Mental Illness and Long-Term Disability: Understanding Coverage for Depression and Anxiety

Most long-term disability policies cover conditions that prevent a person from working for an extended period but will eventually be resolved. The person will eventually return to work. A mental illness disability can also interfere with a person’s life, leading to functional impairments that can prevent them from working. The World Health Organization reports that depression is a leading cause of disability worldwide.

mental health and long term disability

Depression, anxiety, and other mental illnesses must be diagnosed and documented just like any other physical condition. In many cases, these illnesses also exhibit physical symptoms like fatigue, headaches, and other aches and pains that do not resolve. But since there isn’t a physical diagnostic like an X-ray or a blood test that shows mental illness, you’ll need to show proof that it’s as equally disabling as a physical injury.

What The Policy Says

If you’re planning to file for long-term disability for depression, the first thing you need to do is read your policy. You need to know if it allows for mental illness, and for how long.

Typically, LTD coverage for mental illness is 12 to 24 months. If that’s the case, you will only have one to two years of coverage, maximum. Benefits will end once the period ends, and the severity of your illness will no longer matter.

Some policies consider mental illness an “exclusion.” That is, the policy does not offer LTD benefits for any type of mental illness. You’ll need to know this before you begin your application.

Proving Disability

To have a successful LTD claim for depression, anxiety, or other mental illness, you’ll have to prove that it meets the definition of “disability” that’s described in your policy. This also requires you to demonstrate that your symptoms are severe enough to prevent you from performing the primary functions of your occupation. Some policies may go so far as to require proof that the symptoms prevent you from working in any occupation.

An insurer wants to see that you are undergoing treatment and doing what’s needed to improve your symptoms. Regular medical care is essential to show that there is a debilitating mental illness present and that you are actively working to resolve it. Without medical care, the insurer can deny your claim or terminate your benefits for non-compliance and lack of medical care.

You should also ensure that your medical records with your treating physician are accurate and complete. Document all appointments and treatments you receive, including medications and their side effects.

Your treating physician is a vital link in the process, and your insurer will require input from them. This includes doctor’s reports that include:

• The occurrence and intensity of your symptoms

• Any favorable findings in the mental status examination

• Their firsthand observations of you during office visits

• The precise restrictions and limitations hindering your ability to work

If your mental illness is due to objective cognitive problems, your benefits may be extended beyond the policy’s standard limits. Your physician may request a neuropsychological evaluation to measure your cognitive deficits. This testing can provide more substantial evidence of mental illness and the disability that it causes.

Your Houston LTD Disability Attorney

If you need help filing a long-term disability claim or are having trouble with the insurer paying your benefits, we’re here to help.

We’ve helped over 4,000 Houstonians receive the LTD benefits they need. The Herren Law Firm can help you with your application, appeals and help you through the process, and give you one less thing to worry about. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation and no up-front fees. We will only collect a fee if we win your case.

Is A Mental Health Disorder Eligible For Disability?

Most people think that disability is strictly for individuals who are physically disabled. But a mental health disorder can be equally disabling, especially if not properly treated. If you have a mental health disorder that prevents you from working or inhibits your everyday functioning, you may also be eligible for disability payments.

Is A Mental Health Disorder Eligible For Disability?

Adults who are living with a mental health disorder may not have the funds to take care of themselves or to be able to seek treatment. Millions of people with disabilities are unable to get proper treatment because they do not have the means to obtain care. But it’s vital to get a diagnosis before pursuing a claim for disability.

The Blue Book

Social Security has an organized listed list of impairments, commonly called the “Blue Book.” Mental disorders are contained in Section 12 and are arranged into 11 categories. These are the impairments that are serious enough to prevent a person from working. It also lists the medical requirements that determine if a person can receive benefits for a disability.

Conditions in the Blue Book already meet the Social Security Administration’s definition of disability. However, children who are applying for SSI will not be based on an occupation, but whether a condition will cause “marked and severe functional limitations”

Just being diagnosed with an illicit condition does not automatically qualify you for disability benefits. The Blue Book details the symptoms, test results, and other data that show that your condition is serious enough to be actually disabling according to SSA guidelines. It also lists the records you need to prove to the SSA that you are disabled.

Social Security Requirements for a Mental Health Disorder

Social Security’s requirements for mental disorders are much the same as physical disorders. It must be a condition that will keep you disabled and unable to work for at least 12 months.

To show that you are disabled, you will also need medical evidence that documents your disability and shows how it prevents you from working and disrupts your everyday life. This will include things such as psychiatrist’s notes, lists of medications, treatment records, any associated diagnostics, and documented impacts of your symptoms on your “activities of daily living,” or ADL.

You must have these documents available and in order before attempting to file your claim application. While SSDI can be done online, SSI requires an in-person interview and cannot be completed online.

There are two disability programs available:

• For Social Security Disability Insurance, or SSDI, you will need to have previously worked and paid into the Social Security system for five of the last ten years. Monthly benefits are based on your lifetime earnings, known as your “average indexed monthly earnings,” or AIME. You will qualify for Medicaid after 24 months.

Supplemental Security Income (SSI) is designed for those who have not paid into Social Security in the last ten years or have never worked. Both adults and children can qualify for SSI. If you qualify for SSI, you also qualify for Medicaid benefits.

If you are unable to work but don’t meet the bluebook’s criteria to qualify on a medical basis, you can still be approved with a medical-vocational allowance. It will take your age, work history, educational background, transferable skills, and medical condition into consideration. Your physician can fill out a residual functional capacity form, or RFC, to add to your disability claim.

The RFC will indicate if you have difficulty focusing, cannot work with others, have difficulties with communications, are unable to complete a task, etc. It lists these indicators and symptoms so that the examiner can understand whether or not you can work, and what type of work you are able to do. Including an RFC from your psychiatrist or psychologist can be key to approval for your claim.

Get Help With A Mental Health Disability Application From Herren Law

Having a mental health disorder can prevent you from working and impact your daily life. We also understand how important it is for you to receive your benefits in a timely fashion. Herren Law has helped over 4000 Houstonians receive the disability benefits they need.

When you call us, we’ll immediately begin going through your records, working with you one-on-one, and representing you during your hearings. The first step in getting an experienced SSD attorney on your side is to contact our Houston law office at (713) 682-8194. We offer free, no-obligation consultations, and there is no fee unless we win your case.

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