Depression is one of the leading causes of disability in the United States. More than 16 million
adults in the U.S. have suffered from at least one major depressive episode in the last year. Clinical depression is a mood disorder characterized by persistent feelings of sadness, hopelessness, and isolation so severe that it interferes with one's daily life. Depression can also have accompanying physical symptoms such as fatigue, loss of appetite, and chronic pain. Depending on the severity, depression can be debilitating both mentally and physically, making it impossible to maintain a regular routine, such as going to work everyday.
Depression as a Disability
Although depression affects such a large segment of the American population, long-term disability (LTD) insurers are often reluctant to approve any claims based on mental illnesses. This is due to the fact that many mental illnesses can be exceedingly difficult to prove i.e. there is no objective test for depression. Instead, depression and anxiety are diagnosed clinically by psychologists, psychiatrists, and therapists based on an interview. These mental health professionals rely heavily on what their patients tell them in a clinical setting. Because of this, individuals suffering from depression often look and act normally to others. However, their ability to perform in a work environment with any reasonable consistency is severely limited.
Someone suffering from depression may experience some of the following symptoms:
- Trouble concentrating, remembering details, and making decisions
- Feelings of guilty, worklessness, and helplessness
- Insomnia, early-morning wakefulness, or excessive sleeping
- Loss of interest in things once pleasurable
- Overeating or loss of appetite
- Digestive problems
- Persistent sad, anxious, or empty feelings
- Suicidal thoughts or attempts
While these symptoms can make even the simplest of tasks overwhelming, they can make maintaining the routine and social interactions required to hold a job impossible.
LTD Limits on Mental Health Conditions
Because of the growing prevalence and awareness of mental health issues, LTD insurers have included language in their policies specifying how these types of claims will be addressed. Today’s disability policies almost universally contain lifetime limitations, capping payments on disability claims based on mental health conditions to 24 months. This limitation is commonly referred to as a Mental Illness Limitation. A Mental Illness Limitation provision appears in almost all employer-provided group plans (ERISA-governed LTD plans
) as well as many individual LTD policies. However, unlike most group plans, an individual policyholder may purchase a policy rider that will remove this limitation in exchange for a higher monthly premium. It is important to read and understand your policy and its limitations.
The primary reason insurance companies will provide for a two-year limitation is because mental health conditions are considered more treatable than physical impairments. Many physical conditions, whether cardiac, spinal or neurological, are often permanent conditions, and therefore require indefinite LTD benefits. Conversely, mental health conditions such as depression or anxiety can hopefully be managed with medication and counseling. From the perspective of the insurance company, these types of conditions are temporary and thus only require temporary benefits. However, mental illness is often a lifetime battle and so, it is critical to know what your policy says and how it may (or may not) protect you.
Documentation is Key to a Successful Claim
Mental health conditions are unique in that many sufferers do not always seek medical care, only see a doctor sporadically when symptoms get worse, or discontinue treatment or medication when they feel better. However, it is important to keep in mind that LTD insurers rely heavily on medical records and your treating doctor’s opinion to determine whether you are eligible to receive disability benefits. Therefore, it is imperative that you receive regular treatment from a mental health professional, preferably a psychologist or psychiatrist, if you are to have any chance of prevailing on a disability claim based on depression. Remember, if your mental health symptoms are severe enough to keep you from working, the LTD carrier will expect you to be pursuing treatment consistent with a disabling impairment.
Always verify that your LTD insurer has received any and all medical documents that address your mental health condition. These documents will include records from any general practitioner, internist, psychologist/psychiatrist, psychiatric facility, and/or hospital where you have received treatment.
WARNING: Do not rely solely on your LTD insurance company to request and collect all the information needed to make an informed decision on your claim. It is your duty to provide proof of your disability. The insurance carrier’s requests can be inadequate, abbreviated, or even strategically designed to collect information unfavorable to your case. To ensure that the insurance company receives a thorough understanding of your condition and its subsequent limitations, talk to your doctor about making specific findings regarding your ability or inability to:
- Be on time
- Sustain a regular work schedule
- Understand and remember simple or complex instructions
- Focus-on and complete tasks
- Maintain concentration
- Handle work-related stress
- Respond appropriately to social interactions with co-workers, supervisors, and the public
While insurance companies rely heavily on medical records to make disability determinations, you may also supplement your claim with information from other parties. Collect and submit statements from your family, friends, co-workers, supervisors, or anyone else that has witnessed how your depression has created difficulties for you at work or in everyday life. Any information that you can provide to bolster your claim will only help.
Long-Term Disability vs. Social Security Disability
Although mental health claims can apply to both LTD insurance and Social Security disability (SSDI)
benefits, there are important distinctions between the two. As previously mentioned, it is common for a LTD insurer to limit the maximum duration of a long term disability claim to 24 months if the disability is based on a mental health condition. Even if the claimant also has a physical impairment, the insurer may still apply a limitation for the duration of benefits due to a mental health condition. Although many policies exempt certain mental health conditions from this limitation (ex: Alzheimer’s, dementia, organic brain disease, bipolar disorder), the two-year limitation almost always applies to claims based on depression.
In contrast, SSDI claims are not limited in duration due to mental health conditions. Once approved your SSDI benefits won’t be terminated after two-years but they may be subject to Continuing Disability Reviews. The Social Security Administration also considers the combination of physical and mental health conditions when considering if someone is disabled. If someone with a mental health problem does not have any physical impairments, it may be challenging to prove disability unless they meet or equal the listings defined by the Social Security Administration
. Otherwise, you will have to prove that you are unable to perform even very simple, routine work, on a regular basis.
Even if a disability claim based on mental illness is supported by significant medical documentation, a treating psychiatrist’s detailed opinion, and a statement from everyone you know, a LTD insurer is still likely to deny an initial disability claim and force you argue your case on appeal. In these difficult cases, it is critical to hire an experienced disability attorney who can guide you through the appeals process and, if necessary, file a lawsuit against your insurer. Contact the expert disability attorneys at Bross & Frankel
for your complimentary consultation today.