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Tips for long-term disability claims for mental health conditions

On Behalf of | Oct 28, 2022 | ERISA, Long Term Disability Claim Denial

As chronic mental health disorders gain more legitimacy, people who suffer from especially crippling conditions are applying for long-term disability in greater numbers. The insurance industry often lags behind medical opinion but filing a successful long-term mental health disability claim is possible. Here are a few things to keep in mind.

Scope of mental illnesses

According to the World Health Organization, depression is one of the most common disabilities in the world. But mental health disabilities that limit one’s ability to work cover a wide range, including anxiety, PTSD and bipolar disorder.

These disorders can impact work in several ways, such as poor concentration, panic attacks, fatigue due to insufficient sleep, erratic mood swings, crying, diminished executive function, self-harm and suicidal thoughts. No one should be expected to work under those conditions.

Limitations and exceptions to mental health disability benefits

Most group long-term disability insurance policies set time limits to mental health claims. These can vary but are generally between one to two years.

Before applying for long-term disability, read the terms of your plan carefully. There will likely be terms and conditions that could affect the success of your claim. You’ll want to be careful to work around these, assuming they aren’t the foundation for your claim.

An exception that can extend mental health disability benefits beyond two years is when a physical injury leads to a mental health disability. For example, if someone is injured in a remarkably bad car crash and later suffers PTSD as a result, the mental disability stems from a physical injury and is therefore not limited by the mental illness payout limitation.

Prepare to fight

For-profit insurance companies regard long-term mental health claims as burdens to their profit margins. Even if exceptions in your plan don’t disqualify you, you may still be in for a fight to get your claim approved. This is just standard operating procedure for insurance companies, so it’s best to assume you may have to go through a denial appeal battle so it doesn’t come as a shock if it happens. Consider it an unwritten part of the process.

Retain copies of all documentation from doctor and psychiatric assessments and treatments to present as evidence, if necessary.

Social Security benefits

In addition to the long-term disability benefits through your insurance, you can simultaneously apply for and receive mental health Social Security Disability Income (SSDI) benefits. As of January 2022, the average SSDI payment was $1,223.

Consult an attorney for guidance if you need help filling out a long-term mental health disability claim or appealing a denial of coverage.