Frankel & Newfield, P.C.

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Insurer Unable to Apply Mental and Nervous Policy Limitation

Score one for the disability insurance claimant, as a Federal Judge recently determined that it was improper for Standard Insurance Company to seek to apply a limited benefit period to a claim for benefits resulting from a mixed impairment. The claimant, a physician with a long history of migraine headaches and depression, was paid benefits under his ERISA group insurance policy, but the claim was terminated at the 24 month mark, on the basis of the mental and nervous limitation.

The Court determined that because the migraine headaches were in and of themselves disabling, any effort to apply the limited benefit period was improper. The Court rejected a number of interesting arguments, including one that the opinions of the treating doctors were entitled to less weight because they were prepare specifically to support a finding of disability (in contrast with the typical insurer provided peer review reports?).

This decision could be of great benefit to the long term disability claimant community, as we often see insurance companies handling long term disability insurance claims seeking to invoke the limited benefit period under a mental and nervous limitation. If your disability involves both mental or nervous conditions as well as physical limitations, we can help you with your claim.

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