MENTAL DISORDER IS NOT ALWAYS “MENTAL ILLNESS” UNDER INSURANCE POLICY EXCLUSIONS.

Bipolar disorder is a euphemism for what used to be described as “manic depression.”  It is cataloged as a mental disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (IVth Ed.).  Anyone who knows or is related to a manic depressive person would probably describe it as a mental illness.  So do insurance companies.  Many insurance companies exclude or otherwise limit benefits on disability and death insurance policies for conditions of mental illness.  There has been a long running debate among mental health professionals, scientists, philosophers, ethicists and others as to whether the manifestation of behavioral material, or cognitive malfunction in human beings is based on physical or situational causes.

It was the late poet Theodore Roethke who wrote “what is madness but nobility of soul at odds with circumstance.”  Recent developments in genetics and brain scan technology provides greater hard evidence that many “mental” disorders have a physical cause.

The serial opinions in the long running case of Jane G. Fitts v. Federal National Mortgage Association and UNUM Life Insurance Company of America have continued with the latest iteration of her saga.  Jane Fitts was a lawyer at Fannie Mae, the quasi governmental mortgage broker who allegedly suffers from manic depression and was disabled by it in 1995.  UNUM provided disability benefits to Ms. Fitts for a period of two years then stopped because of a clause in her policy that limits benefits under the policy to two years for a condition characterized as mental illness.  Fitts filed suit under ERISA, the Americans with Disability Act and a Washington, D.C. health care statute.  She was tossed out of court on summary judgment but the District of Columbia Circuit reinstated her ERISA claim, holding that the standard of review was “de novo”—a fresh look, rather than determining whether the insurance company was acting arbitrarily and capriciously.

Ms. Fitts used a combination of evidence to show that there was a physical component to her bipolar disorder, including brain scans showing atrophy in a parietal lobe a family history suggesting a genetic predisposition and expert testimony opining that her afflictions is a neuro-biological condition affecting the physical structure and chemical activity of the brain.  An expert for the defendants countered that biological markers were insufficient to characterize bipolar disorder as a physical illness because all mental disorders may correlate with biological changes.  The trial court, on remand, essentially said there was a problem with the definition “mental illness” in the insurance policy, which under the doctrine of “contra proferentem” means the insurance company loses because they drafted the insurance agreement and were asserting its validity.  See Philips v. Lincoln National Life Insurance Co., 978 F.2d 302 (7th Cir. 1999).  In the list of many rulings in the case, Fitts v. UNUM Life Insurance Company of America, D.D.C. No. 98-00617 (2/23/06), Judge Henry H. Kennedy ruled that there remain material issues of fact pending which required a trial, more particularly as to whether Ms. Fitts actually suffers from bipolar disorder or whether her illness is of a less severe form of personality disorder which may be less physically based.  Hang in there Jane. Anybody engaged in litigation with this kind of history of ups and downs should have little trouble establishing manic depression.

Comments

[albertson]

My opinion is Depression and Mental is one of dangerous health.but the mental hospital comity had decided a good policy for those metal patient under this insurance policy,the mental patient can get treatment through the insurance policy and recover very soon.
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albertson
Addiction Recovery California

Addiction Recovery California

[andrewwilliam]

My opinion is mentally disorder is the variety one. We can't expect what they actually do at that time.

So the policy for those metal patient under this insurance policy the mental patient can get treatment through the insurance policy and recover very soon.

------commented by Andrew William

Montana Alcohol Addiction Treatment

[David]

It should simply be clear that benefits are being limited by such policies because acknowledgment of mental illness as a dynamic in a persons ability to work would require a costly change in the status quo. I have worked for 20 years before becoming increasingly un-able to work due to rapid mood swings from depression, to mania to debilitating anxiety. My ability to provide a roof over my family and earnings have gone from $75k to soon be a pithy $12k per year. Home, car, child's education, savings... gone. Sense of well being gone. I'm ready to join the fight.

[Robin Smith]

For mild to moderate depression, regular exercise of moderate intensity can be an effective treatment in itself. As per the latest research, exercise can further assist depression in individuals with depression who have responded only partially to an antidepressant medication. Both aerobic exercise like brisk walking, cycling or jogging.

http://healthfreak2.wordpress.com/2009/10/07/benefits-of-exercise-in-managing-depression/

[Addiction Treatment Center]

Bipolar disorder is a psychiatric problem which is generally related to mood disorder. It is a form of manic–depressive disorder also referred to a bipolarism or manic depression. Proper treatment can only cure them.

[Penegra]

Mental illnesses can take many forms, just as physical illnesses do. Mental illnesses are still feared and misunderstood by many people, but the fear will disappear as people learn more about them. If you, or someone you know, has a mental illness, there is good news: all mental illnesses can be treated.