The 24-Month Mental Health Limitation in Long-Term Disability Policies
If your long-term disability benefits were cut off—or are about to be—because the insurer says your disability is “caused by or contributed to by” a mental or nervous disorder, the limitation may not work the way the letter says it does. Federal courts have rejected insurers’ clock start dates, their labeling of conditions as “mental,” and their attempts to count a physical claim against the mental-illness cap.
A cap on duration, not a finding that you can work
Most group long-term disability policies limit how long benefits are paid when a disability is attributed to a mental or nervous disorder. The wording varies by policy, but a common version reads like this:
“Monthly Benefits for Total Disability caused by or contributed to by mental or nervous disorders will not be payable beyond an aggregate lifetime maximum duration of twenty-four (24) months unless the Insured is in a Hospital or Institution at the end of the twenty-four (24) month period.” Reliance Standard policy language quoted in McEachin v. Reliance Standard Life Ins. Co., No. 24-1071 (6th Cir. Nov. 13, 2024)
The cap is not always 24 months. The Reliance Standard policy in Okuno v. Reliance Standard, 836 F.3d 600 (6th Cir. 2016) used the same wording with a twelve-month limit. And the wording matters as much as the number: “caused by or contributed to by,” “due to,” an undefined “mental illness,” and the presence or absence of a hospital-confinement exception each change what the insurer has to prove before the limitation ends your benefits.
A termination under this clause is not a finding that you can work. It is an insurer’s claim that your disability falls into a category it agreed to pay for only a limited time. That claim has three parts—which condition is disabling you, when the clock started, and whether the condition is “mental” at all—and each one can be wrong.
Four ways the 24 months get counted
Select a situation. The bar shows sixty months of a claim: when a physical condition alone supports benefits, when the mental-health clock is actually running, and where the dispute usually sits.
Months of disability
Your claim was approved for a physical condition. Depression or anxiety came with it.
Chronic pain, a spinal injury, or a serious diagnosis often brings depression or anxiety with it. Insurers sometimes treat that overlap as a reason to start the mental-health clock on the first day of benefits. The Sixth Circuit rejected that approach. Under its but-for test, the effect of the physical conditions has to be considered separately; if they alone make you totally disabled, the “mere presence” of depression or anxiety does not trigger the limitation. In McEachin, the court applied that rule to hold the 24-month clock did not begin until the claimant’s physical conditions stopped being independently disabling.
Sources: Okuno v. Reliance Standard, 836 F.3d 600 (6th Cir. 2016); McEachin v. Reliance Standard, No. 24-1071 (6th Cir. 2024).
Your claim rests on major depression, PTSD, bipolar disorder, or another psychiatric condition.
When a psychiatric condition is the disability, the limitation usually applies from the first month of benefits. The questions then turn to the policy’s exact terms. Many policies continue benefits past the cap if you are confined in a hospital or institution at the end of the period; the policies in McEachin and in Pickering v. Equitable both contained a version of that exception. Some policies count only months actually paid; some aggregate across separate claims over a lifetime. And whether a physical condition has developed during the claim that is independently disabling on its own is a live question at every point—including after month 24.
Sources: McEachin (6th Cir. 2024); Pickering v. Equitable Financial Life Ins. Co. of Am., No. 1:25-cv-00046 (D. Utah Sept. 3, 2026).
The insurer says you already received 24 months, so nothing more is payable for a mental condition.
Michael Pickering’s long-term disability claim was approved for congestive heart failure, COPD, and hypertension. After 24 months, Equitable terminated benefits under the any-occupation standard and, in litigation, argued that because he had already received 24 months of benefits, the policy’s 24-month mental-illness limit left nothing to pay for his anxiety. The court disagreed: the limitation applies only when a mental illness plays a causal role in the disability, and “an incidental mental condition should not limit the duration of benefits granted for a physical condition.” Pickering had “not exhausted the potential twenty-four-month period of benefits based on mental illness.”
Source: Pickering v. Equitable Financial Life Ins. Co. of Am., No. 1:25-cv-00046 (D. Utah Sept. 3, 2026).
Your condition has psychiatric symptoms but a physical cause.
Traumatic brain injury, chronic fatigue syndrome, and other conditions can produce memory loss, slowed processing, or mood changes that an insurer’s reviewer describes in psychiatric terms. Where a plan does not define “mental illness,” the Ninth Circuit has held the term ambiguous because the plan does not say whether a disability is classified “by looking to the cause of the disability or to its symptoms”—and ambiguities are resolved in the insured’s favor. Dorian Law litigated this question for a Chevron employee with a traumatic brain injury; our write-up of that 2025 decision is here.
Source: Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938 (9th Cir. 1995).
Where insurers have been wrong about the limitation
The but-for rule: overlap is not causation
Okuno v. Reliance Standard Life Ins. Co., 836 F.3d 600 (6th Cir. 2016)Reliance Standard applied a twelve-month mental-disorder limitation to a claimant whose disability involved both physical and psychiatric conditions. The Sixth Circuit held that a claim is not properly limited merely because a mental disorder “contributes to” the disability; the effect of the physical conditions must be considered separately, and the limitation applies only if the mental disorder is a but-for cause of total disability. The practical effect: an insurer that cites depression in a claim built on a physical impairment has to show the physical impairment alone would not keep the claimant from working.
The clock starts when the physical disability ends
McEachin v. Reliance Standard Life Ins. Co., No. 24-1071 (6th Cir. Nov. 13, 2024) (published)Reliance Standard terminated Annette McEachin’s benefits after about three years and argued her 24 mental-health months had already been spent. The Sixth Circuit affirmed an award of benefits: until April 2021, her “physical disability alone justified benefits,” so the limitation did not apply during that period and the 24 months began only then. The court also sent back the question whether the clock could be tolled during the following two years, holding a claimant “may present later evidence of poor health” to show her earlier condition. On remand the parties resolved the case.
A physical claim does not consume the mental-illness months—and the reviewer missed the record
Pickering v. Equitable Financial Life Ins. Co. of Am., No. 1:25-cv-00046 (D. Utah Sept. 3, 2026)Equitable’s medical case manager discounted the treating physician’s opinion that Pickering could not do sedentary work because of his mental health, stating that “there was no mention of mental health treatment or care within the medical records.” The court found the record “on multiple occasions addresses Mr. Pickering’s anxiety disorder as well as associated treatments and medications.” It reversed, remanded for Equitable to consider that evidence, and held the full 24-month mental-illness period remained available because his original claim rested on cardiac and pulmonary conditions.
An undefined “mental illness” is read in the insured’s favor
Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938 (9th Cir. 1995)Applying its earlier decisions in Kunin v. Benefit Trust Life Insurance Co. and Patterson v. Hughes Aircraft Co., the Ninth Circuit treated a plan’s undefined “mental illness” limitation as ambiguous and resolved the ambiguity in the claimant’s favor. For claimants in California and the other Ninth Circuit states, this line of cases is often the starting point when an insurer classifies a condition with a physical cause as “mental.”
Leaving mental health out of the claim is not the answer either
The obvious reaction to a 24-month cap is to keep depression and anxiety out of the claim entirely. That can cost more than the cap itself.
Omitted from the record
Shortill v. Reliance Standard, No. 2:25-cv-00264 (D. Me. 2026)Susan Shortill argued in court that Reliance Standard had failed to assess her declining mental health. The magistrate judge found she had not asserted a mental health condition in her claim and had not offered evidence that she “pursued treatment for depression with a therapist or other mental health provider during the relevant period.” The district judge adopted that recommendation in August 2026 and entered judgment for Reliance Standard.
Documented without precision
The Okuno / McEachin patternA record that mixes physical and psychiatric limitations without separating them hands the insurer its argument: that the mental condition is part of the cause and the cap applies from day one. The but-for test protects the claimant only when the record shows what the physical conditions do on their own.
The answer is precision, not omission: treating-provider opinions that state which limitations come from which condition, placed in the administrative record before the appeal closes. In most ERISA cases, the court decides on that record and nothing else. This is the core of the Litigation Back Approach—building the claim file for the federal judge who may eventually read it.
When a termination letter cites the mental health limitation
ERISA and insurance-denial litigation is the entirety of this firm’s practice. On a mental-health-limitation termination, the work follows the record, in this order:
- Identify what the approval rested on. The insurer’s own approval letter and claim notes usually say which condition it accepted as disabling. If that was a physical condition, the Pickering rule and the but-for test are in play immediately.
- Test the clock’s start date. We find the date the insurer’s file says the physical conditions stopped being independently disabling, and compare it to the date the insurer started counting. Under McEachin, the months before that date should not count.
- Read the exact limitation language. “Caused by or contributed to by” is not the same as “due to.” A defined “mental illness” is not the same as an undefined one. Confinement exceptions, lifetime aggregation, and excluded diagnoses vary from policy to policy.
- Check every reviewer statement against the file. A reviewer who says the record contains no mental-health treatment, or no physical findings, is making a factual claim that can be tested page by page—the error that led to reversal in Pickering.
- Separate the limitations in the treating providers’ opinions. The appeal record should answer the but-for question directly: what the physical conditions prevent, standing alone, and what the psychiatric conditions add.
- Request the complete claim file before drafting the appeal. ERISA’s claims regulation entitles you to all documents relevant to the claim, free of charge. That includes every medical and vocational review the insurer relied on.
For how these disputes connect to insurer-specific practices, see our pages on Unum and MetLife long-term disability denials, and our long-term disability denial FAQ.
Mental health limitation FAQ
Was your claim cut off at 24 months?
Send us the termination letter. We will look at what your claim was approved for, when the insurer started the clock, and what your policy actually says—before your appeal deadline runs.
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