A decade ago the number one cause of disability was Fibromyalgia followed by Lyme disease and Mental Illness. Today the three major causes of disability are Mental illness, ADHD, and PTSD. With the exception of ADHD, all of these diagnoses are what insurers call “subjective”, meaning that there is no “objective evidence” to prove that you have what you say you have. Statistics would seem to indicate, therefore, that people are filing for disability primarily for mental illness.
Proving a disability claim for behavioral issues is very much the same as proving a claim for Fibromyalgia. I can remember in 2000 that FMS was often treated with morphine drips. Today, it is believed that most depression insureds can be treated with anti-depressants and with therapy can go back to work within 12 months. Most insurance companies do not treat mental health claims as a permanent cause of disability. It is believed, except for the most severe mental illnesses, that mental health is “subjective” in nature and that with proper treatment and medication, most insureds can go back to work.
It is for these reasons that nearly all ERISA Group Plans limit mental health claims to 24 months. At the time this limitation was approved, it was believed that “mental illness” could go on forever, if you let it, and insurance companies weren’t going to pay for that. Mental health claims, therefore, are often difficult to support and receive beyond 12 months, or at best, 24 months maximum benefit.
The DSM-5 describes the symptoms of mental illnesses such as Depression and Anxiety as tearfulness, fatigue (inability to get out of bed), lethargic behavior, sleep apnea, gastrointestinal issues, lack of affect (no expression), heart palpitations etc. The Diagnostic and Statistical Manual (DSM) is the guidebook for diagnosing psychological disorders, and of course, insurance companies use this Manual as a guidebook to determining whether or not to pay claims.
From what I’m seeing there is a majority of those filing for mental health claims who are more busy now than they ever were.Although people seem to use the excuse, “well….my doctor told me to stay social and involved. Daily exercise is part of my treatment plan.” And, this is generally good advice for those suffering from depression and anxiety. For others who continue “running around”, and active most the day, my question would be, “When do you have time to be depressed?”
Insurance companies will be looking for the symptoms described in the DSM and yet the insured is engaged in activity, without a tear or semblance of fatigue. On the phone all the time? Real depression and anxiety severe enough to cause loss of functional capacity to work is usually not manifested in group activity, wrapped around phone calls, and visits from friends.
Insurance companies have their ways of finding out exactly what your real functional capacity is with surveillance, and Independent Medical Examinations. It’s best for insureds to know up front that in order to receive disability benefits, you have to at least have some semblance to the expected symptoms officially attributed to the claimed disability.You can’t file a disability claim, say you can’t work, and then flitter through your life as if nothing went wrong. My experience with this always is: IT DOES NOT WORK AND CLAIMS ARE DENIED.
The requirements are the same for mental disease as they are for physical disease: you must show mental Restrictions and Limitations that preclude you from working. If you’re continuing life as always, you can’t do that, and eventually will be found out by surveillance.
Proving a mental health disability claim can have its challenges. But, if depression and anxiety are wearing you down, then symptoms should be showing that. Then, the legitimacy of the claim takes care of itself.
