Some may associate disability with physical impairments like the inability to walk or stand. However, disabilities are not limited to physical ailments and many people suffer from disabling mental health conditions. Proving that a mental health condition is disabling can be challenging because disorders like major depression and bipolar disorder may take time to conclusively diagnose.
In order to prove that a mental health condition is disabling, a person’s medical treatment must document the severity of symptoms over an extended duration. This requires that the claimant regularly treat with a psychiatrist and/or licensed psychologist. Although a therapist or counselor may treat someone for mental health problems, the Social Security Administration and long term disability insurers give more weight to the opinions of licensed psychologists and psychiatrists rather than therapists or counselors. Generally, the Social Security Administration affords more weight to the opinions of accepted medical sources, like a treating psychiatrist or psychologist, while long term disability insurance companies more freely pick-and-choose which medical opinions they rely upon to make a determination.
Severe mental health problems can also be evidenced by visits to the hospital and inpatient treatment. Some mental health listings under the Social Security Administration require episodes of decompensation. Medical records of a hospitalization can serve as strong evidence of an episode of decompensation. Moreover, the opinions from third parties, like a family member or friend, may help show episodes of decompensation. Any person who has been able to observe the claimant’s personality or behavioral health over time can provide relevant evidence revealing the severity of the claimant’s mental health condition.
An important resource for mental health impairments is the Diagnostics and Statistics Manual of Mental Disorders (DSM). This resource is useful because it can be used to show that someone with longstanding symptoms meets the diagnostic criteria of a severe mental disorder. The DSM can be used as a tool to show that the claimant’s symptoms meet a particular mental disorder while ruling out less severe disorders.
Another issue that often arises in mental health treatment is a patient’s ability to comply with their providers’ treatment. Although patients’ mental health issues may pose a challenge to complying with taking medication or otherwise following the physician’s treatment plan, it is essential for a claimant to document that they have done everything in their power to follow their treatment plan. If a claimant does not follow a treatment plan, it may appear as though the claimant is not actively attempting to comply with their medical providers’ orders. Any indications that a claimant is unwilling to follow a treatment plan may adversely affect the claimant’s disability claim.
Although mental health claims can apply to both long term disability insurance and Social Security disability benefits, there are important distinctions between the two types of benefits. First of all, most long term disability insurance policies have limitations for the amount of time which a person can receive long term disability benefits from a mental health condition. It is common for a long term disability insurer to limit the maximum duration of a long term disability claim to 24 months if disability is caused by a mental health condition. Even if the claimant also has a physical condition, the insurer may attempt to apply a limitation for the duration of benefits due to a mental health condition. However, there may be exceptions to this limitation, including conditions caused by organic brain disease or dementia.
Conversely, Social Security disability claims are not limited in duration due to mental health conditions. In fact, the Social Security Administration has a set of listings for adult mental disorders found at the following link: 12.00 Mental Disorders. If a claimant does not meet a listing, they can still prove disability if they otherwise show that their condition is so severe that it prevents the claimant from performing any substantial gainful activity. The Social Security Administration also considers the combination of physical and mental health conditions when considering if someone is disabled. If someone with a mental health problem does not have any physical impairments, it may be challenging to prove disability unless they meet or equal the listings defined by the Social Security Administration.
The O’Ryan Law Firm handles long term disability claims and Social Security disability claims. We may be able to help you if your benefits have been denied. Please contact the O’Ryan Law Firm today so that we may investigate your long term disability or Social Security disability claim.