Employees in Chicago who receive long-term disability benefits due to physical conditions frequently also receive mental health therapy. The stress of physical disability can often take a toll on one’s mental health, causing depression and even anxiety. Some people even get diagnosed with adjustment disorder, a stress-related condition caused by experiencing “more stress than would normally be expected in response to a stressful or unexpected event . . .” With many long-term disability insurance policies containing 24-month limitations for disabilities caused by mental health, can getting therapy to cope with physical disabilities place you at risk of triggering such a policy limitation? A recent case evaluated an insurer’s attempt to invoke the limitation.
In Berg v. Unum Life Insurance Co. of America, No. 2:21-CV-11737, 2023 WL 2619015 (E.D. Mich. Mar. 23, 2023), Dr. Berg contracted breast cancer, diagnosed in her right breast. She then claimed long-term disability, which Unum approved. While on disability, Dr. Berg attended regular therapy sessions. After approving Dr. Berg’s benefits, Unum terminated the benefits contending a mental health limitation applied and that Dr. Berg was disabled due to generalized anxiety disorder. After unsuccessfully appealing, Dr. Berg sued under ERISA § 502(a).
The United States District Court for the Eastern District of Michigan held Unum could not apply the policy’s mental health limitation. While Dr. Berg did attend regular therapy sessions, the record clearly showed Dr. Berg was unable to continue working as a physician due to the cancer treatment and medications, including the cognitive side effects and fatigue from treatment and medications. The court thus entered judgment in Dr. Berg’s favor and ordered Unum to pay past due benefits.
If you have a long-term disability claim due to a physical condition and receive regular therapy, contact an experienced ERISA long-term disability attorney to learn how to best protect yourself from an insurer trying to wrongly apply a policy mental health limitation.