For you, depression and anxiety are as disabling as any other type of physical injury. Your mental health is as critical as your physical health to your ability to get out and work each day. Depression and anxiety can be crippling injuries and keep you from functioning at your job and earning a living.
Depression and anxiety can be the basis of a long-term disability claim. Long-term disability policies should cover mental disabilities just as much as they address physical disabilities. However, getting disability benefits from your insurer for depression and anxiety can be an uphill battle.
Never hesitate to seek the assistance of a long-term disability benefits lawyer if you need to seek coverage of a mental disability.
Long-Term Disability Claims Are Difficult by Nature
Any long-term disability claim will be complex, given insurance companies’ power over the process. Claims based on your mental health may be even more difficult, but they are still winnable. You can increase your chances of getting the benefits you need and deserve when you hire an experienced long-term disability lawyer. You can expect that you will need to take on the insurance company directly.
Your Policy May Contain Limitations
Your policy may have specific limitations relating to mental health conditions. Insurance companies like to use carve-outs to try to make it more difficult for you to obtain benefits under your policy. They may try to exclude conditions like bipolar disorder or very tightly define what constitutes a mental health disability.
The insurance company may include a limitation on mental health claims, only paying benefits for a set period (such as two years). You may need a layer to closely review your policy to determine whether your claim qualifies for benefits.
You Have the Burden of Proof When Filing a Disability Claim
You will have the burden of proof to show that your disability keeps you from engaging in occupation or employment. Your description alone will not be enough to persuade the insurance company to pay your benefits.
You will need some evidence that will be more objective. Usually, you will need detailed treatment notes from a mental health professional and your personal statement to receive benefits.
You will need to have had persistent symptoms and have received consistent treatment. Moreover, you will also need to stay with the treatment, meaning that you regularly see your doctor and take the medications they prescribed you. Substantiation and documentation are keys to your claim for the insurance company and when you may need to appeal.
The Insurance Company will Dispute and Minimize Your Condition
The issue as far as your long-term disability claim is concerned is that depression and anxiety are more subjective claims. These claims depend on your description of what you are going through daily. There is no objective physical test like an MRI or CT scan to show the extent of your injuries.
The insurance company will be difficult enough when you have a physical injury that they can see on paper in front of them. They will be even tougher when there is a more “subjective” injury. You can expect to have your condition questioned and minimized during the claims process because the insurance company does not want to pay your benefits.
Sometimes, your symptoms may be caused by a neuropsychological issue, as opposed to depression or anxiety. These symptoms will show up on an objective exam. In addition, if your symptoms are neuropsychological, you may not be subject to mental health limitations in your policy.
The Insurance Company Always Cares About Saving Money
The insurance company is living in its world, and the center of its world is its quarterly profits. They do not make money by paying your claims and will do everything they can to deny them.
They know that ERISA is an insurance company-friendly law, and they will try to take full advantage of it. The insurance company knows that granting benefits means hundreds of thousands of dollars out of their pocket or more, and they want to avoid that whenever possible.
Thus, an insurance company will never trust you or not try to question your reality. They know that they can get away with it. To you, your mental health condition overtakes your life and affects your daily existence. You will be shocked and appalled when the insurance company dismisses you with the conclusions of their own “independent” experts or minimizes your day-to-day existence. However, you must deal with it as part of the claims process. Be ready to fight to show that you are disabled.
You can expect the insurance company to try to deny that your condition exists or to downplay the severity of it. The insurance company’s favorite argument is always a “yes, but.” They may acknowledge that you are dealing with anxiety or depression but still argue that you can work. While it is easy for them to say, you will need to go through them first and then fight them to get the benefits you believe you deserve.
How to Position Yourself for Success in a Long-Term Disability Claim
Here is what you should do to give your claim the best possible chances of success:
- Get treatment for your condition early, so you can have extensive documentation when you file a claim.
- Consistently go to your appointments and take all prescribed medications as instructed (you can be sure the insurance company will review your file to see that you have done everything possible to treat your condition).
- Keep a journal of what you have been going through and feeling every day.
- Hire an attorney to help you prepare your claim, knowing that mental health disability claims usually mean a difficult fight.
- Consider getting a second opinion in addition to your primary treatment provider in case the insurance company tries to make its case by attacking the credibility of your doctor.
- Be ready to challenge the insurance company’s characterization of your mental health.
You Can Appeal When Your Disability Claim Receives a Denial
You always have the right to appeal when the insurance company denies your claim for benefits. ERISA lays out a specific appeals process you must follow under these circumstances.
Although legislators ostensibly passed the law to protect employee-benefit claimants, the appeals process is not necessarily favorable for you. However, getting the benefits you deserve with a fight is possible. First, you need an attorney prepared to go the distance on your behalf because that is what you may need to do to get benefits.
The Insurance Company Gets the First Chance to Review Your Appeal
Unfortunately, you will need to go back through the insurance company first as part of the appeals process. They are the ones who get to hear the appeal, even though they initially denied your claim.
Insurance companies often state they will have an appeals division review your case that has nothing to do with the initial denial. Even if that is true, you cannot expect them to give you fair consideration. Many administrative appeals simply uphold the initial denial, only prolonging the process.
You want a trusted disability lawyer handling your appeal. If you receive a denial, immediately seek assistance from a disability attorney.
You Can Take Your Case to Federal Court Next
Your audience is not necessarily the insurance company, even though you must take this part of the case seriously. You must go to the insurance company first, even if you think it may be a waste of time. ERISA does not allow you to go to court or add any information to your file that was not part of your insurance company’s appeal.
Assuming the insurance company has denied your appeal, your next step is to go to the federal district court. Here, you will get a more objective review from a federal judge. Depending on the language of your policy, the judge will either review the file from scratch with no deference to the insurance company or they will look for any error that the insurance company made.
Either way, the insurance company cannot get away with arbitrarily denying your claim in the face of clear evidence to the contrary.
The record that you build for the insurance company appeal is the one that the federal judge will consider. If you miss something during the administrative appeals process, you cannot go back later on and supplement the record. Thus, you must hire an attorney before you appeal to the insurance company. You will not have the opportunity to fix any errors or fill in any gaps in evidence in the future for the court to consider.
Never underestimate how complex the disability claim appeals process can be. Always have a legal professional handling every step of your appeal – from administrative appeals to federal court.
The Insurance Company Can Take Your Benefits Away After Granting Them
The insurance company may also try to take your benefits away at some point. Many long-term disability policies will change the definition of disabled at a certain point in time (if there are extended benefits or no limitations on your benefits). Your policy will then require you to show that you cannot do any work as opposed to the work you did at the time of your disability.
This requirement considerably raises the bar for qualifying for long-term disability benefits. Once a policy switches from “own occupation” to “any occupation” coverage, the insurance company expects you to get re-trained or take whatever work is available so they do not have to pay you. You might have to fight for continued benefits at this point, and an attorney can help.
Hire an Attorney for a Long-Term Disability Claim
Already, you are going through a challenging period. Depression and anxiety are severe conditions that can take over your life. If your condition is serious enough to claim long-term disability benefits, you cannot and should not try to handle the claims process alone. It is difficult enough to deal with the insurance company when you have a physical ailment. It will be even more challenging when you are experiencing mental health difficulties.
An attorney can help you prepare your claim to put you in the best position to get disability benefits. In addition, you will need an attorney to help you file an appeal. While nothing says you must hire a lawyer, you will likely not be in a position to take on the insurance company alone.
If you filed a claim without an attorney, and the insurance company denied it, you will have a compressed timeframe to file an appeal. Then, you must take all phases of the appeals process seriously.
If money is a concern, know you will only need to pay an attorney if and when you succeed in obtaining benefits. You will not have to pay a long-term disability attorney out of your pocket. Thus, there is no risk to you in getting the legal help that you need when your long-term disability benefits are on the line.
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