Long-term disability insurance is designed to provide financial support when individuals can no longer work due to medical conditions caused by injury or illness. However, claims for benefits can often be denied, particularly when the underlying condition is related to a mental health condition, such as depression. Understanding the reasons behind these denials and how to navigate the claims process is vital for those whose claim for long-term disability benefits for depression is denied.
Eligibility for Long-Term Disability Benefits Due to Depression
Generally speaking, in order to be eligible for long-term disability benefits due to depression you will require a formal diagnosis from a qualified mental health professional. This may include evaluations from psychologists, psychiatrists, or licensed clinicians. Included with a formal diagnosis the severity of your depression symptoms must be documented, in particular when the onset of symptoms started. These findings are required to establish the depression and that it applies to the period for which you were covered under your long-term disability policy.
Simply having depression is not enough to trigger coverage. An insured must demonstrate how their depression symptoms hinder their ability to perform their employment in specific, or potentially any employment whatsoever. This often involves providing evidence showing that their condition has led to absenteeism, reduced productivity, or a complete inability to work.
Common Challenges for Long-Term Disability Claims for Depression
There are numerous reasons why long-term disability claims are commonly denied, and despite providing complete medical documentation, many insureds face hurdles when filing a claim for long-term disability benefits due to depression that are specific to mental health-related disabilities.
Society has come a long way with respect to recognizing the significant impact that mental health conditions can have on an individual’s quality of life and functioning. Unfortunately, there is still significant stigma and misunderstanding relating to mental health in general, and certainly within the insurance industry. Insurers often question the validity of so called “invisible illnesses” (i.e.: illnesses without objective causes, like a benign brain tumour or a spinal cord injury) where the impact of the illness is not easily quantified and it requires subjective reporting. In cases such as these, insurance companies will often assert that an insured should be able to return to work after X amount of treatment and if the insured is not returned by that point simply cut them off from their long-term disability benefits.
Insurance companies often require proof that the claimant is actively participating in a treatment plan, which may include therapy, medication, or alternative treatments. Non-compliance with treatment can be a reason for claim denial. However, when you have depression and motivation, decision-making, memory, and anxiety are significant symptoms, failure to actively participate in your treatment may be a symptom of your illness, not a shirking of your responsibilities under your contract of insurance. Regardless, insurance companies will seize on things like these to deny legitimate long-term disability claims for depression.
How an Experienced Long-Term Disability Denial Lawyer Can Help
The experienced insurance denial lawyers at Taylor & Blair LLP can assist you with your denied long-term disability claim for depression. We will:
- Provide a Free Consultation: Your first meeting with us is free of charge. In the initial consultation we will go over the denial of your long-term disability benefits, and the strengths of your case.
- Make Sure You Understand the Basis for Denial: Our experienced insurance denial lawyers will carefully review the denial letter you received from your insurance company to understand the reasons for the denial.
- Review Your Insurance Policy: We will review your long-term disability insurance policy to understand your entitlements under the policy and the specific criteria under your policy for receiving long-term disability benefits and make sure the insurance company has properly adjudicated their decision.
- Contact Your Insurance Company: We will contact your insurance company and obtain a copy of your entire insurance file with them. This will contain all the information they used to adjudicate your claim for long-term disability benefits, including internal communications.
- Gather Supporting Documentation: Our firm will collect all the documents you need to prove your ongoing disability. This can include medical records, test results, letters from treating physicians, and other relevant documentation that supports your claim for long-term disability benefits. Insurance policies often require the insured to provide the documents they base their decision on so make sure you give them everything they need.
- Get Your Doctor On-Side: Once you have reviewed the denial letter and your insurance policy and have a good understanding of why you were denied long-term disability benefits, we will often contact your doctor and discuss the basis for the denial with them. If you have your doctor on your side, it can make challenging a denial of long-term disability benefits much easier in the long run. In certain cases, if we require the opinion of a specialist Taylor & Blair LLP has longstanding relationships with medical specialist experts in a variety of fields who can provide us with expert opinions on the severity of your disability.
- Start a Lawsuit to Enforce Your Rights: Sometimes you need to start a lawsuit to enforce your rights to the long-term disability benefits you contracted for. We will start the lawsuit and move it forward to ensure that you receive the benefits you are entitled to.
If Your Long-Term Disability Claim for Depression Was Denied
If your claim for long-term disability benefits due to depression has been denied, contact the experienced insurance denial lawyers at Taylor & Blair LLP today for a free consultation.
There are strict timelines in which you have to bring a lawsuit to enforce your rights to your long-term disability benefits. To help expedite a review of your claim, please have a copy of your long-term disability policy and the letter denying your long-term disability benefits prepared for our review.