Why Do Disability Claims for Mental Health Often Get Denied?

Published on September 13, 2017, by Matthew Sharp

Insurance Bad Faith

Why Do Disability Claims for Mental Health Often Get Denied?

Mental health disability claims are often denied due to insufficient medical evidence and failure to get appropriate medical treatment. Mental illness is considered an invisible illness, so documented medical proof is required.

Mental Health Disabilities

Mental health disability insurance is provided by both federal and state programs that assist people living with life-limiting mental health disorders. The two primary mental health disability programs are Supplementary Security Income (SSI) and Social Security Disability Insurance (SSDI). When mental health disorders interfere with a person’s ability to complete necessary tasks for the daily living, he/she may be eligible for mental health disability benefits. Mental health disability claims handled by a disability insurance attorney commonly involve mental health disorders such as depression; anxiety; panic disorders; bipolar disorders; obsessive-compulsive disorder (OCD); post-traumatic stress disorders; social phobias; and addictions.

Eligibility for Mental Health Disability

Determining eligibility for mental health disability is usually not a simple process. The affects of mental health disorders vary from person to person, so qualifying for benefits require clear, documented medical evidence. There is a list of disorders under SSI guidelines, but being diagnosed with one of the disorders on the list doesn’t automatically qualify someone for benefits. The level of impairment is the main factor that determines eligibility for mental health disability. A mental health disorder must:

  • Interfere with a person’s ability to work and provide financial support for himself/herself
  • Significantly reduce a person’s capacity to complete everyday tasks necessary for daily living
  • Prevent a person from taking care of himself/herself or caring for others

Claim Denials

Unfortunately, claim denials for mental health disability are common. Insufficient medical evidence and failure to get appropriate treatment are the two main reasons for claim denials.

Medical Evidence

Since mental illness is considered to be an invisible illness, the documented medical evidence is required for disability eligibility and benefits. Reporting symptoms are not enough evidence to prove disability. All doctor visits and treatments must be clearly documented by medical professionals. This may include a detailed letter to the insurance company detailing the claimant’s symptoms, treatments, restrictions, and limitations.

Appropriate Treatment

Because mental illness is typically considered to be a treatable condition, in most cases a person must be actively engaged in regular, ongoing medical treatments with a physician or a psychiatrist to be eligible for disability benefits. Since psychiatrists are considered specialists in treating mental illness, an insurance claim may be denied if a person is not seeing a psychiatrist.