Depression isn’t just a sad mood – it’s a severe clinical condition that can lead to serious problems in functioning for those who suffer from it. The symptoms of major clinical depression can make it difficult to carry out your day-to-day activities, including working.
If your depression interferes with your ability to perform your job duties, you may consider filing a long term disability insurance claim. While depression can qualify you for long term disability benefits, there are certain challenges that come with getting a mental illness claim approved by your insurance company.
Here’s what you need to know before filing your long term disability claim for depression.
What Are the Disabling Symptoms of Depression?
Clinical depression (also referred to as major depression or major depressive disorder) is marked by pervasive feelings of sadness, despair, and loss of interest in activities you once enjoyed. It is caused by a chemical imbalance in the brain.
The way depression manifests may differ from case to case, but the most common underlying symptoms include:
- Pervasive feelings of sadness and worthlessness (lasting consistently for longer than two weeks);
- Fatigue and loss of energy;
- Inability to concentrate or focus;
- Slowed speech and physical movements;
- Unusual sleep patterns (insomnia or excessive sleeping);
- Loss of interest or enjoyment in all activities;
- Loss of appetite and/or significant change in body weight; and
- Suicidal thoughts.
Any of these symptoms, if presenting severely and frequently enough, can be disabling.
Though it may be obvious to you why you can no longer work with depression, your insurance company will require details of all your symptoms and the ways in which they specifically impair your ability to perform your job duties.
Remember that depression presents differently in each person. To fairly evaluate your long term disability claim for depression, your insurer must understand how your condition personally affects your functioning.
How is Depression Diagnosed?
Before filing for long term disability, the first step is receiving a diagnosis for your depression. The insurance company will require proof of diagnosis to approve your claim.
A doctor will be able to give you a correct diagnosis. First, a doctor may conduct a physical examination, blood labs, or other testing to rule out other health conditions causing your symptoms.
If your symptoms are not caused by other illnesses, your doctor may conduct a mental health evaluation. Your doctor may also provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating depressive disorders.
Your doctor or mental health professional will likely conduct a full diagnostic evaluation. By interviewing you on your moods and behaviors, and how long these symptoms have persisted, your doctor will determine whether you are suffering from clinical depression.
In addition, your doctor or mental health professional may question you on any family history of depression or other mental illnesses. Your doctor or mental health professional may also talk to your close relatives or spouse to see how they describe your symptoms and family medical history.
Types of Depression
Your insurance company may also want to know what type of depression you suffer from. Some types of depression may have overlapping symptoms but are categorized differently by their length and severity. Other depressive disorders have symptoms unique to their type.
A few types of depression include:
Major Depressive Disorder
Also know as “major depression”, this is a common type of depression marked by classic depression symptoms, with episodes lasting weeks to months.
Persistent Depressive Disorder
This is a type of depression similar to Major Depressive Disorder, but with symptoms that last two years or more. However, symptoms may fluctuate in severity, and can be less intense than Major Depressive Disorder – though still impairing function.
Unlike Major Depressive Disorder or Persistent Depressive Disorder, those with Bipolar Disorder experience episodes of mania along with depressive periods.
How Do You Prove You Cannot Work Due to Depression?
Anyone who has suffered clinical depression understands that it can ruin your career and relationships alike. However, you should never assume the insurance company will understand how your individual symptoms impact you and your job. To increase your chances of claim approval, you must explain why each of your symptoms prevents you from performing your job duties.
For example, during a depressive episode, you be unable to get out of bed due to your severely depressed mood and fatigue forcing you to call in sick. You may be preoccupied with your debilitating symptoms and unable to focus, concentrate, or pay attention during an important meeting or telephone call with your biggest client. Or your lack of interests, low energy and feelings of hopelessness may make routine tasks seem overly stressful or cause you to procrastinate and miss a strict deadline.
There are many ways depression symptoms can impair your ability to work. These need to be explicitly outlined in your evidence when submitting your claim.
Write A Personal Narrative About Your Depression
Given the varying symptoms of depressive disorders, you should explain to your insurance company how your individual symptoms prevent you from performing your job duties. You can do this by preparing a detailed, written narrative for the insurance company. In many cases, it is helpful if the narrative addresses all your symptoms by listing them separately first. Because most symptoms of depressive disorder are subjective in nature, your narrative can also address the severity of your symptoms, as well as factors that trigger or exacerbate your symptoms.
Provide Evidence From Your Doctor(s)
When determining whether your depression is disabling, your insurance company will likely also want the opinions of your treating doctor(s). Your doctor’s support is key. Your doctor’s reports should focus on:
- The frequency and severity of your symptoms;
- Any positive mental status exam findings;
- Their direct observations of you during office visits; and
- The specific restrictions and limitations that prevent you from working.
Undergo a Neuropsychological Evaluation
In addition to a personal narrative and supportive reports from your treating doctor(s), you may consider undergoing a Neuropsychological Evaluation. A neuropsychological evaluation will measure your cognitive deficits.
Neuropsychological testing objectively and scientifically measures how your disability is impacting your cognitive functioning. This includes memory, learning perception, problem solving, speed processing, verbal functioning, and executive functioning, among other things. The evaluation usually also includes IQ testing and screening for any primary or secondary psychological diagnoses. It also will include validity testing to demonstrate the reliability of the test results.
Many conclusions can be drawn from a valid neuropsychological evaluation, including your primary diagnosis, secondary diagnosis (if applicable), and your deficits in specific areas of cognitive functioning. The results provide the insurance company with strong and objective evidence to demonstrate how and why your depression impacts your ability to work.
Your narrative, doctor’s support, and additional neuropsychological testing will all go a long way in helping to prove your depression long term disability claim.
Get Appropriate Treatment for Depression
When evaluating your depression long term disability claim, the insurance company will want to see you’re receiving appropriate treatment. Even if your claim is approved, they will still require proof of ongoing treatment for your condition.
The insurance company can easily use non-compliance and lack of appropriate care as a reason to deny or terminate your depression long term disability claim.
To demonstrate appropriate treatment, your treatment team should include specialists such as a psychiatrist and/or psychologist. Treatment options may include:
- Medications: Your doctor may prescribe mood stabilizers; antipsychotics; antidepressants; and anti-anxiety medications. It may take some time (and trial and error) before you and your doctors find the right medication or medications.
- Psychotherapy: Your doctor may recommend psychotherapy, which may include individual counseling (to help you address specific problem areas, recognize your symptoms and manage your stress); cognitive behavioral therapy (to help identify negative thoughts, change your behaviors and come up with coping strategies); and interpersonal and social rhythm therapy (to help come up with a routine for daily activities such as sleeping, eating, diet and exercise).
- Day Treatment Programs: Your doctor may suggest an out-patient day treatment program designed to help you recognize and control your symptoms.
- Hospitalization: If you are experiencing suicidal idealization, your doctor may recommend an in-patient hospitalization. In-patient treatment may help address your symptoms, stabilize your mood, and keep you calm and safe while doing so.
- Electroconvulsive Therapy: Electroconvulsive therapy, while rarely used, can be helpful if you are experiencing severe depression that is not relieved by medications or other treatment methods.
Again, it is important to follow your doctor’s recommendation. Your insurance company will want to see you are in treatment and doing everything in your power to improve your symptoms.
WARNING: LTD Policies and Mental Illness Limitations
One thing to keep in mind when filing for long term disability is whether your long term disability insurance policy includes a Mental Illness Limitation.
Policies that contain a Mental Illness Limitation typically limit your benefits to two years if you are disabled due to a psychiatric condition such as depression or anxiety. Of course, each policy is different, so the prescribed maximum period may be shorter or longer depending on the terms of your particular policy.
Some policies with Mental Illness Limitations contain exemptions for certain mental conditions – occasionally, bipolar disorder is exempt, though most other depressive disorders are not.
If you are solely disabled due to depression and your policy contains a Mental Illness Limitation that does not exempt it, your benefits will most likely stop when the maximum allowable period expires. Unfortunately, the severity of your mental illness will become irrelevant after the maximum allowable period expires.
However, if you can demonstrate that you are disabled due to objective cognitive problems, your benefits may extend beyond limitation period. A neuropsychological evaluation, as discussed earlier, can provide this evidence.
Depression is a serious medical condition that may result in disability. Knowing how to substantiate your claim will significantly increase your chances of approval. To get your depression long term disability claim approved, your claim should be supported by sufficient medical evidence and proof of appropriate treatment. It is also important to explain (in detail) how your symptoms prevent you from performing your job duties. Don’t assume the insurance company understands. You have to explain it.
If you are suffering from any of the symptoms above or if you have already been denied disability insurance benefits but have depression, our New York long term disability lawyers can help. Call Riemer Hess LLC at (212) 297-0700 for a consultation on your disability case.