Mental health: Insurance companies reimburse less than with physical injury

Mental health: Insurance companies reimburse less than with physical injury
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Insurance companies have policies that reimburse substantially less for those suffering from mental illness compared to those with physical injuries, with many companies even going as far as completely excluding mental health issues from their insurance policies.

For the first time in Belgium, an insurer who reimburses less for mental health issues than physical health has been convicted of discrimination, De Standaard reported.

Sophie Onghena (26) was doing her first year as a lawyer but was forced to stop due to post-traumatic stress disorder caused by an incident in her personal life. She applied for an income with her health insurer, but the application was unsuccessful.

In case of physical illness, the insurance company pays a part of your income after six months of getting insured, but when it comes to mental health issues, the fine print states that the waiting period is two years.

That means Onghena would have been paid if she was dealing with a broken leg, for instance. “But apparently psychological complaints are not considered a real illness,” she said. Her four-month illness cost her €4,000.

Anyone dealing with long-term illness has the right to 60% of their gross salary after one month, which further decreases after one year. For those who are self-employed, that amount is even lower.

Many employees, especially self-employed ones, therefore often take up guaranteed income insurance, meaning that up to 80% of the full annual salary is retained.

Mental illness

However, many of those policies exclude mental health issues, including issues like burnout. Other insurers charge extra for this, build in a longer waiting period like in Onghena’s case, or strictly limit the intervention in time instead of guaranteeing it until retirement age.

In some cases, additional actions are required, such as obtaining a certificate from a psychiatrist or following a reintegration process. These restrictions also apply to many hospitalisations and supplementary (private) insurance policies.

That often means that someone who ends up in the hospital due to liver disease after alcohol abuse is insured, but those who want to tackle their addiction at an earlier stage are not.

Cause for hope

But for the first time in the Mechelen labour court, Belgian judges recently ruled that an insurance distinction between physical and mental illness is discriminatory.

A woman suffering from depression had collective disability insurance which stated that “mental and personality disorders” could provide compensation for a maximum of two years. The court ruled that that was discrimination based on health status.

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Although that doesn’t mean all similar clauses in current policies are immediately illegal, but it does offer hope for the future.

Insurers’ defence

The insurance sector stated that mental health problems are difficult to diagnose, as they base their policies on existing studies and statistics. “The uncertainty about these types of risks affects the guarantees offered,” says Peter Wiels of the sector association Assuralia.

“The diagnosis is traditionally based on a purely medical-scientific model: if you can’t see it, it doesn’t exist,” explains lawyer and academic assistant Alexander Maes.

“But invisible disorders can also be diagnosed using certain methods. Psychodiagnostic research is at least partly based on the subjective experience of the patient, but through scientific interpretation, the result can still be called legally objective.”

Equal treatment abroad

Professional associations of psychiatrists argue for a ban on unequal treatment of mental and physical illnesses by insurers, which already exists in countries like the Netherlands and the United States.

Maes agrees. “The legislator could provide clarity, but this judgment actually proves that such a distinction can already be discriminatory today.”


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