for a claim based on a physical medical condition with secondary depression to be approved for depression so as to enforce the limited pay period. If your claim has been approved for a 24 month mental health limitation and you disagree with this assessment please feel free to contact Attorneys Dell and Schaefer for a free consultation.