Long term disability (LTD) plans provide benefits in the event of a wide range of illnesses, injuries, and conditions, including mental health conditions. However, unless you clearly and compellingly demonstrate to the insurance company representative reviewing your claim that your condition prevents you from working, you may be denied disability for mental illness.
Insurance companies are likely to deny mental health-based LTD claims because it can be difficult to determine whether a mental health condition is the direct cause of your inability to work. However, mental health conditions are undoubtedly a leading cause of long term disability. So why the discrepancy?
An experienced disability lawyer assists clients whose mental health disability claims applications are denied. We understand that mental health conditions are often invisible to health clinicians, LTD claims reviewers, and even loved ones. These “Invisible illnesses” aren’t immediately visible to others in the same way physical health conditions can sometimes be.
Invisible illnesses are not always mental health conditions, but mental health disorders are almost always invisible. Especially to those who aren’t trained to detect them or otherwise choose not to see them, including LTD claims reviewers.
Reasons for Long Term Disability Claim Denial
Supporting people with invisible illnesses like mental health conditions is important and this includes bolstering safety nets like the LTD system. If denied disability for a serious mental illness, it is important to keep hope and hold the insurance company accountable. After all, employees pay into LTD plans to use them when they need them.
Thankfully, for the vast majority of those who are making legitimate disability claims, the appeals process offers an opportunity to strengthen your claim. With the help of an experienced disability lawyer, you can incorporate additional evidence, include a revised statement from your doctor and counter the insurance company’s reasons for denial discussed below.
1. You do not have the proper documentation.
In addition to seeing a doctor and getting your medical records, there are a number of steps to completing a long term disability application. These pertain to everyone seeking disability benefits, including those with mental health claims. Records should include an official doctor’s report with a current medical evaluation as well as any pertinent medical tests.
Claims are denied when either portion of the application is incomplete or the medical documentation does not accurately reflect your symptoms and their impact on your job. Sometimes these can be fixed by having a conversation with your doctor. Your lawyer can also add meaningful details to your application that emphasizes the severity of your condition.
2. Your long term disability claim application contains errors.
A lawyer can assist you in compiling, organizing, and carefully reviewing your LTD application to avoid errors. There are a number of steps and documents that must be completed including an application, medical records, and physician statement. Expert disability lawyers help navigate the disability insurance claims process so that you can spend more time with your family and focus on your recovery.
3. You aren’t seeing the proper medical or mental health specialist.
Insurance companies will sometimes allege that a claimant is not doing enough to get well and back to work.
Specific reasons for this type of denial include not seeing the right doctor or following through with the proper medical care. You are expected to pursue recommended psychological treatment and potentially take doctor prescribed medication meant to support your mental health.
Seeing your established family doctor is a great way to get started on the road to an improved quality of life. But many insurance companies use a family doctor or general practitioner’s inexperience in treating mental health conditions as a reason to deny your LTD claim. Treatment providers, such as a psychologist or psychiatrist, can develop an appropriate treatment plan, and when applicable, provide medication prescribed by a mental health physician. Treatment plans can also include attending recommended psychological treatment sessions like cognitive-behavioral therapy.
4. Your mental illness or condition does not satisfy the insurance company’s definition of “total disability.”
This is where the concept of invisible illness really comes in. It’s possible that the insurance company will acknowledge your mental health condition, but decide that it isn’t serious enough to warrant disability benefits.
While no formal legal definition for “full” or “total” disability exists, it is a term insurance companies use to indicate that they do not feel that your mental health disorder is serious enough to prevent you from working. Your LTD application may benefit from statements and evidence that a disability lawyer can use to meet the insurance company’s standard of total disability.
5.The insurance company has evidence that contradicts your mental health claim.
Believe it or not, insurance companies will sometimes monitor applicants’ daily lives to prove that their claims are inaccurate or overstated. An expert disability lawyer can provide advice on these types of tactics and provide assistance in the event the insurance company makes false claims in order to deny disability benefits.
6. You haven’t made a compelling long term disability benefits case.
In the course of completing long term disability claims, applicants have an opportunity to make statements regarding their mental health and how it affects their ability to work. A lawyer can help translate the medical evidence in your disability claim provided by a doctor into a convincing argument for why your mental health condition warrants full disability benefits.