Long-Term Disabilities: Mental Health Disabilities

What is Long-Term Disability Insurance?

Long-term disability insurance (LTD) is an insurance program made to provide payments to workers who can no longer perform their job duties. Any worker who develops an injury or illness that leaves them unable to work is eligible for long-term disability payments as long as they are covered by an LTD insurance plan. Workers are eligible whether this illness or injury was developed on the job or not. To receive these payments and stay afloat when you are not in the workforce, you must file a claim with your insurance company, proving that you have a qualifying disability.

Before receiving long-term disability insurance payments, you must sign up for short-term disability insurance payments first. As its name suggests, short-term disability insurance payments only last a short while, typically from three months to one year. These payments will continue until you can return to work or until the expiration date. After your short-term disability payments stop, you can file a claim for long-term disability payments if you are still unable to work.

Long-term disability payments are made by insurance companies but are governed by either state or federal agencies. Unfortunately, because long-term disability payments eat into insurance companies’ profits, many companies are hesitant to approve claims. Insurance agents will scrutinize claims heavily, finding any missing information or innocuous error as a reason to deny your claim.

Learning more about qualifying long-term disabilities can help you file your claim and submit the required evidence to get it approved. Mental health disabilities, in particular, can be difficult to file claims for, so it is essential to gather as much information as possible before filing your claim. If you need assistance getting long-term disability insurance payments to support yourself and your family members, don’t hesitate to contact our experienced team of attorneys. You can call our office today by dialing 480-999-4740.

What Mental Health Disabilities Are Covered by Long-Term Disability Insurance?

Mental health disabilities, also called mental health disorders, are conditions that change an individual’s thought process, behavior, or mood. Several mental health disorders may qualify you for long-term disability payments. Understanding which mental health disorders are covered by your insurance policy will help you submit the right medical evidence to prove that you are unable to work.

All insurance policies are different, but many insurance companies provide long-term disability coverage for the following disorders:

• Depression
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Anxiety
• Schizophrenia
• Agoraphobia
• Attention deficit hyperactivity disorder (ADHD)
• Drug addiction
• Neurocognitive disorders
• Panic attacks
• Sleep disorders
• Personality disorders
• Eating disorders

If you have a mental health disorder, you must submit evidence to your insurance company of both your diagnosis and your work history. Your diagnosis from a mental health professional, like a therapist or psychiatrist, will likely be enough to prove that you have this disorder. You may also be required to submit evidence of your treatment plan from your healthcare team.

Mental disorders like the ones above can become so severe that they limit an individual’s ability to work a routine job. If your mental health disorder impairs your ability to maintain a schedule or do normal work activities, then your insurance company may cover it. For more information about mental health disorders and how insurance companies classify them, contact our office today.

What is the LTD Claims Process?

If you have a mental health disorder that limits your ability to work, you must submit a long-term disability benefits claim to begin getting payments. In this claim, you will submit medical evidence as well as your work history proving that you have a disability and that it hinders your ability to perform regular work functions. Before you submit a claim, it is essential that you read through your insurance policy entirely to understand which disorders are covered and whether you qualify for long-term disability benefits. If you are confused by your insurance policy or would like help combing through any of the details, our team of attorneys can help you.

After you read your insurance policy entirely, talk to your doctor or healthcare provider and let them know that you are submitting a long-term disability claim. Your insurance company will likely reach out to your healthcare team for more information, so it’s best to let them know ahead of time. Your doctor or healthcare team can also help you gather medical records and documents about your diagnosis and test results to prove your disability.

To submit your actual claim, your insurance company will likely have you submit a questionnaire or other document answering questions about your disability. It is essential to answer all questions to the best of your ability, adding as many details as possible. Be sure to include information about your disability and the specific ways in which it hinders your ability to perform normal work functions. Try not to use one-word answers, even for yes or no questions. Generally, the more information you include about your situation, the higher the chance of success you have.

Your insurance company will likely request copies of your medical record and your work history showing the date you became disabled and the date you stopped working. If your insurance company needs more information or documentation from you, they will reach out after your claim has been submitted. Similarly, they may also reach out to your doctor or healthcare team to ask questions about your diagnosis or test results if they think it could impact their decision.

Your insurance company may also use third-party medical experts or doctors to review your case or even give you a medical exam. They may use this information to approve or deny your claim. Once your insurance agency has made a decision, they will notify you of your claim’s status, typically through the mail. If you receive a denial letter, the letter will explain why your claim was denied and how you can submit an appeal for further consideration.

Why Was My Long-Term Disability Claim Denied?

It is an unfortunate fact that over half of long-term disability claims are denied. If you have received a denial notice, read your letter carefully, as it should explain exactly why your claim was denied and how you can appeal it. Understanding why your claim was denied will help you during the appeals process. If you do not understand why your claim was denied or do not understand what your denial letter is saying, our team can help.

Every insurance policy is different, but there are some common reasons why LTD claims are denied, including the following:

Surveillance Evidence

If an insurance company does not believe an individual qualifies for long-term disability insurance payments, they may hire a private investigator to surveil them. A private investigator can use evidence like photos and videos to prove that an individual can perform normal work functions, leading to a denial of benefits.

Missed Deadlines

Because disability insurance policies are governed by the state or federal government, there are deadlines you must follow to qualify for payments. If you miss a deadline even by a day, your insurance company can deny your claim.

Insufficient Medical Evidence

Medical evidence includes your medical records, like test results and diagnoses. If your insurance company believes your medical evidence is insufficient, meaning it does not prove you have a disability that impairs your ability to work, they may deny your claim.

Lack of a Qualifying Disability

Your insurance company has its own definition of disability that you must fall under to receive payments. If your disability is not on the list, insurance agents will compare it to the list to determine whether it qualifies. If they believe it is not comparable to the ones on their list, they will likely deny your claim.

Independent Medical Exam

Independent medical exams are sometimes given when an insurance company disagrees with medical evidence. These exams are done by doctors and healthcare professionals employed by the insurance company. It’s possible that this independent exam will find that you are capable of working and supporting yourself, in which case your claim will be denied.

Can You Appeal a Denied LTD Claim?

Many people are tempted to give up when they receive a denial of benefits notice in the mail. Fortunately, a denial of your initial claim is not the end of the road. You can go through the official appeals process to request that your insurance company revise its decision. In most cases, you have 180 days from receiving the denial notice to appeal.

Before submitting your appeal, read your denial letter carefully, as it will tell you why your claim was denied. If it is something simple, like a lack of medical evidence, you can work on gathering documents or getting additional tests done to prove that you have a disability. If there were errors in your application, you can work on correcting them or providing additional information to avoid missing documentation.

Statements from healthcare professionals about your diagnosis can also be helpful, especially from mental health professionals like therapists and counselors. Your friends and family members can also submit written statements about your disability and how it impacts your ability to hold a job and support yourself. Ask them to include information about your day-to-day life and all of the things you cannot do due to your disability. These statements can be very valuable, especially if your claim was denied because of a lack of medical evidence.

After you have gathered all the necessary documentation, you can submit your appeal to your insurance company using the instructions in your denial letter. Your insurance company will process your request and then review your initial application as well as any additional evidence you have provided. Once your insurance company reaches a new decision, they will notify you.

If your claim is again denied after an appeal, you can file a lawsuit against your insurance company. You can work with our team of attorneys to file this suit in court. The only evidence that a judge can review at your hearing is your initial application and any additional evidence you submitted in your appeal. The judge will also review the insurance company’s policy to determine if your claim was denied in good faith. The judge will make the final decision on whether to approve or deny your claim. If you would like to learn more information about LTD litigation and whether it’s right for your case, contact our team today.

How Can a Long-Term Disability Attorney Help Me?

Receiving long-term disability payments can be life-changing for those who are unable to work anymore. But if the process of making a claim and potentially an appeal seems overwhelming to you, you’re not alone. Many individuals who qualify for long-term disability payments do not receive them because of stingy insurance companies who act in bad faith. By consulting an experienced legal team, you can greatly improve your chances of getting your claim approved.

Our lawyers at Roeschke Law can help you gather the necessary medical evidence to prove you have a disability that hinders your ability to work. We understand what insurance companies are after, and we can advise you on gathering the right documentation for a higher chance of success. We can also help you talk to your healthcare provider for extra statements and medical testing to prove your diagnosis beyond a reasonable doubt. Whether you’re submitting your first-ever claim or you’re going through the appeals process, our team would be happy to assist you. For more information about our services, call a member of our team today at 480-999-4740.