By far, the majority of claims currently brought to my desk involve mental health. I’m not going to speculate why that is, it’s just a fact that more people are filing behavioral or mental and nervous claims. As a result, more and more claims end after 12/24 months. It’s very important that anyone filing for an M&N claim be aware that benefits are limited.
The claims abuse actually begins much earlier when insurers do two things: 1) If there is also a claimed physical disability, insurers will allege the secondary “depression” is really the primary diagnosis just to limit benefits to 24 months, and 2) Request SSDI files under false pretenses to obtain Federal Form 831 where mental approvals of SSDI are listed. From there, insurers obtain actual psychotherapy notes and actually “read into them” work capacity. In fact, Prudential is an expert in doing this.
Both therapist and insureds need to be cognizant of the fact that company Authorizations do not give permission to release actually therapy notes. In fact, Unum’s general authorization (in the second paragraph) states, “Does not include actual psychotherapy notes.”.
Of course, Unum doesn’t read its own Authorization and sends it to therapists as permission to release the notes. In addition, therapists do not read the authorization and release the notes. Insureds need to be aware of this and point out the limitation to therapists. If your psychotherapy notes ARE released, it will be without your permission. I know you don’t want that.
Insurance companies generally have a standardized view of behavioral health. It is presumed that if properly medicated, and patient receives ongoing CBT (Cognitive Behavioral Therapy), they will be able to return to work within 12 months. If insureds cannot return to work within 12 months, it is presumed that either the insured is not properly medicated, or is receiving the wrong therapy. This is the time when insurers often require neuropsychiatric tests to prove their point.
This, of course, does not include some of the more serious diagnoses such as Bipolar, or Personality disorders. PTSD falls in the category of “Depression”, and is managed just the same. In any event, it is “preplanned” in most cases that mental health claims are alleged even when there is a physical disability, and are denied within 12 months.
DCS has never recommended to therapist that they release actual therapy notes to insurers. In my opinion, the actual benefit of therapy is lost when insureds do not share information because they know it will wind up on the desk of someone at their insurance company. Therapy notes ARE NOT WRITTEN FOR THE PURPOSE OF SUPPORTING OR NOT SUPPORTING PRIVATE DISABILITY. Therapy notes are the property of the therapist and are written as reminders of what transpired during the therapy sessions.
Insurance companies use the information from therapy notes to claim the insured has work capacity. In another example, Prudential denied a claim when it was discovered the insured had a live-in boyfriend who didn’t work. Insurance companies can get carried away with their own illusions, and for the most part mentally impaired insureds were done in by their own statements to therapists.
Therefore, it is very important for those suffering from mental health issues to know how to manage their claims at a time when they are least likely to be able to do it. My recommendation is to read what your Plan or policy says about mental health limitations and financially plan accordingly.
If you would like more information about coming onboard as a DCS Client please feel free to contact me by visiting my website located at:
http://www.disabilityclaimssolutions.com
Tel: 207 793-4593
