Deciphering Mental Disorders and Substance Abuse Policy Exclusions – Part 2

In Part 1, we looked at how disability insurance companies broadly define mental disorders and substance abuse.  In this post, we will be looking at a sample mental disorder and substance abuse limitation provision.

What Does a Mental Disorder and Substance Abuse Limitation Look Like?

Here is a sample limitation provision from an actual disability policy (this provision is taken from the same policy containing the definition of “mental disorders and/or substance abuse disorders” discussed in Part 1):

maximum indemnity period means the maximum length of time for which benefits are to be paid during any period of total disability (see the Policy Schedule on Page 1). Benefits will not be paid beyond the policy anniversary that falls on or most nearly after your sixty-seventh birthday, or for 24 months, if longer, except as provided by this policy.  In addition to any limitations described above, the maximum indemnity period for a disability due to a mental disorder and/or substance abuse disorder is also subject to the following limitations:  (a) The lifetime maximum indemnity period is 24 months; (b) the 24-month limitation also applies to all supplementary benefits payable by virtue of your disability due to a mental disorder and/or substance abuse disorder; (c) any month in which benefits are paid for a mental disorder and/or substance abuse disorder (regardless of whether paid under the base policy any supplementary benefits or both) shall count toward the 24-month limitation; (d) this limitation applies to this policy and all supplementary benefits under this policy.

Note that this provision is not entitled “mental disorder limitation” or “substance abuse limitation.”  Instead, it is entitled “maximum indemnity period.”  In fact, this provision is actually part of the policy’s definition section, and not the main part of the policy—highlighting the importance of carefully reviewing the definitions in your disability insurance policy.

Note also that this particular provision provides that any month in which disability benefits are paid counts against the 24 month limit.  So, for example, if you received disability benefits for a period of 12 months in connection with a substance abuse related disability, and subsequently returned to work, the next time you needed to file a claim related to a mental disorder or substance abuse, you could only receive a maximum of 12 months of disability benefits.


When purchasing a disability policy, watch out for mental disorder and substance abuse exclusions and limitations.  Always be sure to ready your policy carefully so that you understand the scope of the protection you are purchasing.  If you already have a disability policy, an experienced disability insurance attorney can review your policy and determine whether it contains any mental disorder or substance abuse limitations that might limit your ability to collect disability benefits under your policy.

Search Our Site