SSDI and Long-term Disability Benefits for Affective Disorders

Affective disorders such as bipolar disorder and depression can leave you unable to work and pay the bills. SSDI and long-term disability (LTD) insurers are also reluctant to approve claims for benefits for mental health issues, and despite growing medical and psychological research, LTD and SSDI carriers continue to deny initial applications and force people to appeal.

No matter if you have an employer-provided group plan (such as ERISA), an individual LTD policy, or an SSDI, the application process is rigorous and leaves substantial room for mistakes. Even comprehensive documentation from your employer or doctor might not be enough for the insurer to approve a claim, leaving you unable to receive monthly disability benefits of 50 to 80 percent of your prior earnings.

Definition of Affective Disorders

According to the Disability Evaluation Under Society Security, section 12.04, a person suffering from (and unable to work) an affective disorder experiences a “disturbance of mood, accompanied by a full or partial manic or depressive syndrome. Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation.”

Diagnosis requires medically documented persistence, either continuous or intermittent, of one of the following:

• Depressive syndrome characterized by at least four of the following:
  • A pervasive loss of interest in most activities
  • Appetite disturbance with weight change
  • Sleep disturbance
  • Psychomotor agitation or retardation
  • Decreased energy
  • Feelings of guilt or worthlessness
  • Difficulty concentrating or thinking
  • Thoughts of suicide
  • Hallucinations, delusions, or paranoid thinking
• Manic syndrome characterized by at least three of the following:
  • Hyperactivity
  • Pressure of speech
  • Flight of ideas
  • Inflated self-esteem
  • Decreased need for sleep
  • Easy distractibility
  • Involvement in activities that have a high probability of painful consequences
  • Hallucinations, delusions or paranoid thinking
• Diagnosis of bipolar syndrome including a history of episodes of both manic and depressive syndromes and currently characterized by either or both syndromes.

SSDI and LTD Applications for Affective Disorders

The application process for an SSDI or LTD claim requires extensive documentation. Most carriers (either private, SSA, or ERISA) consider a Mental Residual Functional Capacity (RFC) to investigate a claim. The RFC assesses psychological, emotional, psychiatric, or cognitive impairments that could be affecting your ability to work in your own occupation or in any occupation.

Consistent treatment is essential for prevailing on a claim for affective disorders. When filing a claim, your doctor can complete an RFC form or write a letter to the insurer addressing limitations you face in the workforce. The application should also include all other medical records related to your condition, such as those from hospitals or psychiatric facilities.

It is important to note that many insurers may not request comprehensive information, hoping to elicit unfavorable responses to your claim. Therefore, the paperwork needs to show a connection between your inability to work and an affective disorder, regardless if the insurer requests this documentation.

 SSDI and LTD Benefits for Affective Disorders

SSA and LTD insurers assess the documentation, including the RFC, to determine whether you are capable of performing your prior job or any other kind of work. In cases where depression or bipolar disorder are so limiting that there is no job you can perform, you could be awarded benefits under a “medical-vocational allowance.”

LTD benefits are known to be more rewarding than SSDI, and LTD can give a monthly allowance from 50 to 80 percent of your prior salary. For Social Security benefits, the SSA considers your average earnings for all the years you’ve been working. Throughout the U.S., the average disability benefit for an individual averages around $1,165, while disabled workers with a spouse and child(ren) average around $1,976 a month.

Many LTD carriers limit disability benefits for affective disorders to 24 months, though bipolar disorder is sometimes exempted from the two-year limitation.

Reasons for Denying a Claim

Many disability claim examiners are not licensed psychiatrists, and due to the initial reluctance to approve disability benefits for affective disorders, denials may be both legitimate and illegitimate. The reason(s) for a denial, in this sense, are important details you and your attorney can use when appealing or presenting a case at administrative levels and in federal courts.

The most common reason for denial is insufficient medical evidence, and examiners deny claims if they don’t see that you’ve attended regular medical treatment. Missing medical records and/or a doctor’s statement also carry significant influence in a denial.

Appealing a Denial of Benefits for Affective Disorders

When denied, it is important to act quickly. Most LTD and SSDI denial forms include an appeal deadline date. In general, you have 60 days to request a disability hearing in front of an administrative law judge (ALJ) for SSDI and 180 days if you have a group plan covered by ERISA.

After denial, the first step in forming an appeal is to hire an experienced disability attorney who understands the Houston and Texas disability benefit landscape. Over 30 years of experience helping more than 4,000 people has given Herren Law in Houston the ability to navigate this landscape effectively, and you’ll receive honest and personal communication, respect, and a diligent work ethic to fully support your case and give you the best chances for a successful claim.