Claim Denied-ADD

[Melodee Irene]

What is the name of your state?

Georgia.

In March of this year I was diagnosed with severe Adult ADD. I am currently under the care of a psychiatrist who made the intial diagnosis and I have since seen a neurologist who has confirmed same. The severity of the ADD is such that it has interfered with my ability to gain and keep employment.

I am on the maximum amount of Ritalin I can take which is giving me only about 6 hours of relief. I am also under the care of an psychologist who is counseling me on behavioral modifications. Medication and behavioral therapy are necessary rehabilitative measures that I am taking so I can go back to work.

Meanwhile, my disability carrier has denied the claim stating this is a mental disorder which is excluded from my policy. While I concur ADD is about the brain, it is a neurological disorder not an anxiety disorder.

Does anybody out there have any experience with ADD and disability coverage? Do I fight it or am I fighting a losing battle. Any suggestions or feedback would be appreciated.

Thanks.

 

[ALawyer]

Is it a privately purchased policy or a company fringe benefit? If the former, contact your state insurance departmenr.

 

[Melodee Irene]

This was a group policy purchased for a small business of which I was 1/3 partner. I believe the disability coverage was purchased just for the partners-but can't confirm 100%.

Why would it matter if private or fringe?

Thank you.

 

[CIAA]

Melodee Irene,

Employer sponsored ERISA plans are regulated and enforced by the US Dept of Labor, private or non-employer plans are regulated by the state...different rules apply.

The answer to your question is largely going to depend on the specific policy language. At least one recent case has held that some policy wording may not be sufficient to exclude those "mental" conditions that have a physical cause or significant physical manifestations.

www.ciaaoftexas.com/mentalillness.htm