Depression and Anxiety Disability Insurance Claim Information and Help
- Disability Insurance Benefits For Mental Disorder Claims
- Cognitive Dysfunction and Disorders in Long Term Disability Claims
- Depression & Anxiety Disability Insurance Claim Help & Tips
- Malingering and Disability Insurance Claims - What Does It Mean?
- Cognitive Limitations Create Difficult Issues In Obtaining Disability Insurance Benefits
- Liberty Mutual Wrongfully Denies Disability Benefits for a Pediatrician with Depression
One of the most difficult disabling conditions to prove is depression or anxiety. Disability insurance providers often challenge these claims because there is no objective test that can prove someone is depressed. People diagnosed with depression usually look normal on the exterior; however, their ability to function and perform in a work environment with reasonable continuity is severely limited. In a disability claim, the insurance company will rely on a hired psychologist or psychiatrist to determine if the claimant has restrictions and limitations caused by depression or anxiety. Often, a claimant’s treating psychologist or psychiatrist will not take thorough notes, and the insurance company will state that the claimant’s doctor has not documented any restrictions or limitations. We have handled thousands of disability claims dealing with depression and anxiety. Let’s talk about how our experience can help you.
We also see disability companies argue: “If your depression was so debilitating, why were you not hospitalized?” The disability carriers will sometimes arrange for the claimant to submit to a two-day neuropsychological examination and another exam with a forensic psychiatrist. In 8 out 10 times, these hired guns will decide that the claimant is not disabled and can return to work. The neuropsychological testing is also used be insurance companies in an effort to prove malingering or exaggeration of symptoms. It is important to hire a law firm that has experience in dealing with neuropsychological testing and depression disability claims. Claimants need to be aware that most ERISA governed disability policies and many individual disability policies will limit mental nervous claims to two years of benefits only. In many of our cases, if a person has an physically disabling condition, then we will attempt to prove that the depression or anxiety is secondary to the physical condition. This argument can allow a disability claim to extend beyond two years.
Our Experience with Disability Insurance Claim for Depression and Anxiety
Our disability insurance lawyers have recovered benefits for hundreds of claimants with depression or anxiety. Here are some examples of our resolved cases for claimants with depression or anxiety:
- Unum issues disability insurance benefits to currency trader suffering from depression and chronic fatigue
- $800,000 lump-sum disability settlement for attorney with depression
- Liberty Mutual reverses decision to terminate disability benefits
- Former government bond trader and 9-11 survivor receives more than $1M in long-term disability benefits
- Unum Provident and Monarch Life Insurance Company pay total disability to dentist
Our Lawyers Handle Depression Claims Daily
Depression is one of the most common psychological problems for a short or long term disability claim. One in six Americans has been diagnosed with depression. Depression is a chronic medical illness that does not just affect the mind but also the body, affecting how you think, feel and behave. There are several distinct types of depression including:
- Major Depressive disorder
- Dysthymic disorder
- Manic depression
- Atypical depression
- Chronic depression
- Double depression
- Endogenous depression
- Situational depression or Reactive depression
- Agitated depression
- Psychotic depression
- Melancholic depression
- Catatonic depression
- Post-partum depression
Depression is rarely an isolated condition. People with depression often suffer from other conditions, injuries, illnesses or disabilities, including heart disease, diabetes, Parkinson’s, HIV/AIDS and cancer.
Symptoms of Claimants Seeking Disability as a Result of Depression
People suffering from depression may exhibit some of the following symptoms:
- Loss of interest in a normal activities
- Persistent feeling of sadness
- Insomnia
- Significant weight loss or gain
- Suicidal thoughts and behavior
- Slowed thinking
- Indecisiveness
- Distractibility
- Decreased concentration
- Fatigue
- Loss of energy
These symptoms make even the smallest tasks seem overwhelming. Workers suffering from depression could be entitled to benefits if their condition makes working a regular schedule impossible.
If you have more questions about receiving benefits for your depression, contact our disability insurance lawyers for a free consultation. Schedule a free consultation with us, and we will give you an assessment of your best options. We handle cases in all 50 states.
The following resources provide additional information about depression and anxiety:
- National Institute of Mental Health
- Psychology Information Online
- American Psychiatric Organization
- NARSAD The Brain & Behavior Research Fund
- NAMI National Alliance On Mental Illness
- American Foundation For Suicide Prevention
- Mental health America
For updates about depression and disability insurance, check this page for news. We provide a feed of information that could be relevant to your benefits.
My name is Sonia, I am so alone, lost, scared, lonely. I feel like I have no life anymore, my world was turned upside out on December 12, 2013. My company of 23 years wrongfully accused me of steeling from them. Of course I did not and they have found that out. Now, I was not fired because they had no proof of me doing such an awful thing. What happened to me after was crazy. I got sick, could not sleep, was scared, would not eat or go anywhere alone – my life changed. I was told my job abilities were not good and that I had to pick it up because I was affecting the company’s sales and customer service and my members. I told my boss I was sick and was seeing a doctor for help, that I had deep depression and was having anxiety attacks. I also told him I was on medications. He was more upset then anything else. I would ask to see the company doctor and they would not send me, that is why I started to see my own doctors. On April 03, 2014 the company doctor put me out for one week and said on her note that I could return to work, but only with one restriction: for me to return to my old store, because I need the support from my co-workers to get better and feel safe. Well, my district manager said no to the company doctor, that I had to return to the same store and that was final. He doesn’t understand that it’s not that I don’t want to, I just can’t. My personal doctor is now, as of April 4, 2014, has pulled me out. My doctor said this is too much for you and why can’t they understand you have an ongoing metal disability because of what they put you through. I hope you can help me, if not I will understand. Thank you.
Sonia,
Do you have disability insurance coverage from your employer? If so, have you filed a claim for disability benefits under the policy? Being required to see a company doctor appears to be more of a Worker’s Compensation protocol.
Hello,
I have been on STD for 2 months for chronic fatigue, dizziness, and headaches. Last year, I was diagnosed with Hodgkin’s Lymphoma and underwent 6 months of chemotherapy and have been cancer free for almost a year. After a battery of tests, all tests came back as basically normal. The only thing that has been identified was bicuspid aortic valve insufficiency. My internist has been very supportive and completing but most of my other doctors (cardiologist, pulmonologist, oncologist, etc.) will not acknowledge that there area of specialty is causing these symptoms. However, my internist does seem to think that my symptoms might come from cumulative effect of the chemo, heart problem, etc.
An additional factor is that I have suffered most of my life with depression and bi-polar disorder and anxiety… but was first diagnosed in 2005/2006 and seemed to be able to manage it through medication. The doctors have suggested that my mental issues might have worsen as a result of the cancer diagnose and chemo. I have strong family history of cancer, heart disease, and depression/depression/bi-polar disorder. The plan is to see a new psychiatrist this week to get an objective opinion.
The company that administers my employer’s STD plan has suggested that the continuation of my STD benefits might be denied since my test results are coming back normal, even though my doctor will not approve my return to work. Additionally, I have concerns about having to extend my benefits since this has been going on for almost 6 months.
I know that I can file for an appeal if they deny the extension to the claim but the stress if really getting to me at this point. It is funny to me that STD is suppose to give you time to diagnose, rest, etc. and all the insurance company and my employer seem to want to do is add to my stress and anxiety level. Basically, I am freaked out. BTW, did I mention that I was only working at the job for 3 months before going out on STD? I know my job is at jeopardy. Hence, maintaining income via STD and/or LTD during this time is even more important since I have zero job security. HR actually contacted me on Friday and want to speak with me on Monday. Not a good sign.
Sorry about the long drawn out rant. My question is when should I get an attorney involved? Any advice would be helpful.
Thanks.
Bob,
Please feel free to contact us as it relates to your STD claim. Additionally, I would caution you that your claim for LTD benefits may be denied on account of a pre-existing condition. Most long term disability policies contain pre-existing condition language that states that if you have been covered under the policy for less than a year and you go on disability, then the insurance carrier will look to the 3-6 month period prior to the effective date of coverage to see if you were being treated for the condition that is disabling. If so, your claim could be denied on account of it being a pre-existing condition.
My son fits in the depression category. He has been with this since 2008 or maybe longer. Never really understood his reactions. I have had to fight with the school district to get the proper help needed. I had to pull him out of public school and use home schooling. I pushed him hard with long hours to help him graduate. He has been in Mental Health treatments and till this day continues on Depression Medications. He continues with his sessions with both Doctors, medical and counselor. He continues with not been sociable with others, has only one friend, suicidal thoughts, can’t sleep, weight gain, losing interest in many things, acts like a teenager at times and is going to be 22 years old. I have to make sure he takes his meds and push for him to get ready. Otherwise, shows no interest in how he looks. I have tried to get him SSI, first time under age and our income was too much, so they said. Second denied not enough information was provided, third denied due to courts doctors decisions. I am not as young as I use to be and I want to make sure that my son can receive the help needed. I would need help in trying to prove he is really disable.
Guadalupe,
Please feel free to contact our office and we can assist you in getting in contact with a Social Security attorney that might be able to assist you.
I went on a STD for depression and on the third month I was on STD and my doctor requested an extension for another month. The insurance co. denied my claim stating that the doctor did not fill out the form completely. I had my doctor look over the form and he stated that he didn’t understand what else was needed. I’m right now appealing my claim. Because of this I was forced to return to work financially. I have a co-worker whom is appealing her claim with this particular insurance company because she was told also that her doctor didn’t provide adquate information according to their guidelines. Please let me know which way I should peruse.
Dee,
If you are back to work the insurance company would only be liable for the one month of benefits they did not pay. Only you can decide whether to pursue a longer term disability or continue to work.
I have been out of work for STD since July. Aetna is the claim administrator and they denied my claim. I have a behavioral clinician statement complete by a licensed counsellor and they denied that. She sent in three letters explaning my conditions: fibromyalgia, major depression and anxiety disorder. I went to see a psychologist and performed several testing to confirm that I have those conditions. The pscychologist completed a behavioral clinician form and both doctors said the same thing. Aetna still denied it and said it does not support me to be on STD. They said they looked at Facebook and saw pictures and statements of me happy and they don’t add up with what the doctors said. What should I do at this point?
Lee,
Your policy is most likely governed by ERISA, which will require the filing of an administrative appeal before any lawsuit can be filed. Please feel free to contact our office to discuss how we may be able to assist you with same. In the mean time I would strongly urge you to increase the privacy settings on any of your social media accounts to prevent the general public or your insurance carrier from readily viewing the contents of your posts.
Hi,
I have severere PSTD and anxiety and have been seeing someone for over 6 month for it but it’s getting worse and worse. It is hard for me to function day to day and this includes working. I think I am going to get fired for missing so much work and I don’t know what to do. I can barely make it here every day as is and now with the added stress of worrying about work all the time is not helping. I just want to stay in my apartment forever and not have to deal with all of this. Help!
Erin,
If you are unable to work due to your medical conditions and you are covered and eligible to receive benefits under an employer provided disability policy you may wish to consider exploring those options. As a word of caution, if you have been employed for less than a year or have been covered under a LTD policy for less than a year then your conditions could be deemed pre-existing. If you have copies of your employer’s disability policies please feel free to contact our office for a review of same so we can determine how we might be able to assist you.
I am a 50 year old man who is the sole caretaker of my wife, who survived an anurism 6 years ago at age 42. I am a High School Math teacher. Used to coach HS baseball, and I was department chair. After my wife came home, I attempted to continue as usual. I was wrong to do so. I quit coaching in the middle of a successful baseball season too time, and mental space commitment. I later dropped the Department Chair job because of the same. So I taught and caretook, along with every chore that goes with each. I loved teaching, it wasn’t my life, my wife was. So in my 29th year, still 5 yrs from being able to retire I have been having panic attacks at school. The first one was 2 years ago. It was so bad paramedics took me out of my classroom, during a class, to the emergency room. I was physically drained for 2 days. Last year was 3 attacks, all at school. This year it was 6 in the first month of school. I start with heartrate increase, then my brain fires in all different thought directions, until I feel like I will pass out. This happens when students are in class, and sometimes when they’re not. I’m on meds for depression and anxiety. Just started therapy (I fought it until it got this bad). I lose sleep and am wiped out for 2 days. From your information I should seek LTD, but this process seems so long. I am out of school (3 weeks now) on FMLA by Dr.’s orders, but have not seen a psychiatrist because their booked out months ahead. I run out of paid leave next week, so I need to know, do I return to work? Will that hurt my case for LTD if I need to use that route? But most of all I worry I’ll go back and a bad attack will happen. Not to mention the social stigmatism as I was a popular teacher with faculty and students.
Chris,
Unfortunately, no one can ever decide for you as to whether you should return to work or not. Only you can make that determination. If you are not treating with a mental health professional then there is a chance the insurance company could argue you are not under the appropriate care of a physician or provider for your condition. As every disability insurance policy varies, please feel free to contact our office to discuss your situation in greater detail.
Hello, I am 55 years old. I have been diagnosed with severe depression for 11 years now. Therapy, all different meds, and it’s just getting worse. Unable to concentrate or interact with superiors and customers. Also I have been diagnosed with emphazema, COPD and lung nodules. I am an oil burner mechanic and I am constantly exsposed to diesel fumes and soot and mold, ect. My primary doctor says I can’t work anymore, and my phyciatrist also wants to sign me out from work. I have been with the same company for 30 years. Could I get SS disability?
Matt,
Do you have a disability insurance policy through your employer? If so you can explore your options under any such policy. With respect to SSDI eligibility you will need to consult with an attorney that handles SSDI claims. If you need assistance finding one please feel free to contact our office and we can assist you with same.
I have just been written out of work by my regular physician for anxiety attacks. I am having 8 to 10 of these a day. I can not focus or leave my house because of fear. I am agoraphobic and have a really hard time facing people right now. I am filing for STD this week because I can not afford to not have an income. I have been written out for one month as of right now. What do I need to do to make sure the STD gets approved?
Amanda,
Unfortunately there is no way for us to advise you with such limited information as to how to present your claim in a way to give you the best odds of being approved. Please feel free to contact our office to discuss how we can assist you in filing for benefits.
I requested that my insurance company find a doctor to perform an IME. They have scheduled the appointment with a forensic psychiatrist. Is this common in a case regarding depression and anxiety? I’ve never been treated by a forensic psychiatrist, so why would they have a psychiatrist of this nature perform the review. Just curious. Thank you.
March31,
It would be an appropriate physician to examine you? Is there any particular reason you requested that an IME be performed? Is the carrier indicating they do not believe you are disabled?
I am on LTD with Liberty Mutual and they wanted me to use The Advocators Group that they work with to assist me with my appeal with the SSA. I don’t know if they are really working in my best interests or if they are really working for Liberty Mutual. Can you address this? It would seem this might be a conflict of interest and that I am not getting the best representation on my claim. The Advocator Group “waives” their fee so it would seem to me that they must be “employees” of Liberty Mutual. To date it doesn’t seem that they have even had any one with legal background even look at my documents or communicate with the SSA.
Also, I have many health issues not just several mental health issues and it is my understanding the SSA must consider all a persons health issues and rank them together for a total health picture. Is this accurate?
Louise,
You have no duty to use the Advocator Group and can use a SSDI attorney of your choosing. With respect to the fee received by SSDI, it is not waived – what happens is Liberty Mutual cannot apply the amount paid to your attorney by the SSA as part of the amount subject to offset – so it is essentially a “free” service regardless who you use. If you need assistance in finding a SSDI attorney to speak to please feel free to contact our office and we can assist you in getting in touch with one.
Hi, My Husband has been suffering from depression and anxiety for two years now. He was seeing a doctor through our insurance from his job at Metro, then the doctor advised him to try and go back. Because he had been out of work for a year already and disability was going to be up. But he had to see the Metro clinic doctor first, but the doctor from Metro said he was not ready to return. And then he was realized from Metro about a month later. They wanted him to come back and then take a family leave, but he couldn’t he was really bad and his dad was dying at the time. So it made things worse for him. Now he is still having a hard time just coming out of the room, and saying hello to the family when they come over. Do you Think we have a case? He still hasn’t applied for disability either?
Amber,
Did he have disability insurance coverage through the employer? Since he has been released he would not technically be covered under any employer policy but he could attempt to make a claim dating back to the time he went out of work. If he has sufficient work credit he could also look to file for SSDI disability.
I suffer from Bipolar depression and attempted suicide last Aug 2014. I suffered severe injuries and was out of work for almost a year. My insurance company denied my disability stating there is an exclusion in my policy that for injuries that were self inflicted. I have had several surgeries and still unable to work. Is there anything I can do?
Ricki,
Your disability could be prevented if the actual disabling condition is a result of the self-inflicted injury. However, if your claim for disability is based on the Bipolar diagnosis then you have a strong argument to make. Please feel free to contact our office to discuss further.
When brain scans or imaging show abnormalities, do insurance companies ever categorize the disabling condition as “physical” rather than “mental”? Some recent studies indicate very early childhood trauma can prevent normal brain development, and that this in many cases can be quite obvious in scanned images. Would this type of objective proof be able to counter the “self-report” label, which is commonly the basis for the 24-month limit on mental vs. physical (i.e. legitimate) disabilities?
Margaret,
It can certainly be argued, but it is no guarantee that it will overcome the specific language used in a policy. Many limitations for mental health will be defined to mean any mental health condition found in the DSM-V, regardless of cause.
I appreciate your prompt reply. That’s what I’d assumed regarding Insurance Co. resistance. Unfortunately, the scan is costly (can be up to $5000 out of pocket), not covered by health insurance (since not medically necessary), and no guarantee of what results will show. Then, even if physical abnormalities are obviously visible from scan, disability benefits may still be denied. Perhaps in some far distant future, the brain will be accepted as a legitimate part of the body?? Thanks again for responding, and for this consistently informative site.
I’m glad that it notes that depression and xaniet can be a secondary to my physical disabilities and also to my lost of employment, career. It has been almost 14 years since my injuries to my neck and back and still suffer from Major depressive disorder and chronic anxiety. I was only 29 when I got injured and canceled my first law school class. I’m now 43.i also damaged my PERPHERIL nerve from neck, carpopedal spasms, neuropathy in both hands, mental health issues, hallucinations, and tremors starting from my neck.
I hope this firm can assist to restore my LTD which were approved in 2006 and never received a termination letter from ING ( VOYA). I was lost due to my depression and the employer, probation det., never help me to accomadate me in a different position.
Daniel
Daniel,
I am sorry, but I do not quite follow your comment. Please feel free to contact our office to discuss your disability insurance claim with ING.
Hi I am Walter –
Just to give you a quick background on my situation, I developed cancer in 2014 which led to other conditions like major depression and anxiety disorder, this was also accompanied by chronic IBS condition all of this is medically documented. This made it very difficult for me to function. i had taken 2 medical leaves over the past year and a half, and i requested ADA accommodations several times in order to continue to see my doctor when i needed to do so as well as protection on those days when i developed flare ups, however, i truly believe that towards the end they were looking for ways to have me fired but because of the ADA their hands were tied and there wasn’t much they could have do but wait. upon return from my last FMLA i came back to a cleared desk, all of my personal items were boxed and it looked as if they were preparing to have me fired ( i took pictures) however, i did return and since than i noticed behavior changes in the work environment towards me. They were subtle but i could sense and see the irritation from my immediate supervisor. When i applied for my last ADA accommodation they gave me a deadline for the paperwork to be handed in, but my doctor was out on vacation at the time and could not fill it out, so they denied it because it was not in on a timely basis. I finally contacted the doctor and she called them personally explained to them that it was not my fault and they had her fax the ADA to them which she did along with a letter explaining the importance of having the ADA. The HR department contacted me and requested i send them my portion of the ADA form which i did, they than contacted me to say that their was a discrepancy between the doctor’s statement and mine. At the end she wanted me to redo the ADA papers again, which made it very difficult because at that point i was only given 4 to 5 days to contact my doctor which was nearly impossible due to her busy schedule. Shortly afterwards i got sick again, and i was than called to a meeting where my absences were discussed and i was written up and told if i would be out without prior notification and approval i would be further disciplined, and of course i got sick for almost 2 weeks after that meeting. During those 2 weeks I called on several occasions and left voice messages informing them that i was not coming in because i was still sick and i also told them i had doctors letters that i would submit upon returning. I than received a final letter of termination, according to them i did not continuously call to inform a supervisor of my absences although in the past 15 years past practice has always been to leave a voice message that you would be out sick for however time needed without the need to speak to an actual supervisor. They also said that they tried to contact me to be honest with you i don’t recall receiving those calls, however, this company and my supervisors knew that i can a preexisting condition and they also knew that flare ups and doctor appointments were going to be inevitable but they made it very difficult towards the end for me to get the needed accommodations.
Walter,
You may want to contact an ADA attorney to discuss any violations that may have occurred.
Hi my name is Brea A and I have currently been on STD/FMLA for about 4 weeks now. My doctor put me on leave because of my depression and anxiety, I’m lost, don’t know who I am anymore. And my life has completely been turned upside down, I’m not focused at all. Sadness has been a pillow of mine for a few months now. I kept telling myself that I would get better. But it just got worse from the headaches, not being able to keep food down, back, neck and shoulder pain that bothered me tremendously at work. I recently was told that I was denied on my STD because my doctor did not say why I wouldn’t be able do my job and what limitations there was… Which she did, in every way as possible. So now I’m facing more issues …not being able to pay bills that have not stopped since I’ve been out of work. This is so stressful and heavy …I just need some clarification and justice. I really can’t believe what is happening. Loss after loss.
Brea,
Have you received your formal denial letter? If so, please feel free to contact our office to discuss your claim in greater detail.
Hi,
I am getting divorced and will no longer be eligible for LTD insurance from my husband’s company. My company does not have LTD insurance. I have a history of major depressive disorder and an attempted suicide. I am on anti-depressant and anti-anxiety medications. What are my chances of getting LTD insurance (I’m still working and don’t plan on going on LTD insurance) and what companies provide it to people with a history of mental illness?
Amy,
There is a strong chance that a private disability carrier may not write you a policy based on the history of mental health conditions or exclude mental health conditions from coverage. Your best bet is to contact an agent to discuss your options for coverage.
Hi,
Several years ago I had a sexual harassment claim against a superior where I worked. It was handled very quietly and the gentleman retired early and is no longer allowed where I work, even to visit. Since that situation, many of my co workers have treated me differently, no more friends at work, they treat me very differently than before. Many people got wind of the situation and he had his cronies that hate me and make me feel uncomfortable. After that situation my son and his fiancé were in a very public situation which involved me to be in several months in court fighting the system for him and her. Both have received a long prison term and it was very public. Many of the local news vans were parked outside my home for several days. My coworkers still treated me badly. I also have MS which seems to flair up at certain times and I have custody of my 3 year old grand daughter which has rocked our world. We have been in a custody fight and my nerves have been shot. I cannot sleep, I am on Lexapro to stop me from crying, cannot concentrate, still cry uncontrollably, memory loss, short temper, fatigue, irritability, social isolation and my mind won’t stop. This past week, I had a meant down at school where the crying was uncontrollable and I threatened a younger girl at work. The threat was nearly to shut her up, not mentioned to take seriously. I never touched her, got in her face or thwarted around. I sat in a chair and said something inappropriate. Since this situation, I have been suspended from work and the staff will never treat me the same. It will be a very unhealthy work environment and I am already anxious about my return. Panic attacks have now begun. I believe that I am very depressed but I need to work. My husband is home with our granddaughter and I need to work, but am afraid to go back to work. And make matters worse, during my recent conference, my supervisors brought up an incident which happened during my sexual harassment time and are holding it against me. They also have brought up dealing outside of work where they have half of the story. I have a psychological evaluation coming up and I am concerned terribly about going back to work. Should I get a lawyer and can I collect permanent disability for stress. I cannot go back to work and I am a bundles of nerves, panic attacks and crying and my situation wile only continue and worse. Please advise me. The situation is much more horrible that you can image, but my world has been rocked for sometime and I need help. Thank you
Veronica, if you have short/long term disability with your employer then you should certainly consider filing a claim for same due to stress and anxiety. It seems you may have some type of action against your employer, but you would need to consult with an attorney that handles employment/labor issues. Please feel free to contact our office to discuss.
I have been out on std for approximately 6 weeks. 4 of those were approved and i’m currently seeking an extension. I see both a medical doctor and a licensed therapist frequently. Diagnosed with Severe Depression disorder. My extension is likely being denied – as the STD insurance company has advised me they are not getting supporting documentation from my doctors to support disability. My symptoms and conditions have not changed since they first approved the claim. Now I’m about ready to give up and just ask my doctor to release me back to work – of which I am extremely fearful and scared I will have the same continued issues I was experiencing that lead me to finally take the leave. My medical doctor stated that she felt the depth of questions was a violation of hipa laws. My therpist also received the request and she said the questions being asked are regarding serious brain degenerative issues of which in my case there is none.
Here’s my question – Do i have a write to see all these documents being reviewed by the STD insurance company nurse and for them to explain to me WHY my claim is not being approved when both my medical doctor and my therapost support and recommend time away from work due to my symptoms? IE: lack of sleep, lack of concentration, impaired cognitive skills, decision making / problem solving, retention of information – short term memory loss, anxiety attacks, irritability, extreme hi’s and low’s. Medical doc recommends 3 months off and STD wants to make things more and more difficult to approve benefits – I dont understand what is diffrent between the first time they approved and this second time they likely are not going to. I can’t sit here waiting without being paid – so am about ready to just throw my hands up and just go back to work and HOPE i don’t get fired. UGH – what a frustrating and extremely stressful process to go through.
Heather, the documents being reviewed by the nurse would likely only be your medical records. You would unfortunately, not have a right to see any documentation from the carrier in the claim file until such time that there is a denial of benefits. Have you discussed the problems you are having with your HR department.
Hello. I am 31 years old and had to resign from my job because of my anxiety. I have gotten to the point that I can barely even leave my house without taking my medication. However, all of the medication that I have been put on does not work that well and make me extremely tired to the point where I will fall asleep almost as soon as I take them. Is there any way that I could get disability for my anxiety?
I started having severe depression anxiety symptoms that effected my job. So severely that I couldn’t go in without forcing myself. Even throwing up. After some time I was released from my job. In the mean time I was awarded Ltd after extensive paperwork and doctors notes. After having been on it for a little over a year i never got a notice of discontinued coverage until I called in. My caseworker said they deemed me not eligible anymore though my doctors submitted the same paperwork as before. My condition hasn’t changed. In fact recently I have emense thoughts on suicide. Especially because of this. I need help.
Kelly, if you resigned from your job you may no longer be eligible for coverage under any disability policy as coverage usually ends the last day worked (if no claim is filed). Your only option if you are unable to work is a potential filing for Social Security disability.
Rob, ERISA gives you a finite amount of time with which to submit an administrative appeal of a denial of benefits. Please feel free to contact our office t discuss how we can assist you with same.
I am looking to file a LT disability claim through my employers disability insurance. The claim is due to the mental distress and harassment I have been suffering over the past couple of years. I just started seeing a counselor regarding my condition. At what point do I file a claim or inform my Human Resources manager that I am filing for disability? I am concerned that I will be reprimanded in some way for doing so and want to make sure I am protected. I also heard two sides that getting the disability can either be very difficult or not as as long as I have documentation from my doctor. Is that correct?
Thanks
Nancy, please feel free to contact our office with a copy of your disability policy to discuss how we may be able to assist you in filing claim. It is very important how the information is presented on the application.
I had breast cancer and subsequent treatments in 2014. I’m still on hormonal therapy medications that induce severe menopausal symptoms, bone pain, joint pain, muscle weakness but I continued to work until early this year without accommodation. Then, I had an MRI which found another lump. I went into panic mode and several tests before finding it was benign. Turns out to be another disease. I have multiple diseases and diagnoses but added anxiety over cancer recurrence and work related stress in February. After a nervous breakdown and thoughts of suicide, my psychologist suggested I take time off. I was approved for 12 weeks under FMLA but with several doctors forms, Cigna is still denying my short term disability benefits. They keep saying there is not signficant evidence of why I couldn’t work. My psychologist has filled out all of their forms and answered all of the follow up questions but they continue to deny it. What else can I do? I’m receiving weird looks and comments at work like I faked the whole thing. I’ve never had poor performance but now I am, because I can’t afford to not get paid again.
K, have you filed all of your administrative appeals with Cigna? If not, your course of action is to formally appeal the denials. If you have, then the only option may be to bring a lawsuit. Please feel free to contact out office to discuss your claim in greater detail.
I went out on STD a few months ago for depression,fatigue, anxiety etc. I just now got it approved because of several paperwork mix ups. The whole time (3 months) I have been running around, worring, stressed, emailing,faxing, calling etc… trying to get it approved, it’s just making my condition worse. Come to find out I was doing all this for the for NYS STD, not the one I pay extra for and where the majority of money was going to be coming from. I thought Unum and Hartford (who handles NYS for my company) were together!? My house is going into forclosure after the 31st of July (3 days from now) and I can’t believe that after finally getting an approval, it was only for the NYS STD and not Unum. I pay extra for more coverage through Unum. I get the sate pay for $170wk, and pay to get $1600 a month if Unum had approved it. So when the rep from Harford told me it was approved and they would be able to send the money to my account by this Friday, I was so relieved until she said the amount! Instead of $4800 which I was expecting she said $1300. I couldn’t believe it! How can Unum have specialists in behavior health claims accoring to their website and not cover it?? I don’t know what to do, I’m so scared I’m going to lose my house
I’ve tried calling and I either get the people who only know what they are reading, that it’s declined. Or I get the “I will transfer you to someone who can help” and they can’t. Even my HR Rep, who is very nice but has no knowledge about Unum. Every cent of that back pay was going to the mortgage!! Now what do I do??
Steve, I don’t quite follow your fact pattern- Unum has denied the claim or they are still reviewing it?
I been in long term disability for 2 years now. I have a depression and anxiety attacks. I lost concentration. I don’t want to get out from bed. Now Cigna want to go back to work. I have my feet on pain all day and night after a he’ll spur operation.
Amanda, most Cigna disability policies contain a 24 month maximum benefit to be paid on any claim resulting from a mental health condition. Was your claim denied on that basis? Please feel free to contact our office to discuss your claim in further detail.
I sent the message you didn’t quite follow the the fact pattern. I appoligize for that, I’m very frustrated lately. Yes Unum declined my claim. When I received the letter I called the Rep from Hartford who I had been dealing with the whole time not realizing they only handle our NYS disabilty. Anyway I told her I got declined and she said don’t worry that my claim is still pending but she didn’t realize the decline was from Unum not Hartford. Being in the state of mind I am, I did not realize we use both Hartford and Unum. Normally I would be up on all this kind of stuff. Long story short I was offered a plan that only covers very specific mental health issues. I did not know this when I purchased the plan 3 years ago. Talking with a friend in the business, I should have been offered a white collar plan because I am in sales, not blue collar like it seems to be. The specific mental health issues it does cover I do believe I have, I just can’t get more of an in depth explanation of what my Dr has to provide. Not sure what to do and I am about to lose my house and I’m scared that this is going to take more time to get me on track again. I just don’t know how they can not cover mental health issues. This is real and now it’s worse because of this financial situation.
Steve, please feel free to contact our office with a copy of the policy and any correspondence from Unum as to the denial of your claim to determine how we may be able to assist you.
Hi- I went out on FMLA 5/16/16 through 5/28/16 and was approved for STD starting on 6/5/16. I was called by my case manager for STD this morning advising me that as of 8/22/16 my STD was denied. He stated the nurses that reviewed my claim felt I was able to return to work and I had the right to appeal within 45 days. On 5/14 I found my son overdosed on my kitchen floor with vomit coming out of his nose and mouth and his eyes rolled back unresponsive. He was revived in the hospital and kept sedated in a coma state for two weeks to recover. After the overdose I was diagnosed with PTSD/depression and being treated by my PCP (for medication) and a psychologist on a weekly basis. I have constant flashbacks and dreams reliving the overdose and my insomnia has gotten worse. I still have not been able to find the right medication (I’m on my fourth prescription) to deal with the depression. I have trouble concentrating and often loose my thoughts in the middle of a conversation where I just go blank. I have difficulty making any decisions and have a great deal of self doubt. I feel that part of my brain has just shut down and I am trying everything possible to get it back but I am being told I have to learn to live this way which is just completely stressing me out. I am not capable to process an appeal for STD on my own at this time and I would like your advise on how to proceed- is it time to contact an attorney?
Linda, please feel free to contact our office to discuss how we can assist you in appealing your denial.
I have been on ltd for 21 months approved right away after visit from mass mutual to my home. I was a CEO of a software company and had patents pending which are now approved, unfortunately my disposition is to stay indoors and almost never go out side. This started after a drawn out legal battle with people I did business with, and while the case was going forward my mother died then my father was diagnosed with cancer. I tried to continue to work but my work product was definitely being affected. I couldn’t sleep, sad, susicidal thoughts and many other issues all this while my son was starting High School (Prep School) he worked so hard to get there, not only grades but 10 years of wrestling – he was excepted and started on the Varsity team, while felling the weight of knowing his father was not doing well, and to add to his weight, he couldn’t return because of the financial impact of me being sick. So, finally when my mental illness started to affect my wife, son and daughter I finally gave in to filing a claim. As mentioned, the claim was approved in short order and actually the wait period shortened. Now it’s 21 months into my disability covered by Mass Mutual and have been told that I have 3 months left, my family have adjusted to my income but I do t know what I am going to do, I am on 4 psych meds and 4 other meds for my heart (I’m 45 years old) my income has always been significant much more than what I receive, and welcome the day I’m back to my old self but today is not the day. I Mass Mutual has an unlimited aggregate, I want to go back to work, but in my field your reputation is the most important asset. So I think I need to go back to work regardless in 3 months then if things don’t work out I can revile, but I’m apprehensive of my board or other Senior Execs knowing my situation, which may ruin my valuable reputation. Can you please give me some information.
J, unfortunately, we wouldn’t be able to provide you any guidance regarding your return to work strategy or the route you should take, but we are willing to discuss your Mass Mutual policy. From my experience Mass Mutual IDI policies still contain 24 month limitations for disability caused or contributed by mental health conditions. If your policy contains such language there would be very little we could do to assist you in getting around that. Please feel free to contact our office to discuss your claim further.
I am 51 female veteran, diagnosed with ptsd, panic disorder, gad, mdd. I had worked for my company for 15 years. The above had been manageable till an incident at work increased the severity of them (I was burned in the military)-I was at work the batteries in the UPS room started to burn-fire department was called. I started seeing dr shortly after to review my medications and get further treatment. A few months later my symptoms increased and I could no longer manage. My doctor put me out for currently 6 months.
Mutual of Omaha put me thru many “hoops”. finally they sent me 2 checks. Then they said they needed more documentation. My doctor has sent them many medical records. Then they needed a Behavior Health Attending Physicians Statement-which my doctor has filed out-my current gaf is a 30. MOO then said they did not cover me because of a military clause. I then replied the military clause did not apply to me due-my accident was not a due to a war declared or undeclared and happened on American soil. Spoke to Laura again and told me it was not an issue. Just received word that they can not find a reason for me to collect disability
My employer has an insurance company that they work with for our STD and they seem to take a long time approving claims even though all of the documentation is giving and this can plus has caused a financial burden on my where my anxiety and depression kicks in to where I don’t feel good about myself because most of all my anxiety kicks in. Is there anything that I can do about this? Im always making the phone calls to my case worker and always get her voicemail or I talk with a representative and they keep telling me thst my case wasn’t approved….. Can you please help and give some advise of what to do…
Thanks
Lorie, MOO will have to issue you a formal denial letter explaining the reasons for denying your claim. Please feel free to contact our office to discuss the denial and how we can assist you in appealing the decision.
Melissa, insurance companies and third party administrators (TPA) typically have 30 days to render a decision on an application for disability with potential extensions under certain circumstances. If the company/TPA is not past its deadline there might not be much that can be done. Please feel free to contact our office to discuss your case.
I started to see a neurology in november of 2015 in MI. He didn’t find anything and basically didn’t explained why I was having so many symptoms then in March of 2016 went to NC to a Dr that specialized on finding of CSF leak and she found out that I was having Intracranial Hypertension which is also called Psedutumor she gave me medicine that is called diamox and my symptoms end up with side effect which made my balance, vision, nauseas, chronic pain, fatigue, focus, dizziness, major headaches worse. Went to my primary doctor in may 2016 to help me with my condition but took forever to refer me out due that I kept getting send back to the neurology that I had in the beginning then I made it clear to please find another one because I didn’t feel comfortable with my first. He also send me to the physical therapy but because he didn’t point out my trigger points it wasn’t helpful for my short term disability case. Also, he sent me to do a sleep study that took forever due that I end up having Excessive daytime sleepiness and prescribe me Provigil 200 mg in agust. Now I’m seeing a new neuro that believes that I still have psedutomor, hearing, vision, and something with my muscle pains. Still the STD denied me what should I do next since I was off for 3 months and didn’t got paid? I’m still working full time but is becoming hard to work due that I do Family Service Advocate
Tiredofbeingdenied, you would have the ability to go through the administrative appeal process to try to secure the STD benefits.
Dear Mr. Jessie:
My name is Nora. I am currently employed with United Heath Group. This year has really been a hard one for me.. In January, I lost my granddaughter who was born with Edwards Syndrome, then in March my grandson was hospitalized because of his asthma . Since February 2010, my spouse was diagnosed as disabled due to Hepatitis C and Cirrhosis. He is currently a patient at Methodist Specialty and Transplant Clinic. So since 2010, I was on FMLA (intermittent) at my previous employer and never had a problem. Then I started working with UHG in April 2014, I waited for my one year then I applied for FMLA for my spouse through the TPA Sedgwick which was approved . Then in March of 2015, I had a T.I. while at work, I was hospitalized and was approved for Short Term Disability from Sedgwick. Since then, I was also on intermitten FMLA for my spouse. Then on June 2, 2016, my spouse was diagnosed with Liver Cancer after using Harvoni for Hepatitis C. Then on August 18th he was involved in a motorcycle accident which left him with two broken legs, hip fracture, three broken ribs and wrist fracture. He was released from the hospital and transferred to a rehabilitation center where he is recovering. I applied for FMLA through Sedgwick on August 19th. I did receive my letter stating my FMLA will exhaust on November 11th, which I am aware of. With everything going on I never really thought to much of myself, until my son mentioned to me that I was losing too much weight and that I looked drained. I never realized this until I finally sought help which was at the end of September. I decided to go see a Psychiatrist. My last appointment which was on Thursday. I did inform her I would be returning to work on the 14th of November. She stated that I was not emotionally stable to return to work. I then called my case specialist at Sedgwick to see if I qualified for Short Term Disability for myself, and she replied that I did not.. Please advise on what to do next..
Thank you,
Nora
Nora, we would need to see any letter with respect to why you do not qualify for a disability benefit in order to be able to assess what your options/rights are.
My name is Greg. I was recently on short term disability for 2 months. My claim was denied due to a prior suicide attempt. However I was medically cleared from the suicide attempt and sought help for my major depression and anxiety. Do I possibly have a case?
Greg, we would certainly be willing to review your denial to determine what assistance we may be able to provide. It seems like the denial was potentially based on pre-existing condition language in the policy. Have you already appealed the denial? Have you returned to work?
Good Morning,
My sister, in her 40’s, recently changed jobs (there for about 6 years), was fired from the new job in October and now is starting her own consulting firm. In January was newly diagnosed with Bi-polar with a major psychotic episode and mania that required over 1 week involuntary hospital stay. I have seen my sister go from someone confident and able to work to someone that is now struggling to work. She is seeing a psychiatrist and therapist routinely. Her medications are consistently having to readjusted as she has panic attacks, racing thoughts and anxiety and many other issues. She needs time with the new illness and for the medication adjustments to work. Most medications take a minimum of 2 weeks to see if it effective and then more changes to the meds.
We do not feel my sister can work yet she is trying with the consulting company as she needs money but she does not seem close to capable to working or consulting. Her decision making is very poor at this time. Would she qualify for any assistance, disability or social security? Any help would be appreciated as we are new to Bi polar and are very concerned about the serious effects it is having on her ability to function and hold a job. But we realize that she needs money to live and hopefully get to a functioning stage at some point in time down the road with continued doctors visits, medication changes and help. Any help would be appreciated in guiding us to assist her with applying for short term/long term disability or social security or any other assistance available.
Ethan, if she does not have any type of employer provided or private disability insurance her only option may be to file for Social Security disability. However, to be eligible for SSDI she would have to be completely out of work. If she does have a private disability policy please feel free to contact our office to discuss her options under same.
My insurance company has denied my LTD claim for postpartum depression citing insufficient incapacitations or restrictions of my returning to work. I understand PPD doesn’t necessarily restrict work duties to SOME extent, but the medications my doctor prescribed took a toll on me. There’s no way I’d have been able to work well on the dosage of Xanax and some of the other heavy hitters. I’m appealing, but when discussing with my doctors, what is a better way to describe the medication factor? My doctor cleared my return after only three months, so I’m not asking for an extended amount of LTD.
Meg, if the side effects of the medication were the largest portion of the claim then they will need to address how those side effects prevented you from returning to work.
I am a 32 year old hotel manager with Marriott. I provide for my wife and two daughters as my wife watches our little girls until they get into school, ages 2 and 4. My wife also has Lupus and Ethlo-standros so most likely cannot work. I’ve been working at this Marriott for 4 years and they make around $60 million a year with well over 150 employees. I manage the Front Desk, office, lobby, gift shops and bellmen. I have been having panic attacks, anxiety and difficulties breathing (catching a “satisfying breath”) for over 2 years and it’s progressively getting worse. Because I’m salaried, I often work 60 hours or more and because of scheduling, often work 9 or more days straight. These shifts contain 7am to 5pm, 1-11:30 and a mixture of the two, swing shifts. On May 12th, I was told to take FMLA Leave. I was told to do so and basically forced to do so regardless of what they had me sign. Now about a month later, I’m worrying about my STD checks as I do have STD coverage that I pay for through payroll deductions. My therapist and psychiatrist are doing everything that they can and had started the process very early on. It doesn’t appear as if my employer is doing much to help and nobody from Marriott has contacted me to even ask if I’m alright. Is the process usually long to start collecting the STD checks because my therapist and psychiatrist do not recommend getting back into work until I’m fully recovered from my break down at work on May 10th. My therapist and psychiatrist are anticipating having me back up and ready for work by mid July. This is obviously creating more anxiety and panic as I am tapping into all of our savings just to get by and am afraid that we may run out of money without a steady stream of income. My psychiatrist and therapist believe I have severe depression, accute anxiety and panic disorder and possible manic/bipolar with extreme highs and extreme lows. Also probably PTSD from a violent childhood/past. Maybe it’s my personality and own issues but I feel as if my fellow Marriott employees and employers had completely abandoned me and when I contact the short term disability insurance company they do not assist me and do not answer my questions. My apologies as the first letter did not state that they forced me to take leave after witnessing somewhat of a mental breakdown during a management meeting. What I had signed for my employer (while I was in distress) signed and what my claim is for is “Voluntary STD Leave” when in reality it is “Involuntary STD Leave” as my employer did not give me any options. I had to sign the paper and take FMLA Leave and a loan from my 401K and use up all of my PTO. Any thoughts or ideas? Thank you in advance.
C, what is the status of your STD claim? If you have been out since May I am assuming that it has been filed? Please feel free to contact our office to discuss your situation in detail and to determine your rights under your STD and LTD policies.
I have been on STD for severe depression and anxiety through my company for approximately 3 months. My questions are, am I allowed to take a pre-planned trip if my therapist if fully aware and ok with it? If she recommends me to do a few hours of volunteer work or take a class online to help motivate me is that the same as trying to get me to exercise or is this something that might get my STD taken away? My job is extremely demanding (70+ hours a week) and my STD benefits are close to full salary, therefore I don’t want to jeopardize either. However, its hard to get better from severe depression if you never do anything outside the house.
Gary, there can always be a risk that the STD carrier could use the activity you perform against you. Without being familiar with the intricacies of your case we would not be in a position to advise as to your question regarding travel. If you do take the trip it would be wise to not post publicly to social media.
I have recently found that the disability insurance carrier that we have through my work is less than great. They have a record of denying claims. My doctor and my counselor are through the same facility, so they have been trying to coordinate. I have been on several medications, yet I am still having severe anxiety and depression. I have used my FMLA coverage, because thus far, that’s been the “easiest” to get approved.
At this point, I’m at the end of my FMLA rope, and have bills that need to be paid. One week was approved for STD, in the middle of several several weeks of abscences, and none of the others due to “insuffiecient” records. Does this make sense? I’ve been on FMLA for a period of time for the same 2 things, and yet only one week, randomly, in the middle of it was approved.
I was approved for short term disability by my work for 3 months, I have been under the care of a family doctor, a psychiatrist and a psychologist for over 2 years now. My condition will depression and anxiety has become worse at work so that is why I requested the 3 months off. Cigna is my insurance company that handles my disability claim. They approved me for pay the first month but I have to appeal them to get paid for the last 2 months because they stated it does not stop me from doing my everyday activities in which my psychologist stated in her notes it did. How do I fight this in my appeal? I only gave them notes from my psychologist because I figured that would be all they needed. They told me they had one of their behavioral therapist look over my notes and claim and they stated that’s why they declined the other 2 months because 1 month was all I needed but how can they determine that especially when I had doctors with PHDs that actually treat me every 2 weeks give them the correct information. Please advise?
Dani, please feel free to contact our office to discuss your claim and situation in greater detail to determine how we may be able to assist you.
LC, first and foremost it will be important to provide Cigna with all applicable medical records. Additionally, as your claim is for STD benefits I would recommend you also contact your HR department to let them know the issues you are having in securing the final two months of benefits.
Hello,
I was diagnosed with ADHD, General Anxiety Disorder, and Major Depression. I was granted short term disability, then was told that I had to pay for the health insurance while on disability. Of, course, I was paid 60% of my salary and couldn’t afford it. I ended up having to apply for LTD. My STD was up six months ago, and I have no money coming in. I got another letter stating that they would drop me from the health insurance. Can they do that?
Laleata, not all companies continue to provide health insurance while on disability. If your employer does not continue health insurance while you are on disability you may need to apply for COBRA (or as they indicate) to maintain coverage.
I was diagnosed with Complex PTSD and have been receiving Short term disabilty benefits since July. My last extension was denied because I have not seen the psychiatrist due to my job and insurance being terminated. The psychiatrist had previously requested the extension through 12/17 but they only approved through 12/3. It’s not like my Complex PTSD is going to go away by itself. What can I do?
Teresa, your only option would be to appeal the decision. I would also suggest you contact your psychiatrist to see if they would be willing to write a statement for you as you have not been able to afford treatment.
I lost my teenage daughter five weeks ago to an unexpected tragic death. I am currently on a three month approved leave under FMLA. I have been a registered nurse at the hospital I am employed with for 15 years and have never had to take a leave of absence and so I have three months of extended sick leave pay that I am recieving now.
I am experiencing true PSTD symptoms and have been going to counseling but have not been to a doctor and had an official diagnosis. I am hoping these symptoms subside before my three month leave is up, but my concern is that the possibly could not. It seems to have gotten harder instead of easier.
I have a long term disabiliy policy and was wondering if I would qualify for this until I can heal.
Thank you
Dawn, I am so sorry about your loss. I can’t imagine how hard that is for you. I would be happy to review your STD and LTD policies free of charge and let you know if you would qualify. Please contact my office for a free consultation and ask for Rachel Alters.
I have been receiving emails/letters from an absence management company stating that STD has been approved for 6 weeks. All of a sudden, at the end of week 8, I received a letter stating that the 2 months of work that I have missed due to anxiety and depression are now only approved as FMLA. I have had other ongoing issues with joint pain, fatigue, muscle pain and hypothyroidism. I am desperately trying to find out why I feel so poorly. I have already deposited my pay from the STD status I thought I had. I have worked hard on taking vitamins, de-stressing, going to doctors appointments. I have an appointment in September with a Rheumatologist and an appointment with an Endocrinologist in August. I have tried hard to get in sooner. I am so stressed that I am not covered under STD. I’ve also been told by co-workers that when I return, my boss will seek to make me miserable and ultimately fire me. I have worked very hard for my company and have had good performance reviews.
Lynn, if your disability claim is denied then the claims administrator will send you a denial letter. You should contact one of our attorneys to discuss your options once you receive the denial letter.
I have a friend who took a formal leave and applied for STD. After the insurance rep went over how much he would receive for the time he was hospitalized and in intensive treatment, stated that they now see that it was due to a psychiatric condition and that there is an exclusion in their policy regarding mental health. Is it legal to have a short term ‘disability’ coverage that excludes mental health conditions?? Does ADA protect individuals from this type of problem?
What are people’s options if they are under psychiatric care, and are working on recovery in order to return to work but need income to cover bills in the meantime?
Thank you
Jerry, yes, it is legal for a disability insurance plan to limit or exclude some medical conditions from coverage. Although the STD may exclude mental illnesses from coverage, your friend’s long-term disability plan likely limits benefits to 24 months of payments from disability caused by a mental nervous condition.
I am being asked by Aetna to sign a disclosure of psychotherapy notes for their review for my STD claim for mental health issues. They state it can delay approval or approval can be denied because without this they won’t have enough information. I am in an intensive out patient program, I go mon-Friday 10-4:30, the physiatrist recommended disability, the treatment center filled out all documents requested.
Can they deny my claim if I won’t let them read my personal therapy notes? The whole though of this is making my anxiety and depression worse.
Denise, I understand this is a difficult situation. The carrier is entitled to request any/all documentation it feels is reasonably necessary to making a determination on the claim. You could suggest some other options but in all likelihood they will continue to press for the actual records given that the claim is based on mental health issues. And in the end, they could potentially deny the claim for alleged lack of sufficient information on which to make a determination. You could have your treatment provider(s) request that the records be sent directly to and viewed only by the carrier’s medical consultant to limit the scope of people that have access to the records.
My aunt has been diagnosed with severe depression and anxiety. She was in an IOP treatment that concluded due to insurance limits. The therapist suggested a Partial hospitalization program but this is not feasible due to transportation issues and fear it will put her over the deep end. Please note a doctor on staff who has never seen her made this recommendation. She has a personal psychiatrist and therapist. I spoke to the counselor and we did agree that she would contnue to see her private therapist once or twice a week. Could this be seen as noncompliance or refusal of treatment and interfere with her std benefit approval since we made the decision for her?
Missy, I am sorry to hear of your Aunt’s situation. Without a review of the medical documentation, there is no way to even begin to predict what the insurance company might say. However, always remember that there is more than possible avenue for treatment and the fact that a treating therapist agreed to continue private therapy sessions seems to show that she is incompliance. Should the insurance company deny her claim, please do not hesitate to give us a call.
Have you ever helped negotiate lump sum buyouts for “to age 67” mental/nervous disorder claims on individual policies WITHOUT the 24 month limit?
HI Dave. Yes. I would be happy to discuss with you. Please email me at Rachel@diattorney.com and I will give you a call to discuss.