Does Disability Insurance Cover Mental Health?
Mental health coverage is an important consideration when choosing a long-term disability plan, even if you don’t consider yourself likely to ever need this type of coverage.
True Own Occupation Disability insurance provides financial protection if a physician is unable to perform their primary duties due to an illness or injury. While the conversation around disability insurance often focuses on physical illness and injury, your coverage can also pay benefits if a mental nervous condition or substance abuse issue prevents you from working. However, the cost and extent of mental health coverage still varies widely from plan to plan and may be subject to certain limitations.
Most short-term insurance policies, typically provided by an employer in the form of a group plan, do not provide coverage for mental or nervous disorders. While you should carefully review your short-term policy benefits to know exactly what is included, physicians usually receive the majority of their mental health disability coverage from an own-occupation long-term disability insurance policy.
While public awareness and understanding of mental illness is on the rise, mental health conditions are still often covered differently than physical accidents and injuries by physicians’ disability insurance. Most disability insurance policies include limitations on the amount of coverage for mental and nervous conditions, although unlimited coverage options do exist in certain situations.
Most insurance companies include coverage that lasts for a limited duration of time that a policyholder can claim disability benefits due to a mental, nervous, or substance abuse disorder. Typically, the rider will limit the benefit period to 24 months. This means that if you are disabled by a mental nervous condition for longer than two years, your policy will stop paying benefits to supplement your lost income. A select few companies will offer an unlimited mental nervous rider if you qualify based on your existing health history for an additional cost.
These riders may be referred to by a number of different names, including a Mental Disorder/Substance Abuse Limitation Rider, a Mental Nervous & Substance Abuse (MSNA) Limitation Rider, and Mental and/or Substance-Related Disorders (MSDR) Limitation Rider. Certain specialties and states may require this type of rider in your policy, although it is commonly offered as an optional addition to physician disability insurance plans. By adding a mental nervous limitation rider to your plan, you may be able to reduce the cost of your premiums.
A physician’s mental nervous limitation rider should only limit the coverage in the case of conditions that are exclusively caused by a psychiatric condition or substance abuse disorder. A limitation rider usually does not apply to a disabling condition that is caused by an organic disease (such as MS, Parkinsons, Alzheimer’s, or dementia), stroke, infection, or injury.
While some doctors choose to include a limitation rider for the discounted premium rate, others prefer to minimize their policy restrictions. In this case, it is often possible to find a policy that offers unlimited coverage for mental and nervous disorders if you are able to afford the higher premiums. With “unlimited” mental health coverage, your policy will cover mental or substance abuse conditions in the exact same way as other illnesses and injuries, without any unique exclusions or limitations. However, it’s important to understand that the majority of long-term insurance policies stipulate an overall maximum benefit amount and/or maximum benefit period that would still apply to a disabling mental illness. Even with unlimited mental health coverage, a disabling condition due to mental illness would still be subject to the benefit maximums outlined in your policy for any other disability.
There are a variety of mental illnesses and substance abuse disorders that have the potential to prevent a physician from working. These disorders commonly include but are not limited to: anxiety, PTSD, depression, OCD, bipolar disorder, alcohol/drug addiction, and schizophrenia.
In most cases, the onset of a disability must occur after the insurance policy is purchased in order to qualify for disability benefits. Based on the condition and its severity, an insurance company may exclude your disorder from your policy or even deny you from getting coverage outright in severe cases. However, physicians with pre-existing mental or nervous disorders are occasionally able to qualify for complete, unlimited coverage.
If you have a pre-existing mental or nervous disorder, an insurance company will evaluate your individual case to determine your options for coverage. Depending on your prognosis and personal history, the carrier may determine you qualify for:
- Full coverage
- Partial coverage (with reduced benefits or specific exclusions)
- Denial of coverage
Each insurance company uses a different protocol in order to assess mental nervous conditions and determine how the likelihood that a condition will become disabling. As a result, higher risk conditions such as schizophrenia or suicidal ideation are far more difficult to cover.
Doctors with a pre-existing mental nervous disorder should be prepared to carefully shop around for the best insurance policy for their needs. This type of condition does not automatically preclude physicians from acquiring quality disability coverage, however, they may have to accept reduced benefits or certain coverage exclusions.
While many physicians never anticipate a need for mental health disability coverage themselves, these disorders are not uncommon. Mental health problems are the 4th most common cause of both short-term and long-term disabilities nationwide, according to the Council for Disability Awareness. In fact, the number of mental health related disabilities outnumber those caused by cardiovascular and circulatory diseases each year.
A short-term disability (STD) usually lasts anywhere from several weeks to six months, although some policies will pay short-term disability benefits for up to one year. The most common mental health conditions that cause people to claim short-term disability benefits include:
- Anxiety disorders
- Substance addiction
A long-term disability (LTD) can prevent a physician from working from six months to several years. In severe cases, a long-term disability may prevent a doctor from ever working in their specialty again. Disabling mental health problems can necessitate a significant amount of time for treatment and recovery. The following conditions are cited as the cause of nearly 9% of all long-term disabilities:
- Bipolar disorder
While plenty of mental or nervous issues never result in a disability, it’s also common for the symptoms of these conditions to interfere or prevent a physician from performing key functions of their specialty. For this reason, it is critical for every physician to have an understanding of how their disability insurance covers mental illness and substance abuse issues.
Mental health issues, addiction problems, and nervous disorders can affect people in any line of work. However, doctors often find it uniquely difficult to grapple with their own personal health issues when they are the ones in need of medical care and expertise. As a result, the medical field has a complex relationship with mental health problems within its own ranks.
Professional stress and stigma can exacerbate the severity of mental illnesses and substance abuse disorders in doctors. While rates of mental illness among doctors are mostly consistent with rates among the general population, research has found that physicians are less likely to be diagnosed or seek treatment. Many doctors report that fear of losing their medical license or facing professional repercussions prevents them from getting treatment. In other cases, physicians may believe they are capable of diagnosing and treating their own mental health problems without seeking outside help.
A study focusing on depression rates among physicians found that medical students and residents experience depression at higher than average rates with between 15%-30% of students and residents affected. Among practicing physicians, 13% of men and 20% of women struggle with depression. The study found that even the characteristic personality type of a doctor (perfectionist, driven, and highly self-critical) can increase the risk of substance abuse and depression.
Despite their role as professional caregivers, doctors are not immune to mental health problems or substance abuse issues. While these conditions are gradually becoming more understood and normalized, the persistent stigma surrounding mental illness contributes to the high rate of physician burnout and causes many physicians to suffer in silence.
Purchasing disability insurance with robust mental health coverage is one of the best ways that physicians can protect themselves in case they develop a mental illness. If a mental nervous, or substance disorder prevents you from working, your disability insurance should allow you to take the time to receive proper mental health care without jeopardizing your financial security.
There are a variety of mental health coverage options available to doctors when purchasing disability insurance. Depending on your budget, personal history, and preferences, you may be able to purchase a policy with limited or unlimited benefits for mental nervous and substance abuse disorders. While certain coverage limitations are common, the pre-existence or onset of a mental disorder should not prevent a physician from acquiring a long-term disability policy.
Accepting limitations on mental disorder and substance abuse coverage is still a common way for doctors to reduce their disability insurance premiums. However, if you’re looking for truly unlimited coverage for mental nervous conditions, with slightly higher premiums, the options are available with more comprehensive policy language.