Mental Impairments and Disability

Mental Impairments and Disability

Although mental health parity laws prohibit health insurance companies from imposing exclusions and limitations specifically relating to the treatment of psychiatric disorders, disability insurance policies continue to limit the duration of benefit payments for mental impairments. However, a recent federal court ruling from Pennsylvania, Berkoben v. Aetna Life Ins.Co., 2014 U.S.Dist.LEXIS 39385 (W.D.Pa. February 21, 2014), has joined a growing list of cases recognizing that medical advances revealing the biological cause of most mental illnesses makes such distinctions illogical.

The case involved a computer programmer who became disabled due to a schizoaffective disorder and bipolar disorder. Although the illness was severe enough to qualify the claimant to receive benefits, the disability payments were terminated after 24 months based on a limitation in Aetna’s policy relating to psychiatric conditions. The court ultimately overruled that determination based on the biologic nature of bipolar and schizoaffective disorders.

The opinion in Berkoben is very revealing as to the growing consensus within the scientific community as to the organic etiology of many psychiatric illnesses. Despite the claimant’s success in this case, though, many insurance companies have circumvented the issue by redrafting their mental illness limitations to apply to any condition listed in the Diagnostic and Statistical Manual of Mental Disorders regardless of cause, even though such limitations would exclude dementia due to Alzheimer’s disease or even a viral encephalopathy. This debate will therefore continue until mental health parity is expanded beyond health insurance in order to encompass disability insurance as well.

Author: Mark D. DeBofsky