Is Depression a Disability?

Posted on October 17, 2019 by cjblog

Is depression a disability? It can be, but getting a long-term disability insurer to approve a claim based on mental illness is an uphill battle. If you have a valid claim where your condition significantly impacts your ability to work, an Ocala FL LTD attorney can help.

Clinical Depression and Bipolar Disorder

While many people experience periods of feeling down, clinical depression is a mood disorder that is indicated by persistent feelings of sadness, isolation, and agitation. These feelings interfere with one’s daily life and can lead to fatigue, sleeplessness, changes in appetite, and other symptoms that make it impossible to work. Treatment often requires therapy and/or medication.

People with bipolar disorder, often called manic-depressive disorder, also experience extreme depression that can affect their abilities to work and function in everyday life. Severe episodes of depression can last a few hours, days, weeks, or months for someone with bipolar. Treatment usually requires a combination of counseling and mood-stabilizing or antidepressant drugs.

Making an LTD Claim for Depression or Bipolar Depression

Clinical depression and bipolar disorder may be a disability when they limit your ability to perform necessary functions of your job. However, you must be able to document these conditions in order to have a successful LTD claim. This requires working closely with a psychologist or psychiatrist and making sure your LTD insurer gets all medical records from doctors, medication prescribers, hospitals, and psychiatric facilities.

You should make sure your vocational listings get into your medical record. Specifically, you should request that you doctors send information to your LTD insurer about the following information:

  • Necessary tardiness or excessive absences from work
  • Ability to
    • Stay on task throughout the day
    • Maintain focus and concentration
    • Understand, remember, and carry out simple and complex instructions
    • Respond appropriately to criticism from supervisors
    • Interact appropriately with coworkers and the general public

Your doctor may complete a Residual Functional Capacity (RFC) form or write a letter that addresses this information.

In addition to submitting medical information and opinions from your doctor, you may want to submit statements from third parties, such as former colleagues or supervisors who can discuss their observations about the difficulties you have had at work.

Independent Medical Examinations from Your LTD Company’s Doctor

Your LTD insurer will contact your medical providers to obtain medical records and statements; however, they may also send you to a specialist or to their doctor for a secondary opinion. During these independent medical examinations, it is important to be honest about your limitations and symptoms.

You may also take with you a written record of how your conditions affect you daily in case you don’t remember everything you need to say to the doctor. The IME doctor’s opinion may not be the same as your doctor’s, but it’s important to comply with all of the LTD insurer’s requests in order to move the claim forward. You can appeal any negative decision based on the IME.

Some LTD Companies Limit Claims for Mental Illness

LTD insurers may limit benefit payments for mental conditions and nervous disorders to two years. This is a common limitation in group employer-provided plans that are governed by ERISA. Many individual LTD policies have this or similar limitations as well. Individual policies may have offered a rider that removes the limitation in exchange for higher monthly premiums.

A common term would include language that limits disabilities due to illness or injury that are “based primarily on self-reported symptoms,” such as alcoholism, drug abuse, or mental illness. This may be limited to a benefit period of 24 months or less.

Self-reported symptoms include those like fatigue, pain, and others that are not verifiable with objective tests and clinical examinations. Mental illnesses, such as depression and bipolar depression, almost entirely rely on self-reported symptoms, even though the outcome of those symptoms can be observed by others.

Filing for SSD While Receiving LTD Benefits

If your claim for depression or bipolar depression is approved by your LTD insurer, you will likely be required to file for SSD as well. In many situations, obtaining LTD benefits through your insurer will be just as difficult as obtaining SSD benefits. Both processes require extensive medical documentation and proof of vocational limitations.

It is important to note that while your LTD benefits may be offset by your SSD benefits, your SSD benefits will not be stopped after two years like your LTD benefits may be. In fact, your SSD benefits will not end until your disability ends.

Is Depression a Disability? Ask an LTD Attorney

If you need help filing or appealing an LTD claim for depression or a related disability, speak to an Ocala LTD attorney at CJ Henry Law Firm PLLC today. The process often requires extensive knowledge of how to present medical evidence to the insurer. Call our office to learn more.

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