Published on June 30, 2023

Mental Health and Disability Eligibility in Ohio

Many people focus on the physical outcome of a disability, which may affect your ability to work or complete everyday household tasks. Yet, many people never consider the psychological implications of a short or long-term disability. Whether you have been dealing with a chronic condition that newly qualifies you for disability or suffered a recent injury, it’s important to evaluate how a disability may affect your psychological well-being.

What Is ERISA?

ERISA stands for Employee Retirement Income Security Act, which was implemented in 1974 as a federal law. The ERISA program helps regulate private-sector employee benefit plans. The law makes certain provisions to ensure employers fairly offer benefits through health insurance, welfare, and disability payments. Some of the standards ERISA upholds include plan fiduciary, disclosure requirements, and appeals process requirements. A few provisions included in ERISA are the Continuing Health Care Coverage (COBRA), HIPAA laws, and, more recently, mental health parity.

The Prevalence of Mental Health Disorders Following a Disability

A 2018 study found that as many as 17.4 million, or 32.9% of adults with a disability, experienced frequent mental distress. A disability significantly affects a person’s life, often preventing them from earning a living. In addition to a difficult financial situation making it impossible to access mental health resources, it also threatens their ability to find safe housing.

Some of the most common psychological disorders following a disability diagnosis include anxiety, depression, and post-traumatic stress disorder (PTSD). The occurrence of these disorders can make it difficult for a person to return to the same employment. They may also have difficulty holding a steady job.

Is Mental Health Care Coverage Included in Disability Benefits?

Mental health is covered under most disability plan programs. However, the requirements for what’s considered qualified mental health eligibility may vary, depending on the program. For example, the Social Security Disability Insurance (SSDI) program allows disability benefits for those with diagnosed anxiety or depression.

ERISA also added a Mental Health Parity Act (MHPA) to the plan in 1996. The addition doesn’t require employers to offer employees mental health benefits, but it regulates the ones they do offer. For example, employers can’t put lower limits on mental health benefits than they do on traditional healthcare benefits. It’s important to note that even when ERISA regulates existing mental health plans, benefits are typically limited to a maximum of two years. For some policyholders, this maximum period may be even shorter. However, this time limit has been a popular topic of debate, with many state lawsuits following.

Other topics of mental health coverage, including co-payment, yearly visit limits, prior authorization, and proof of medical necessity, must also be similar to traditional healthcare benefits under ERISA regulations. If you have any questions about mental health disability eligibility or whether ERISA requires your employer to offer psychological care, it’s best to talk with an ERISA disability lawyer. In some cases, long-term disability benefits may be available to those diagnosed with a mental illness.

Requirements for a Mental Health Disability Claim

The specific requirements for filing a disability claim that covers mental health vary, depending on your plan. In most cases, you’ll need a diagnosis with supporting evidence. You may also need to prove that you have attempted any recovery techniques given by your doctor, such as medications, for an extended period of time with no evidence of improvement. You’ll also need proof of previous employment to qualify for disability benefits.

Specific employer benefits plan requirements and eligibility may also vary depending on the state. ERISA is a federal law, but since it only regulates existing plans, it may only sometimes apply to certain employers in the state of Ohio.

What Happens When Mental Disability Benefits Are Denied?

Some employers or insurance companies may wrongly deny benefits when related to mental health. Whether seeking benefits through an employer-sponsored private insurance plan or SSDI, you have a right to appeal. Before appealing, it may be worth it to talk with a lawyer. Find out why your claim was denied in the first place, and then gather any extra needed evidence. An appeal requests that the board review its decision and, in some cases, consider additional evidence.

Many agree that healthcare plans should cover more services related to mental health care, including medications or psychiatric care. Even among plans that currently offer mental health care, eligibility is confusing, and benefits are limited to a short period of time. Yet, mental health implications are a common occurrence in the United States. If you have questions about your disability and mental health eligibility under ERISA, make sure you reach out to a lawyer as soon as possible. 

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