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Depression, Mental/Nervous Disability Claims – What You Need To Know

Tuesday, January 11th, 2011

Similar to claims due to Fibromyalgia, Chronic Fatigue Syndrome and Epstein-Barr, a diagnosis of Depression on a Disability Claim form often sends up a red flag to the claims manager, and a red flag is never a good thing on a disability claim.

Depression is one of the most common psychological problems (anxiety is another) to cause impairments in functionality and create a need to file a disability claim. Contrary to what an insurer may believe, depression is not a malingerer’s disease of choice. It is a medical illness that affects both the mind and the body, impacting on the ability to think, feel, behave and function in day-to-day life. Depression ranges in severity, from mild temporary episodes of sadness to severe, persistent depression.

There are many different kinds of depression:

  • Dysthymic disorder
  • Manic depression
  • Atypical depression
  • Chronic depression
  • Double depression
  • Endogenous depression
  • Situational or reactive depression
  • Agitated depression
  • Psychotic depression
  • Melancholic depression
  • Catatonic depression
  • Postpartum depression
  • Not surprisingly, depression is found to occur at a higher rate among people with other serious illness than those who are healthy. The illnesses most typically associated with depression include heart disease, stroke, cancer, HIV, diabetes and Parkinson’s. Those with chronic pain conditions also often suffer from depression secondary to their physical maladies.

    For purposes of disability insurance claims, anyone suffering from depression must be under the care and treatment of a qualified psychiatrist and/or psychologist, or other qualified professional, in order to demonstrate the seriousness of the condition and be able to document the condition itself, the treatment and the impact it has on day-to-day living and functionality.

    The challenges for claimants pursuing a disability insurance claim occur in several ways:

    If you have a psychiatric or “mental/nervous” claim, the insurance company will ask for a lot of documentation. Some of their requests for information may feel like they are prying into highly personal matters. If you are under the treatment of a psychiatrist or therapist, for instance, they may ask to see medical records that include the treating therapist’s notes on your discussions. This feels like a highly intrusive request, and it is.

    The treating therapist must fill out claim forms and provide anecdotal reports, but they are not required to share notes on the highly personal and private conversations that take place during sessions. Typically, a summary of the treatment sessions will suffice on claims for mental illnesses.

    There are times when a diagnosis of a fatal or chronic or serious illness or injury causes individuals to become depressed as a direct result of having to face a life-changing illness or worse, a premature death. Many disability insurance companies try to re-categorize claimants into the mental/nervous diagnosis, rather than appreciating the physical impairment. This is not a clerical error on their part. Policies on mental/nervous claims are very strict and limitations are severe – with many policies offering a limited pay period of only 24 months for mental or nervous claims. This tactic minimizes their claim exposure, so they will aggressively posture claims that are physical to be considered under this limited pay period.

    That is why it is extremely important that if the depression is a result of a medical condition, the medical records reflect very clearly that there are two separate disabilities, physical/medical and mental nervous.

    Another tactic from the insurance companies is to question why you were not hospitalized if the condition was serious. And just as the insurance companies engage “guns for hire” medical doctors to conduct so-called “independent” medical exams, or have paper reviews done without even the benefit of an examination, the insurance companies may ask for a two-day neuropsychological examination and an exam with a forensic psychiatrist. The professionals conducting these tests rarely find their subjects to be disabled. No surprise, considering that the doctor is being paid well by the insurance company for a favorable opinion.

    If you are struggling with depression or anxiety and your disability insurance company is delaying your claim or has denied your claim, call our office today and learn how we can help. If you have questions about disability claims for depression, we have answers.

    Justin C Frankel

    Written By:

    Justin C. Frankel - Disability Insurance Attorney

    Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

    Learn more about Justin | See Justin’s Publications



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