As many insureds suffering from depression and/or anxiety can attest, filing a disability insurance claim based on these illnesses can be complicated and frustrating. Because “objective evidence” of depression and anxiety is not always readily available, these claims are often denied due to a “lack of medical proof” that the insured’s condition is severe enough to prevent him or her from working. To be successful at the application level, the insured needs to work closely with their treating psychiatrist, psychologist, and/or therapist to make sure the records (or treatment summary if no records can be provided) reflect concrete examples and clinical information that confirm the diagnoses and the severity of the insured’s condition. If psychological testing or neuropsychological testing has been done then that information and the test results need to be included. If the claim has been denied, then it may be necessary to get a detailed statement from each treatment provider as well as testimonial statements from friends, family, and co-workers to submit with the appeal.
At DI Law Group we have successfully applied for disability benefits on behalf of clients with mental/nervous conditions such as depression, anxiety, panic disorder, post-traumatic stress disorder, bipolar disorder, schizophrenia, and numerous other psychological conditions. We work closely with our clients, their treatment providers and, where appropriate, family, friends, and employers to make sure there is appropriate evidence to confirm the DSM diagnoses and severity of the condition. Because we are familiar with the numerous reasons and excuses provided by many insurance companies used to deny these claims we are well prepared to do what is necessary to get a claim approved.
We have also been very successful in filing appeals that will get a denial of benefits reversed. Based on our close scrutiny of the claim, including a review of the proof of claim submitted by the claimant and their doctors, the handling of the claim by the insurance carrier, a review of medical reports in the file and the claim file itself, we are often able to determine what evidence is lacking and then work with our client and their treatment providers to include this information with the appeal. It is important to understand that if your insurance policy was provided as a benefit of your employment or as part of a large group it will likely be subject to the rules and regulations of the Employee Retirement Income Security Act (ERISA) and thus the appeal is more like a mini trial. Under ERISA claims, the insured must exhaust all available administrative remedies, which is normally a single appeal, before a lawsuit can be filed. Once the administrative process is complete and a final denial issued, no additional information or proof of claim can be submitted for review by the court.
Important in both the application and the appeals process is clearly articulating the insureds symptoms and limitations and specifically how they prevent a return to work. This involves providing detailed information about their occupation and not just what is listed on a general job description. It may be necessary to seek psychological testing or neuropsychological testing to confirm the claimant’s limitations and why they are unable to work. It is also important to note that under many group and individual disability policies, mental/nervous claims are only payable for only 24 months. Thus, if there is both a physical and mental component to the claim or if one’s depression or anxiety is a reaction to a physical illness or injury then the conditions must be distinguished so that benefits are payable for as long as the insured is disabled or to the end of the maximum benefit period.
If you or someone you know is thinking about applying for disability benefits, is still waiting for a decision from their insurance company, or has been denied benefits please contact us at DI Law Group for a free consultation with one of our attorneys. Additional information is also available on our website www.dilawgroup.com