Mental & Cognitive Conditions Qualifying for Long Term Disability
Many physical disorders have obvious symptoms that can be shown with objective medical evidence. Conditions like cancer, respiratory diseases and musculoskeletal conditions can be diagnosed with tests and tools like X-rays, blood tests and MRIs.
Mental and cognitive disorders are not as easy to diagnose, and proving that you have one is not always easy. Symptoms are frequently self-reported and may lack considerable documented evidence from your treating physician. This can result in your long-term disability claim being denied.
Our long-term disability attorney can help. We consult with those who are applying for LTD benefits, and we also can prepare an appeal and lawsuit if you were wrongfully denied long-term disability benefits. We will even review your denial letter for free. Call us today at 816-203-0143.
Disabling Mental & Cognitive Disorders Commonly Covered Under LTD Policies
When a mental disorder is severe enough to prevent you from working, you may need long-term disability. Applying for long-term disability is already complicated, and the federal law of ERISA (which governs most employer-sponsored plans) are literally stacked against you. As a result, insurers often deny benefits to policyholders with mental and cognitive conditions.
The first step is to read your LTD insurance policy and learn exactly what your insurer calls “disabled,” to make sure that you qualify. In addition, please be aware that many long term disability policies limit coverage for certain mental or cognitive conditions to a certain period of time (often the limit is 2 years).
Mental and disorders can include a number of various conditions, including:
- Anxiety, including panic attacks
- Bipolar disorder
- Autism spectrum disorders, including Asperger’s
- Affective disorders
- Psychotic disorders, such as schizophrenia and paranoia
- Neurocognitive disorders (NCDs), which is usually characterized by symptoms such as loss of memory, perception, problem-solving skills, mental processing and word-finding or language skill. NCDs may be caused by:
- Somatoform disorders, which have no obvious cause
- Personality disorders
- Substance abuse disorders, including alcoholism and drug abuse
These are just some of the conditions that may render you unable to work. After seeing a physician and beginning medical treatment, applying for long-term disability may be your next step.
Make sure that your application is complete, and includes documentation such as medical records, any available testing, prescription records, and other pertinent information. This is where a disability lawyer can help you at the outset, and ensure that your application is done correctly.
Were You Denied Long Term Disability?
You thought you did everything right. You gave the administrator of the long-term disability policy everything they requested. But your claim was still denied. Why?
Reasons for denials can range from simple typographical errors or missing forms to something more substantive, such as:
- Insufficient or incorrect/erroneous claim documentation
- Missing a deadline for filing
- Applying for a condition that isn’t covered under your policy
- Results of an independent medical exam (IME)
- Not meeting the policy’s definition of “disabled”
- Video surveillance that contradicts your claim of disability
- Insurer error
Insurance companies are not happy about paying out money, and work hard to keep from doing so. One way to hold back on paying benefits under the policy is to require you to have an Independent Medical Exam (IME.) If your policy says that you’re required to attend, you must, or your claim will be denied. This is another reason you need to read your policy closely. Miss it, and they have a reason to say “no.”
The insurance company will send out its own physician to do a medical exam separate from your own physician. The IME is part of the insurer’s investigation into your claim, and failing to attend an IME—or more than one—is seen as being “uncooperative.” While the intent is an objective medical opinion, insurers like to hire physicians who make decisions that favor the insurer instead of the policyholder.
At the same time, right before and after the IME, your insurer may very likely be doing surveillance on you. That means your every move is being watched and recorded in order to find you doing something you claim you “can’t” do.
In other words, if you claim that you can’t walk outside your home because you feel extreme anxiety opening the front door, a video of you taking out the trash will be used to discredit your claim of disability. The video will be cherry-picked to show that you don’t have any disabling mental illness, and that you can, in fact, go back to work.
When an investigator or “independent physician” find something, they will use it against you to prove that you are “dishonest,” and to deny your claim based on their “evidence.”
Getting Approved for Long-Term Disability Due to Mental or Cognitive Disability
Remember that your insurer also has attorneys that defend them any time they are challenged on a case. Shouldn’t you have the same?
A long-term disability attorney can help you with your initial long-term disability application, assist with a denial and appeal, and represent you in court if a lawsuit becomes necessary.
Because insurance companies make it difficult to get benefits based on a mental condition, you may need the help of an experienced Kansas City disability attorney to fight for the benefits you need.
If you are instructed to attend an IME (and you very likely will), our Kansas City long-term disability lawyer can offer advice on how to handle the exam, as well as what to say and what not to say.
A mental disorder can bring a whole new level of difficulty into your life. Because a disability lawyer understands the law, the process, and how insurance companies work, you won’t have to handle this on your own. You can concentrate on taking care of yourself and your family, and let your lawyer take care of helping you get the benefits you deserve.
Get Help from a Long-Term Disability Attorney
If you haven’t filed yet, consider contacting our office for a pre-application strategy session. We’ll help you with your application, and make sure you have everything you need for a successful submission. It may be all the help you need, but if you do need help with an appeal, we will credit your initial charges to the appeal if you decide to hire us.
Already have a denial letter? We can still help, but you have to act quickly, or you may miss a required deadline. Call us at 816-203-0143, download our free long-term disability guide, or contact us online. We’ll review your denial letter for free, advise you on your next steps, and offer a strategy for your appeal. No matter what you do - act quickly because short deadlines apply