Does Disability Insurance Cover Depression
- Asked May 23, 2013 in
Contact Ted Ratliff Contact Ted Ratliff by filling out the form below
Ted RatliffPROOwner, SFS Associates, As long as it is not a pre-existing condition or excluded in the policy it may be depending on the company and terms of the policy. Each company has different guidelines. Depression can be disabling. Check with a local experienced independent agent who specializes in life and health insurance. A good agent can help you select a plan right for you.Answered on May 24, 2013+0
Contact David Racich Contact David Racich by filling out the form below
David RacichPROFountain Hills, ArizonaAssuming the question is asking about developing depression after the disability policy has been in force and past the any contestability of the company, the answer is yes. But if depression is a preexisting condition, the odds are almost impossible to obtain. Most businesses that offer group plans have short term disability that may include depression. Youll need to check with your companys human resource department to confirm. Answered on May 24, 2013+0
How Long Can You Be On Disability For Depression
You can remain on disability for depression for as long as your depression prevents you from working. You may no longer be eligible for disability benefits if your mental health improves and you are able to return to work. The SSA will periodically review your case to determine whether you continue to be eligible to receive SSDI. If your depression improves and you return to work, you must notify the SSA right away.
If youre still receiving SSDI when you turn full retirement age, then your disability benefits will transfer to retirement benefits. The amount of money you receive will remain the same.
Social Security’s Standard Listing For Depression
Social Security publishes a list of common, serious illnesses that qualify for disability if they meet the specified criteria. The purpose of the list is to be able to grant disability quickly for severe impairments. Clinical depression is covered in Social Security’s impairment listing 12.04, Depressive, bipolar and related disorders. The listing includes a set of symptoms and a list of functional problems you must have to qualify for either Social Security disability or SSI disability benefits on the basis of depression.
First, you must show you have severe depression by having at least five of the following symptoms:
- depressed mood
- feelings of worthlessness or guilt
- thoughts of death or suicide, and/or
- a slowing of physical movement and reactions, including speech, or increased physical agitation, such as hand wringing or pacing.
In addition to having at least five of the above symptoms, you must also meet “functional” criteria to show that you have a loss of abilities due to the mental disorder. Generally, you must have an extreme limitation in at least one of the following areas, or a “marked” limitation in at least two of the following areas:
- understanding, remembering, or applying information
- interacting with others
- concentrating, persisting, or maintaining pace in performing tasks, and/or
- adapting or managing oneself.
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Fayetteville Arkansas Disability Attorneys
Ken Kieklak, Attorney at Law, is an Arkansas Social Security attorney that fights for disabled Arkansans in the Fayetteville area. Ken can help you file your social security claim based on your mental disorder, physical ailments, handicap, or any other disability. Even if your disorder is not on this list, you may still qualify for Social Security. Call 316-0438 today to schedule a free consultation on your Social Security Disability needs.
Symptoms Of Depression And Bipolar Disorder
Clinical depression is a mood disorder marked by persistent feelings of sadness, isolation, and agitation that interfere with one’s daily life. Depression may also be manifested in physical symptoms that include fatigue, sleeplessness, and changes in appetite. Those with severe depression may experience crying spells, hallucinations, delusions, and suicidal thoughts or actions. The causes of depression are not exactly known, but are thought to include chronic pain, stress, substance abuse, and genetic factors. Treatment usually consists of talk therapy and/or medication.
Individuals with bipolar disorder, also called manic-depressive disorder, experience feelings of depression alternating with episodes of mania. During a less severe “hypomanic” episode, individuals may be highly energetic and productive, while more severe “hypermanic” periods might feature racing thoughts, hyperactivity, sleeplessness, impulsive decision-making, or irritability.
Those with acute forms of bipolar disorder may experience psychotic symptoms, including delusions and hallucinations. Depression and manic episodes can cycle back and forth rapidly, over a period of a few hours, or slowly, over weeks or even months. People who experience mania and depression at the same time are said to be in a “mixed state.” Treatment for bipolar disorder often consists of a combination of counseling and mood-stabilizing or antidepressant medications.
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Mental Health Professional Statements
In support of your medical records, statements about your mental health condition from your mental health professional is a vital piece of evidence in your claim. Cooperation from your doctors is vital to the success of your claim. It’s also important for your treating doctor to understand how to file the paperwork correctly, meet critical deadlines, and how to deal with insurance companies in long-term disability claims.
What To Do If Your Stdi/ltdi Benefits Claim Is Denied
How Do I Know if my Disability Claim is Denied?
If your claim is denied in whole or in part, you will receive written notice of the denial. This denial letter will include:
the specific reason for the denial reference to the policy provisions upon which the denial is based a description of any additional information that may be necessary for you to perfect your claim, including why such information is necessary a description of the policys internal administrative appeal procedures an explanation of the claims administrators basis for agreeing or disagreeing with your treating providers opinions, the medical experts it hired to review your claim, and the Social Security Administrations determination you are disabled .
How do I File a Disability Claim Appeal?
You have 180 days from the date you receive the disability claim denial letter to file an internal administrative appeal. The denial letter will include instructions for submitting the appeal. It is important to strictly follow your plans administrative appeal process, as failing to do so could forever waive your right to pursue your claim for these benefits.
What Should I Include in the Disability Claim Appeal?
In addition to including the information described in the denial letter as being necessary to perfect your claim, you may also consider including the following:
What Happens While the Appeal is Being Reviewed?
Additionally, in some cases, the claims administrators may even have you surveilled.
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What Should I Do If My Claim For Std / Ltd Benefits For Mental Health Conditions Related Or Unrelated To Covid
If the insurance company calls you or sends you a letter to tell you that your STD / LTD benefits have been denied or terminated, it is important that you act quickly. The longer you go without an income the more difficult things will become for your financial situation and the resulting stress may aggravate your existing mental health condition.
Sometimes the insurance company might offer you the opportunity to provide additional information as part of an internal appeal of the denial/termination of your claim. This may be an option for you if you have not previously provided all the information you and your doctors had related to your claim.
If you have already provided everything and you are not medically or functionally able to return to work, then your only option will be to hire a lawyer to sue the insurance company for your disability benefits. It is important to remember that there are limitation periods for commencing a lawsuit and you do not want to have your claim dismissed based on suing too late.
If you are considering applying for STD/LTD or if your STD/LTD has been denied or terminated, or if you have any questions regarding making a claim for STD/LTD benefits due to a mental health condition that is related or unrelated to the COVID-19 pandemic, we encourage you to contactMK Disability Lawyers to discuss your options and your approach.
Filing A Claim For Stdi/ltdi Benefits
Who is Eligible to Claim Disability Benefits?
If your employer offered STDI or LTDI coverage and you enrolled in this coverage , you are eligible for these disability benefits. Typically, you must have been covered under the policy for a specific amount of time before you are able to file a claim for benefits. Your policys Summary Plan Description and/or Plan Document will explain this specific time period.
You should have automatically received a copy of the Summary Plan Description when you enrolled in coverage. While you do not automatically receive a copy of the Plan Document, you may request a copy from your plan administrator .
How Do I File a Disability Benefits Claim?
To start your disability benefits claim, you should request STDI/LTDI claim forms from your plan administrator, which is probably your HR department. If you are unable to get these forms from the HR department, you can reach out directly to the claims administrator . The claims administrator and their contact information should be listed in your policy documents.
Application Documents Required from You, Your Employer, & Your Doctor
In most cases, the claim forms are comprised of three parts:
a form for you to complete, sometimes referred to as the Claimant Statement or Employee Statement, a form for your employer to complete, sometime referred to as the Employer Statemen,t and a form for your treating provider to complete, sometimes referred to as the Attending Physician Statement.
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Long Term Disability Claims Based On Depression & Anxiety
If you suffer from depression and anxiety and are claiming benefits under a long term disability policy, you must prove your condition is disabling under the disability definition found in your insurance policy. Moreover, you must meet all other requirements of your long term disability policy in order to be approved. In general, this means you must demonstrate your depression and anxiety are so severe they prevent you from performing your job . Documentation of your disability from your treating providers as well as factual evidence from you and your family, friends, and co-workers can all be used to secure your claim.
Typically, long term disability policies limit recovery for claims based solely on mental health claims to two years each plan is different, however, so review the plan terms carefully. If your depression and anxiety issues were caused by an underlying physical health problem such as chronic pain, then you may be able to receive benefits beyond your plans mental health limitation. To secure these additional long term disability benefits, you will need to develop medical evidence showing your physical impairment alone renders you disabled. An experienced long term disability attorney can help develop the necessary evidence.
The Different Kinds Of Disability Insurance Policies And How They Work
There are two basic types of disability insurance coverage: Short-term and long-term. Both provide a benefit that replaces a portion of your earnings, ranging from 50% to 80%. That money can be used to pay for living expenses, repaying loans, or even put into savings. Despite those similarities, the two kinds of policies are bought differently and work somewhat differently, in large part because short-term needs differ from long-term needs.
Most disability is temporary, keeping a person out of the workplace for under a year. Short term disability insurance is designed to replace income for these shorter periods of recuperation from injury or illness. STD is typically obtained as part of a group insurance plan through the workplace, either as a mandatory or voluntary benefit. These plans typically pay a benefit for three to six months.
Other types of disabilities are more severe, longer-lasting, and even permanent. Long term disability insurance is for these situations, with a benefit designed to last for many years even through retirement if needed. Unlike STD, which most people get through work, LTD is often purchased as an individual insurance policy, especially by business owners and higher-income professionals who are concerned about what might happen to their familys lifestyle if they were no longer able to practice their profession.
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My Disability Insurance Rejection
I started shopping for a group disability policy through a professional organization. The monthly premiums were much cheaper than an individual policy would be, so I was eager to submit an application.
I filled out the forms, sent my paperwork, and felt a sense of relief until I received a painful rejection letter a couple of weeks later.
I didn’t make it past the first couple of sentences before angry tears filled my eyes. The company rejected my disability insurance application because of my past history of depression. I felt betrayed, vulnerable, and shamed by their decision. The sting of being deemed “too risky” to insure for disability felt like the ultimate rejection.
After weeks of complaining by phone and email, I was finally able to get the insurance company to reverse their decision.
The underwriters needed proof I was no longer depressed from my healthcare providers, so my psychiatrist and therapist each sent a letter on my behalf. These letters confirmed my current mental health status and were enough for a reversal.
The Five Basic Features Of A Disability Policy
No one wants surprises when the time comes to make a disability claim. Thats why every disability policy, whether short-term or long-term, defines five items that clearly spell out when you can qualify for benefits, how much you can get, for how long, and under what circumstances:
- Premium: The monthly amount you pays to keep coverage in effect.
- Benefit: The amount you get each month you are unable to work, which is typically a percentage of your actual salary. In an individual LTD policy, the benefit usually isnt taxed in a group STD plan paid for by your employer, the benefit will be taxable.
- Benefit period: The maximum length of time you can receive benefits. For short term disability, its almost never more than one year for LTD, it can be as little as two years or go all the way to retirement.
- Waiting period: Also called an elimination period, its the amount of time after you are disabled until you can start receiving benefits. Its often two weeks for short term disability insurance, and six months or more for long term disability insurance.
- Definition of total disability: Every disability policy has a specific definition of what it means to be totally disabled in order to qualify for benefits. This whats covered? question is the focus of the next section.
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What Are Some Of The Issues I May Face In Applying For Disability Benefits Due To Mental Health Conditions During The Covid
This article will focus on issues related to applying for short-term and long-term disability benefits for a mental health condition during the COVID-19 pandemic.
We will aim to address the following issues which you may be facing if you are struggling to work due to a mental health-related condition which may or may not be related to the COVID-19 pandemic and for which you are considering applying for STD or LTD benefits:
Short Term Disability Insurance
On the other hand, short term disability income insurance pays out benefits for those who experience temporary injuries and ailments. It is typically provided through an employer group plan.
Although you can purchase an individual short term disability insurance policy through some companies, many financial experts advise against it. Thatâs because the cost of the premiums may not justify the amount you would receive in benefits. If you canât get short term coverage for free from your employer, you should establish an emergency fund.
Short term disability insurance will typically replace between 40 to 60 percent of your pre-disability income. Benefits generally last three to six months. Some policies may pay as long as two years. Benefits typically begin 14 days from when disability occurs.
Learn More:Short Term Disability Insurance
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The Disability Insurance Underwriting Process
Your risk of becoming disabled plays a large role in determining how much you will pay for coverage. So how exactly do insurance companies calculate your risk of becoming disabled?
Individual disability income insurance requires underwriting. Whereas group plans help insurers spread their risk among a large group of policyholders, issuing an individual policy requires the insurance companies to assess the risk of a single applicant.
Before you get caught up in the cost, it helps to understand the various factors that insurance companies look at when assessing risk.
Mental Illness Is A Top Cause Of Disability
According to the World Health Organization, depression is one of the top causes of disability. When you add in anxiety, bipolar disorder, post-traumatic stress, and other mental disorders, mental illness is a factor in the vast majority of disability cases worldwide. In the United States alone, one in five people live with a mental health disorder, and about 4% of us have severe mental illness.
Our mental health also has a profound impact on our ability to work. Many mental health disorders cause symptoms that interfere with our jobs, including:
- Poor attention and concentration
- Mood swings and personality changes
- Problems with decision-making and executive functioning
- Suicidal thoughts and self-harm
Globally, its estimated that we lose $1 trillion in productivity each year due to depression and anxiety.
Because our mental health issues are so profound and evaluating how severe a mental health condition can be very difficult, insurance companies have tried to lower their costs by limiting coverage of these conditions. Whether you have an employer-sponsored group disability insurance plan or a private policy, you need to understand insurance companies tactics and how to respond.
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