Disability Claim Tips With Ed Comitz, Esq.
Disability Claim Tips With Ed Comitz, Esq.
This guide is intended as a practical resource for dentists who think they might want to file a disability claim. Check in regularly for new claim tips.
Edward Comitz

Claim Tip 6 - Are Disability Claims Involving Anxiety/Panic Disorder Treated Differently than Other Claims?

3/1/2018 10:00:00 AM   |   Comments: 0   |   Views: 544

This is another common question our office receives from dentists who suffer from anxiety and/or panic attacks and are thinking about filing a disability claim.  Generally speaking, in our experience, we find that insurance companies subject mental health claims to heightened scrutiny, and that insurance companies can be particularly aggressive with these types of claims.  In addition, your policy itself may have specific provisions that can impact (1) whether you can collect or (2) how long you can collect for a disability caused by a mental health condition.  A few of the most common limiting provisions to look for in your policy are summarized below.

Specific Exclusions.  When you apply for disability insurance, the company will typically require you to complete a medical questionnaire, and these questionnaires often ask if you have any history of anxiety and/or other mental health conditions.  If there has been such a history, oftentimes the insurance company will add an exclusionary rider to the policy, which is essentially an amendment that states that disabilities caused by a specific condition (e.g. anxiety) are not covered by your policy.  If your condition is specifically excluded by your policy in this manner, you will not be able to collect benefits if you file a claim.

General Exclusions for Mental Disorders.  Some disability policies contain a general exclusion for mental disorders (as a whole).  We used to primarily see these types of provisions in group and ERISA policies, but they are becoming increasingly common in individual policies.  Again, if your policy generally excludes mental health conditions from coverage, you will not be able to collect for a claim based on anxiety/panic disorder.

Limited Benefit Period for Mental Disorders:  Other policies contain provisions that allow a claimant to receive benefits for mental conditions, but only for a limited amount of time.  Most policies with this type of provision only pay benefits for twenty-four months over the lifetime of the policy.  In other words, if you were paid twenty months of benefits for a claim based on anxiety, and then returned to work, you could only receive four additional months of benefits if you needed to file another disability claim based on anxiety (or another mental health condition) in the future.

These provisions also used to be relatively rare, but have become increasingly common in newer policies.  This limitation language can be mixed into other provisions, and appears in different places in different companies’ policies, so it’s important to read your entire policy carefully to see if the policy sets any limits on your ability to collect.

“No Work” Provisions:  Most dentists know that the ideal disability insurance policy is an “Own Occupation” policy, where a dentist is considered totally disabled and able to collect full benefits when they are no longer able to perform the substantial and material duties of their occupation (i.e. clinical dentistry).  In some instances, “occupation” may even be more narrowly defined as a dentist’s specialty (e.g. periodontics).  

While a true own occupation policy allows a claimant to work in another, unrelated field and still collect benefits (provided they cannot work in their own occupation), newer policies sometimes contain “no work” provisions.  This means that a claimant cannot work in their own occupation, and must not work in any other occupation in order to collect benefits.  

This can be especially problematic and disappointing to many dentists with anxiety.  Often the practice of dentistry and being in the dental environment is the primary trigger for anxiety and/or panic attacks.  When removed from this environment, many dentists find they want to and/or would have additional financial security if they were able to pursue a completely unrelated career, say as a financial advisor or real estate agent.  However, if you have a “no work” provision, and you go back to work in another capacity, you will not be able to collect benefits under your policy.

These are just a few of the provisions that can impact your ability to collect if you file a claim for anxiety, panic disorder, or other mental health conditions.  If you are thinking about filing a disability claim based on a mental health condition, it is very important that you read your policy carefully, so that you can be aware of any limitations and make sure that you do not prejudice your ability to collect by, for example, working in another capacity (if that is not allowed under your policy).

In our next post, we will be discussing another tricky question—how do you know when/if it’s time to file a disability claim for anxiety/panic disorder?

Information offered purely for general informational purposes and not intended to create an attorney-client relationship.  Anyone reading this post should not act on any information contained herein without seeking professional counsel from an attorney.

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