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Posted on Saturday, April 20th, 2024 at 1:44 am    

Does Mental Health Short Term Disability Exist_ imageIs a mental health issue interfering with your ability to do your job in Philadelphia, Pennsylvania? If so, you might wonder if mental health short term disability benefits are available.

Short term disability benefits can replace part of your wages when a health condition negatively impacts your ability to work. Technically, it may be possible for you to receive short term disability benefits for a mental health condition.

However, limitations regarding how long an insurer needs to offer benefits may apply. The details of a policy may also influence whether you qualify for benefits.

Does Short Term Disability Cover Mental Health?

You may qualify for short term disability benefits due to a mental health issue. You will have to show medical documentation indicating you struggle with a mental health condition that limits your ability to work.

How you receive disability insurance will also influence mental health short term disability benefits and coverage. For example, you may receive disability insurance through a private sector employer. The Employee Retirement Income Security Act of 1974 (ERISA) will govern your benefits if so.

Mental Health Long Term Disability Benefits Limitations

Currently, the law limits how long insurers must offer disability benefits for mental health issues and substance abuse issues. If ERISA governs your benefits, the insurance company only has to provide coverage for up to 24 months.

That limitation may not always apply. The 2023 ERISA Advisory Council reviewed whether the 24-month limitation violates the Mental Health Parity and Addiction Equity Act (MHPAEA).

The MHPAEA prohibits group health plans from offering less favorable benefits to claimants for mental health and substance abuse issues than they offer to those struggling with other health conditions. Historically, the MHPAEA has only applied to group health plans and not to long term disability insurance providers.

The 2023 ERISA Advisory Council recommends that Congress pass a law ensuring long term disability insurance providers must abide by requirements similar to those the MHPAEA imposes on health plans. In other words, a law could prohibit long term disability insurance providers from limiting the amount of time they need to offer coverage for mental health and substance abuse issues.

As of this writing, Congress hasn’t passed such a law. However, developments such as these indicate change may be on the horizon.

How Does Mental Health Qualify for Short Term Disability in Pennsylvania?

Does Mental Health Short Term Disability Exist_ image 2If you’re wondering how to get short term disability for mental health conditions, be aware that qualifying can be a challenging process. Although a disability benefits insurance provider must abide by the law, as long as they do, their policies can establish their own definitions of what does and doesn’t qualify as a disability.

You may find it difficult to show how your mental health condition qualifies as a disability under your plan. Tips to keep in mind when applying for short term disability for mental health include:

  • Get a diagnosis – An exact diagnosis of a specific mental health condition is essential. You can’t merely show evidence that you’re struggling with the symptoms of a mental health issue. You’ll have a better chance of qualifying for benefits if you can show a doctor or other qualified professional has diagnosed your condition.
  • Document impairments – Your mental health condition must impair you in such a way that you struggle to do your job. A diagnosis alone may not be sufficient to show an impairment. For example, you may also submit medical records or doctor notes describing the specific ways your condition limits your ability to work.

Unfortunately, an insurance company may also categorize a mental health condition as a pre-existing condition for which the law doesn’t require them to provide coverage. This barrier could stand between you and the benefits you believe you deserve.

You have the right to file an appeal if the insurance company denies your claim. Ensure you understand the reasons for a denial so that your appeal is comprehensive.

Contact a Philadelphia Short Term Disability Lawyer

Even if you’re technically eligible to receive short term disability benefits for a mental health issue, claiming benefits doesn’t mean the insurance company will automatically approve your claim. You must provide significant medical documentation showing why you deserve to receive benefits. Luckily, you don’t have to navigate this process alone.

Gathering the necessary documentation is one of many tasks a Philadelphia, Pennsylvania, short term disability lawyer can assist you with. At Capitan Law, we can help you file a comprehensive claim, and we can provide assistance if you need to appeal a denial. Learn more about what we can do for you by contacting us online today or calling us at (267) 419-7888.

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