Disability Insurance Claims

Generally speaking, in order to be diagnosed with a mental disorder, the psychological symptoms that you are suffering from need to fall into the definition of something specific. For example, someone with wild mood swings might be bipolar or schizophrenic, depending on the other symptoms that they display. But when someone has several different symptoms that don’t fall into the pattern of any known disorder, they are harder to diagnose.

The DSM-5 changes that for at least one specific subset of patients in this situation by creating a new disorder: psychological factors affecting other medical conditions.

If you’ve been following along recently, you probably know that we’ve been covering some of the changes that have been made in the DSM-5 and how they might impact your disability claim. Today we’re going to focus on a specific condition and the diagnostic criteria that you need to meet in order to be diagnosed with the disorder.

As always, this information is generalized and meant to give you an idea about what you may face if you file a claim. The best way to get advice about your specific situation is to set up a free consultation with someone at an experienced disability firm.

One of the big changes from DSM-IV to DSM-5, in regards to Long Term Disability Benefits, is that a number of somatoform disorders from the older Diagnostic and Statistical Manual have been given new titles and descriptions in the current manual. There are several reasons that this was done.

We’ve already discussed some of the perceived problems that individuals and organizations, who are working towards Long Term Disability, had with DSM-IV and why the switch was made to DSM-5. The hope was that by implementing some of the more recent research and making certain structural changes to the Diagnostic and Statistical Manual of Mental Disorders, professionals would be better able to identify and treat the problems of patients.

Of course, that’s the goal with every new version of the DSM. Whether or not it is actually successful at doing this is something that only time can tell. The thing that is important for those filing disability claims to know is how the changes might impact their ability to get the benefits that they need. In order to do that, they have to understand what kinds of changes were made.

Getting an RTW (or return-to-work) designation after your disability has led you to filing a claim for long term disability benefits can be incredibly disheartening. After all, you wouldn’t have gone to the trouble of filing the claim if you thought you could just make a few small changes and continue to go to work every day, so for many being told that they can return to work is like sentencing them to 40-plus hours of pain, guilt, and embarrassment every week.

Most people, if they had a choice between sitting at home and receiving long term disability benefits or going to work and earning a living, would jump at the chance of being able to return to their job. It’s not about getting a paycheck for doing nothing – it’s about physically or mentally not being able to do the work.

This is why it’s so important that claimants understand what it means when they receive a finding of RTW or return-to-work. What the evaluator is saying is that they believe the demands of your job are a match for your abilities – even with your condition. If you don’t agree with this, you need to look at the specifics and figure out where the disconnect is.

We’ve mentioned before that one of the issues with functional capacity testing for long term disability claims is that there is no across-the-board test that is used by everybody. While one examiner might decide to try an isokinetic lift test, another may opt for one that is psychophysical. The differences in these testing methods can potentially lead to problems and questions of fairness, but FCE tests aren’t entirely without policing.

In order to resolve your long term disability insurance claim, you are almost certainly going to need to go through a functional capacity exam to help determine your ability to perform specific physical and mental tasks. You might think that these tests will be straightforward and simple to “pass” – after all, you’ve got a real condition and it’s making your ability to live normally difficult – but unfortunately that isn’t always the case.

Throughout the examination, you’ll be asked how bad your pain is and how often you feel it, as well is how much physical labor is required by your job and how frequently. If you don’t know the specific definitions they’re using for words like “occasionally” or “moderate,” it’s entirely possible to self-diagnose yourself incorrectly and have that used against you.