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Disabled by Depression: Tips for Filing an Individual or Group Long-Term Disability Claim

Long-Term Disability Insurance Attorneys Nationwide

A common thread among individual and group disability insurance policies, particularly for private insurers, is the explicit or implicit requirement of physicality for disability claim approvals.

Sometimes, this requirement is made explicit by the policy’s language, which may categorically exclude mental disorders and conditions. Other times, this need to list a physical illness or injury to have a successful disability claim is subtler. In these cases, the language of the policy may not categorically exclude any condition, but the burden of proof lends itself exclusively to physical ailments and documentation—or it gives primacy to physicality. This is observed by the sort of proof requested, or the sort of questions asked of you (the claimant), your employer, or your treating doctor, etc.

Unfortunately, sometimes, disabilities stem from the mind and not the body. Often, individuals’ mental health plummets, leading to an inability to even get out of the bed for days at a time—let alone to work. And sometimes disability insurance companies may feel like this doesn’t count as a disability, or that it is not serious enough to qualify for the level of disability benefits you seek. What can you do?

Understanding Depression and Mental/Nervous Disability Claims

Mental health conditions like depression, personality disorders, or schizophrenia can severely limit your ability to work and cause you to file for individual and long-term disability insurance benefits. Nonetheless, successfully documenting your mental/nervous disability claim is best done with information and a clear understanding of what most disability insurance companies look to for when they approve these types of claims.

According to the World Health Organization, depression is a leading cause of disability worldwide as it affects nearly 300 million persons—and many forms of depression can render a person disabled. According to WebMD, the following forms are the most common among U.S. Americans: Major depression, persistent depressive disorder, bipolar disorder, seasonal affective disorder (SAD), psychotic depression, peripartum (postpartum) depression, premenstrual dysphoric disorder (PMDD), “situational” depression, and atypical depression.

Though the various types of depression contain myriad triggers, the common symptomatic baseline among all forms is the experience of several or all the following occurrences:

  • Persistent sad, anxious, or “empty” moods
  • Feelings of hopelessness or pessimism
  • Fatigue
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Insomnia, early-morning wakefulness, or sleeping too much
  • Appetite or weight changes
  • Thoughts of death or suicide, suicide attempts
  • Aches, pains, headaches, or cramps and digestive problems without a clear physical cause and that do not ease even with treatment

As is obvious from the above list, depression is often very debilitating. Those with chronic depressive conditions can feel emotionally and often physically, devastated—making it difficult to maintain any sense of normal daily routines, including work schedules.

Despite its prevalence and crippling effects, filing a successful individual or long-term disability mental/nervous claim can prove challenging. Though companies will admit no bias against depressive conditions, and perhaps none consciously exists, burdens of proof for disability claims tend to lend themselves toward clear physical conditions. Though depression can present physical symptoms, the condition is largely an internal illness. As such, it is hard to show and prove an ailment that is, in theory, “invisible.”

“Show me an X-ray of your broken mind” is an unfair requirement, but in reality it is what the disability insurer wants in order to pay mental/nervous benefits.

Tips to Help Overcome Common Disability Claim Hurdles and Strengthen Your Chances of Receiving Disability Benefits.

Know how your policy defines disability. Depression is not a catch-all for feelings of sadness. It has many shades and sides. Though always challenging, depression may present especially disabling effects for some.

To qualify for mental/nervous disability benefits, you must prove your depression meets the criteria for disability as defined in your policy. Though every policy is different, the parameters of insurer’s disability definitions tend to include some sort of illness or injury—either physical or mental—that prevents you from performing your regular and substantial duties of your occupation.

To successfully receive mental/nervous benefits you generally must show that the symptoms of your depression are so severe that they prevent you from performing the material and substantial duties of your occupation (or even any occupation, depending on your policy). Any physical symptoms that your depression may present will likely help your case, as physical limitations are readily understood as debilitating.

As you can imagine, proving and documenting fatigue, aches, and digestive problems is easier than documenting irritability, sadness, dark feelings, and anxiety—which might be just as debilitating but harder to track. As a result, use strategy in filing your disability claim. If you have physical symptoms, always include them. They are tangible, viewable, and can only help your disability claim unless your policy has “contributed to” language in the mental/nervous provision.

Example: The insured suffers a back injury that surgery won’t fix and is now sad about their inability to get around. most disability policies cap mental/nervous benefits at 12, 18, or 24 months. Here, while the insured has a documented back disability, insurance companies will look for “contributing mental sadness to stop the benefits at 12, 18, or 24 months. If your policy has a “due to or caused by” definition of mental/nervous limitations, the carrier has to prove the disability is solely due to a mental/nervous condition, not a combination, so be very careful.

Note common reasons for denials. Bear in mind that disability insurance claims processors are not doctors. They are inclined to look for provable elements of your disability, and the proof for which they’re looking is weighted on the side of physical, symptomatic presentations. The following are common reasons for the wrongful denial of depression-related long-term disability claims:

Not seeking timely psychological and psychiatric appropriate medical care. Depression is treatable, but there is no quick fix. A positive treatment outcome requires the patient’s active participation in the treatment that a treating doctor or therapist prescribes. Of course, depression hurts one’s ability to act in “normal” ways, even when those activities are treatment—and some of us don’t subscribe to sitting on a couch and telling a perfect stranger our life’s most unpleasant circumstances, but these policies require care.

It is daunting for people with severe depression to seek timely and proper medical treatment and to take steps to care for themselves in ways that people without depression can do without thought. Such an inability to engage life in normal ways is a serious condition of depression.

To file approvable mental/nervous claims that are ultimately paid, it is imperative to seek regular and appropriate medical treatment for your depression. Disability insurance companies see your active attempts to seek proper medical care and treatment as evidence of your good faith efforts to get better; the absence of actively sought medical care, prescription psychotropic medication, and participation in your recovery often leads to a depression-related claim denial.

To boost your success with receiving depression-related disability benefits:

  • Keep your scheduled doctor appointments and see a therapist along with a psychiatrist
  • Follow the recommended course of treatment, including medication
  • Consistently take any medication prescribed to you and report to your doctor all side effects
  • Ensure your treating doctor actively monitors your prescription medication and documents your side effects

Surveillance evidence seems to contradict your condition. When you file an individual or group long-term disability claim, your insurer will likely hire an investigator to monitor you in your normal, daily life without you knowing. This allows insurers to determine whether you engage in activities that contradict the restrictions and limitations you’ve claimed—which can lead to a denial of benefits. Investigators may also troll your social media for posts that show activities inconsistent with the disability you’ve claimed.

Of course, we understand that people with all sorts of disabling conditions have good and bad days; but we always present our best on social media and in public. This can make you look more able-bodied than you are. Be cautious of what you do and post, especially on the rare good days. If you aren’t, you may help the disability insurance company create a false narrative about your state of disability—which can lead to benefit terminations. Be mindful of how claims investigators may interpret your online activity and do not partake in activities that your condition should limit or make difficult.

Ensure your medical records truly reflect your condition. There is no objective medical test to diagnose depression; instead, your treating doctor will likely look at the overall pattern and severity of your symptoms when making a diagnosis. Disability insurers often challenge depression claims because of the lack of a standard objective diagnosis, so document your condition as thoroughly as possible:

  • Work with your treating doctor to ensure your medical records are as complete and accurate as possible
  • Thoroughly document the form and frequency of your treatments, medications, and side effects

Keep a pain/symptom journal. While disability insurance companies try to ignore symptoms that objective testing cannot prove or that don’t present overtly physical manifestations, the combination of your treating doctor’s records and your personal notes detailing the same symptoms can help your doctor support your disability claim.

Write down how you feel each day and note things like your lack of interest in normal activities, insomnia, lack of or overactive appetite, decreased energy, and weight gain. It is also helpful to log the frequency of your treatments and the intensity of your symptoms.

Note any physical impairments related to your depression. According to the World Health Organization, depression can arise from a complex interaction of social, psychological, and biological factors: “There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.” If your depression is caused by an underlying physical health condition, or if you have any other impairment that limits your ability to work, make note of it when you file your individual or group long-term disability claim.

If you can prove that the physical symptoms alone render you disabled through objective medical evidence, your chances of receiving group long-term disability benefits may increase significantly. This is because these symptoms put a “physical” aspect to an otherwise not-so-physical disability.

Note the mental/nervous condition limitation. The mental/nervous condition limitation is a common provision in individual and long-term disability policies that only allows you to collect disability benefits for a specific amount of time.

If your disability contributed to or is caused by a mental/nervous condition classified in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, your policy may shorten your payment of disability benefits.

Some insurers do not limit disability claims caused by mental and nervous conditions, so look for this provision or limitation in your policy. The most common mental/nervous benefit period limitation is 12 to 24 months. If your depression is interrelated with other physical conditions with which you suffer, your documentation of these physical symptoms in your depression-related disability claim can help or hurt depending on your policy’s language.

Do You Have Disability Claim Questions?

If you have filed or are preparing to file an individual or group sponsored long-term disability claim, or believe your benefits were wrongfully denied, contact DarrasLaw’s top-rated, individual and long-term disability insurance attorneys for a free claim consultation.

Your disability insurance should protect you in the event that an illness or injury disables you, but sometimes insurance companies fail when you need them most. We can help!

At DarrasLaw, our experienced disability insurance lawyers, led by America’s top disability insurance lawyer, Frank N. Darras, have the experience and resources to assist and fight for the disability benefits you deserve—and win. We can offer immediate help with disability claims. We understand that a disability can suddenly and unpredictably hurt your income; we are here and able to assist. We evaluate cases throughout the United States.

If you haven’t experienced a wrongful disability claim denial yet but have questions about your policy and its limitations, contact DarrasLaw.

If you have individual or long-term disability insurance questions, the legal team at DarrasLaw is here to help. Call us today at (800) 458-4577 or email us to schedule your free disability claim consultation or free policy analysis.

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