Most often, when people hear the word disability, they think of a physical ailment that hinders a person from moving around. However, mental health is critical to our well-being. When something is affecting our mental health, it can affect the rest of our body and prevent us from engaging in our usual activities and tasks.
If your psychiatric condition prevents you from working, you can apply for disability benefits if you have coverage. If your disability insurance is through your employer, you will need to comply with the claims process in your policy and under ERISA.
Psychiatric disorders are challenging to get benefits for, and you always want to work with a disability claims lawyer to ensure you get an appropriate decision for your condition.
What is Depression?
There are different stages of depression that affect people to varying degrees. Major depression is when you have one or more depressive episodes without manic or hypomanic episodes. These episodes can hinder people from working and doing other activities. If you cannot work due to your spells, you can obtain disability benefits.
Symptoms of Depression
Symptoms of depression will range but most often include:
- Inability to focus or concentrate
- Loss of appetite or change in body weight
- Feelings of sadness and worthlessness
- Slow speech and movement
- Loss of interest or enjoyment in activities
- Insomnia or excessive sleeping
- Suicidal thoughts
These symptoms can affect every aspect of your life to varying degrees, and if you suffer a multitude of symptoms, it becomes more challenging.
What Is Anxiety?
Anxiety is a constant state of worry or fear, and clinical anxiety goes beyond temporary nervousness. Anxiety becomes a disability when it interferes with your ability to participate in daily activities. You will also experience feelings of dread. You can have anxiety and depression at the same time, which makes life impossible. Having both conditions can worsen your life.
Anxiety can cause you to become physically ill from stress requiring you to call off work. You can also experience panic attacks that require hospitalization.
Types of Anxiety
Anxiety is disabling when a regular event causes extreme terror or feelings of alarm. Five major anxiety disorders exist, and they can affect your life differently.
Types of anxiety include:
- Generalized anxiety disorder: A constant state of tension and worry with no particular event to blame. You must be in this state for at least six months for a diagnosis.
- Obsessive-compulsive disorder: Ritualistic and repetitive behavior to reduce anxiety
- Panic disorder: Attacks of terror or anxiety lasting over ten minutes with no cause
- Phobias: Involuntary and overwhelming fears of familiar places, things, or situations
- Post-traumatic stress disorder: Stress lasting over a month after witnessing or being in a traumatic event
You can experience physical symptoms of anxiety such as:
- Muscle tension
- Increased heart rate
A medical professional will do various tests to see if you have an anxiety disorder, how severe it is, and if it is disabling.
The Elimination Period
For all disability claims, you will have a waiting period, also known as an elimination period, where you do not receive any benefits. The waiting period for a long-term disability claim is three to six months, depending on your policy. During this time, you cannot work, and you cannot apply for benefits; you are just waiting around. The waiting period is a burden for many and can cause mental conditions to worsen.
Short-term disability can help during this elimination period. However, there is also generally a seven-day elimination period for short-term disability. You might use up your sick days, which can cover 100 percent of your wages if you have paid sick leave available. After the elimination period, you might get an approval for short-term benefits that cover between 60 and 100 percent of your wages for a limited time. If your disability persists, you will need to file a long-term disability claim.
Long-term disability benefits might continue for two years, when your insurance company might re-review your file. Depending on your policy details, the eligibility criteria for continuing benefits might change after two years.
One common change includes:
- For the first two years, you might receive benefits if you cannot work in your own occupation.
- After two years, you might only qualify if you cannot work in any occupation.
You might face another struggle with the insurance company and need to prove you still deserve to receive benefits. You should never hesitate to seek help from an LTD attorney if you learn your ongoing benefits are in jeopardy due to your policy terms.
Challenges of Mental Health Disability Claims
Many challenges can arise during a mental health disability claim. Depression claims have two primary challenges. One challenge is that a mental condition and its disabling effects are subjective and difficult to determine without an obvious scientific test. In many cases, they will rely on the testimony of the disabled person making it difficult to gather credible evidence in contrast to physical conditions with apparent signs and diagnostic testing to back them up.
Another challenge is adequately articulating why the condition is disabling. A depression diagnosis alone is insufficient for a successful claim. You must have evidence that depression or anxiety is disabling.
The insurance company will often argue that many people live with these conditions and can still work. Other people can improve through treatment and job modifications, so why are you different? Your evidence must show that modifications, medications, and more are not enough to make you better and capable of working and earning a living.
Lawyers who regularly handle long-term disability insurance claims know what the insurers look for when deciding to deny or approve benefits. You do not need to remain in the dark regarding proper claim evidence—allow your attorney to prepare the strongest possible claim file.
Tips for a Successful Claim
Preparing for a fight like this is challenging when you are feeling anxious or depressed. Applying for benefits can be triggering for people living with mental disorders, and the best tip for a successful claim is to consult with a disability claims attorney. If you face a denial, you can file an appeal and provide further evidence, but you need legal help during this process.
An excellent way to record your symptoms is to have a daily journal that you can present for your claim. Another tip is to gather evidence of your condition, including treatment received, reports from psychiatrists or psychologists, and why it hinders your employment. You must also follow your treatment plans, such as counseling and medications.
The most important tip is to speak with an attorney who can fight for your LTD benefits while you focus on your medical treatment.
Reasons for Denials of Depression and Anxiety LTD Claims
Applying for disability is challenging for a mental disorder, and you can face denial for many reasons.
Some reasons are out of your control, and others you can fight with evidence and legal guidance.
- Insufficient medical records: Ensure you present accurate and detailed medical records when you seek benefits. While incomplete records are a common denial reason, it is also preventable. You need to prove you have an ongoing and incapacitating mental illness and that you have sought regular, repeated, and long-term care. Keep your doctor’s records and notes.
- Lack of care by appropriate medical experts: Doctors specialize in different fields, and your primary care physician is insufficient for you to get adequate care for your condition. A red flag for representatives reviewing your case is your lack of care from an appropriate physician. The best medical professional you can get treatment from is a psychiatrist because they are specialists in mental illness. You should, at minimum, have a referral for a mental health expert in your file.
- An increase in mental illness claims: You can’t do anything to circumvent this denial reason. In the past few years, mental illness claims have increased and have become the leading cause of workplace disability claims. Therefore, insurers and state agencies are trying to combat fake claims by denying long-term disability claims for depression and anxiety. One example is they will say your disability is from a toxic work environment, which the policy may not cover.
- Poor standard of care or documentation: When you are consistent with your care and still receive a denial, it can be because the insurance company does not believe you are getting the best care. If they find your care substandard, they can deny your claim or stop payments on a current claim. Suppose your doctor prescribes medicine but does not document how the drugs affect your condition; that is sufficient for a denial.
- Failure to attend recommended treatment sessions: When you have a referral for a mental health expert, psychologist, or psychiatrist, you must follow through with your appointments and care. If you do not, the insurance company will deny your claim. The insurance company does not accept any reason for you to miss appointments or skip treatments. Go to every session for your health and your financial assistance.
- The policy doesn’t cover anxiety or depression: Review your policy with a long-term disability insurance lawyer, because the insurance company may incorrectly make this claim. Even if your policy excludes anxiety and depression, it might not exclude all of the physical symptoms that can accompany them, which could include disabling chest pain and digestive problems that qualify you for benefits.
- You’ve healed. The insurer may have initially approved your claim, but later determined that you had sufficient time to recover and get back to work. They may cancel your benefits without even examining you or presenting evidence that your condition no longer prevents you from working. Here, a long-term disability lawyer can take swift action to gather the evidence of your continued inability to work and earn a living, then create a convincing case that the insurance company owes you benefits.
No matter the denial reason, take swift action. Do not feel discouraged, as many claims for depression and anxiety disabilities receive an initial denial. Instead, secure legal assistance to begin your administrative appeal right away. You cannot miss the strict deadlines in a group long-term disability claim or you will lose out on years of benefits worth thousands of dollars.
Speak to a Disability Claims Lawyer Today
Mental disorders require different evidence for disability claims, and many people struggle to receive benefits due to preventable errors during the claim process. Discuss your options with a long-term disability lawyer if your condition prevents you from continuing at your job. A lawyer can ensure that they handle every step of the process properly, which takes significant stress off you.
If you cannot work because of your mental state and need treatment and time away from work, you might not know where to turn. Seek help from a trusted disability attorney who handles LTD claims for depression and anxiety.
Your condition is valid and no less disabling than a physical, visible condition. Mental health is health, and you might need to file for short-term or long-term disability, depending on your condition. If you’re suffering from debilitating anxiety or depression, you must speak with a disability claims lawyer today.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded J. Price McNamara ERISA Insurance Claim Attorney, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts