Was your disability claim for a mental disorder denied by Social Security, an insurance company, or the VA? Do you worry your monthly LTD benefits might be terminated?
As a national disability benefits law firm, a large portion of the cases we handle involve mental health-related claims. Mental illness affects every walk of life and every profession. According to the National Institute of Mental Health, nearly one in five U.S. adults live with a mental illness. Depression is a leading cause of disability worldwide.
Not everyone with mental health issues qualifies for disability benefits. Yet severe mental disorders, or a combination of mental and physical impairments, can significantly impede one’s ability to work. It is harder to obtain disability for mental health disorders alone than physical ones because the severity of any mental illness can be quite difficult to measure objectively.
Probably the most important tip for increasing your chance of winning disability benefits based on a mental disorder is to be under the regular care of a qualified doctor who follows the best practices for treatment of your mental health issues. The Social Security Administration would agree with this, as we explain next.
Winning Social Security Disability Insurance Benefits (SSDI) for Mental Disorders
With the Social Security Administration (SSA), disability is all-or-nothing. You are either 100% disabled or you’re not disabled. Social Security defines a disabling physical or mental condition as one that has lasted (or is expected to last) at least a year or result in death. The disorder or combination of disorders prevent you from doing work you did in the past, and it must keep you from adjusting to other work.
As with physical disorders, in your disability claim you must prove to the SSA that your mental impairment is severe enough that you cannot work and you should collect monthly SSDI payments. SSA gives you two ways to do this:One way is to show that your mental disorder meets or equals the criteria in the “Listing of Impairments” maintained by the SSA. If you satisfy the specific listing criteria, you are considered disabled and need to go no further in the evaluation process. SSA categorizes mental impairments into the following 11 numbered sections under Listing 12.00.
| SSA’s Medical Listing 12.00 – Mental Disorders | |
| 12.02 Neurocognitive disorders | 12.08 Personality & impulse-control disorders |
| 12.03 Schizophrenia spectrum & other psychotic disorders |
12.10 Autism spectrum disorder |
| 12.04 Depressive, bipolar & related disorders | 12.11 Neurodevelopmental disorders |
| 12.05 Intellectual disorder | 12.13 Eating disorders |
| 12.06 Anxiety& obsessive-compulsive disorders | 12.16 Trauma- & stressor-related disorders |
| 12.07 Somatic symptom & related disorders |
- If you cannot meet a listing, then you take the next step which is to show that your mental disorder is so limiting to your ability to function in daily life that you could not reasonably be expected to sustain ongoing work at a 40-hour per week job.
Why Would SSA Deny Your Mental Disorder Claim?
Most claimants who apply for SSDI based on a psychiatric condition face the following reasons for denial of benefits:
- Poor diagnosis: Your claim lacks an explicit diagnosis by a qualified specialist.
- Underdeveloped evidence: Your claim did not provide satisfactory treatment history and longitudinal evidence of a mental disorder.
- SSA believes you are employable. This means that while you may have a mental health problem and even a combination of mental and physical disorders, SSA may decide that, based on the information provided in your claim including the mental RFC, you are still able to do sufficient work-related activities.
- SSA does not find you to be credible. Mental health conditions like depression and mood disorders, cognitive defects, or somatoform disorders are very subjective and based on self-reported symptoms. SSA also looks for “malingering,” which means someone is faking, overstating, or exaggerating their symptoms.
An experienced Social Security Disability lawyer will ensure the SSA receives the properly completed forms, medical documentation, and evidence it requires to award benefits in a mental disability claim or on appeal of a denied claim.
For a free legal consultation, call 800-562-9830
Long-Term Disability (LTD) Benefits for Mental Disorders
You may have long term disability insurance coverage under your employer’s benefits plan or under an individual insurance policy. Insurance companies do not make it easy to get the LTD benefits you’re entitled to, and this is particularly true with claims based on mental disorders.
In a long term disability insurance claim, there is no industry-wide definition of mental or physical disability. Every policy has a specific definition of disability that you must meet to qualify for benefits. There may be different specific levels of disability. Policies will be a blend of various definitions.
Among the claims we review for depression, anxiety, PTSD, bipolar, and other mental disorders, a common thread is that insurance companies use the same reasons over and over to deny or terminate payments.
Most employer-provided group plans and some individual policies will limit disability benefit payments for what they call “mental and nervous” conditions, where benefits end at 24-months or earlier. Disability companies push mental health-based claims into this “mental/nervous” category, without regard for how severely you may be limited and the total picture of your condition.
This also affects LTD claims that are based on a combination of physical and psychiatric conditions. Insurers will attempt to pigeonhole the claim under the mental and nervous category, hoping that you will not understand that such denials can be appealed and won with the right evidence and arguments.
We find that many insurers view mental health disability claims as generally not “severe enough” or the claimant is malingering, or it’s all in the person’s imagination. Do not be surprised when you receive arguments that you have not followed your prescribed treatment and medication regimen (their assumption being, if you did you would be better.) Also, be prepared for a denial because the insurance company says the mental disorder is a preexisting condition. Insurers deny valid claims all the time as a means to contain costs and remain profitable. You need a highly qualified long term disability lawyer that deals strongly and effectively with multi-million dollar insurance companies. If you have been denied LTD benefits, you should not sign anything from the insurance company without first consulting with us.
Veterans Disability Compensation for Mental Disorders
Mental or psychiatric disorders may qualify for VA disability if they resulted from an event that occurred during your military service. The VA reports that more than 1.7 million Veterans received treatment in a VA mental health specialty program in the fiscal year 2018.
Mental impairments are likely the most difficult health conditions the VA will rate because of their subjective nature. There are few measurable factors in cases of depression, anxiety, post-traumatic stress disorder, or psychotic disorders.
Also if a veteran has multiple mental disorders, he or she is only given one mental disorder rating. The VA’s theory is that mental health symptoms are so similar, they cannot be separated; all symptoms are combined and rated as one.
To reach its assessment, the VA uses two references:
- Mental Disorder Criteria in the VA Schedule for Rating Disabilities (VASRD), and
- Diagnostic and Statistical Manual of Mental Disorders (DSM–5) published by the American Psychiatric Association.
VA will review all of your evidence to evaluate how your mental impairment and symptoms impact your ability to function and interact in life and at work. When so much depends on collecting fair compensation, you don’t need to go against the VA’s bureaucracy alone.
An experienced veterans attorney can make a world of difference.
At the law firm of Marc Whitehead & Associates, our VA-accredited lawyers handle compensation claims for military veterans across the U.S. with various mental health problems. If you are unsatisfied with your rating decision or need assistance with your claim, call to discuss your options and how we can assist. We will help you establish service connection, handle matters of preexisting diagnosis, and deal with unsatisfactory ratings.
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Get Immediate Help with Your Mental Disorder Disability Claim
Call our firm, ask us questions, and get accurate answers. We understand that a mental disorder can suddenly and unpredictably disrupt your family’s finances and stability. We are here and ready to help with all aspects of your claim.
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