What You Should Know Before You Read:
- Long term disability insurers treat mental health disability claims with significantly more suspicion and scrutiny than many physical disability claims.
- Most LTD policies impose a 24-month limit on mental health benefits, creating financial incentives for insurers to deny or shorten these claims.
- Mental health symptoms are more difficult, if not impossible, to measure through imaging or laboratory testing, allowing insurers to challenge credibility and minimize impairment.
- Dabdoub Law Firm focuses exclusively on disability insurance claims, representing clients nationwide with a proven record of success. Our firm was built to win disability insurance cases.
Why Mental Health Disability Claims Face Greater Scrutiny
Mental health disability claims are among the most closely examined and frequently challenged claims in the disability insurance industry.
Many LTD policies limit coverage for conditions such as depression, anxiety, bipolar disorder, and post traumatic stress disorder to a maximum of twenty four months of paid LTD benefits. This limitation gives insurers a strong financial incentive to restrict these claims at every stage, including evaluation, approval, and review.
At the same time, mental health conditions often lack the type of objective medical evidence that insurers prefer, such as imaging or lab work. Instead, diagnosis relies heavily on clinical evaluations, reported symptoms, and functional assessments. Insurers use this lack of objective data to challenge credibility, question severity, and dispute the existence of true impairment.
How Insurers Evaluate Mental Health Disability Claims
Disability insurance companies typically follow predictable patterns when reviewing mental health claims. Each step introduces opportunities to undermine the claim.
1. Heightened Requirement for Detailed Records
Insurers expect extensive psychiatry or psychology notes, therapy records, diagnostic evaluations, and consistent treatment. Any gap in care, even if justified, can be used as grounds for denial.
2. Requests for Frequent Updates
Mental health claims often trigger more frequent requests for progress notes, questionnaires, and updated assessments than physical disability claims.
3. Reliance on Paper Reviews by Non Treating Professionals
Insurers frequently rely on in-house psychiatrists, psychologists, or behavioral health nurses who never meet the claimant. These reviewers often conclude that symptoms are not severe or that treatment is insufficient. We commonly see insurers claim that because there is no higher level of care, the claimant is not that bad.
4. Demands for Proof of Functional Impairment
It is not enough to have a diagnosis. Insurers want evidence that symptoms affect daily functioning and the ability to sustain work activity. Without clear functional descriptions, the disability insurance company will scrutinize and deny the claim.
5. Use of Surveillance
Insurers sometimes conduct surveillance to identify activities that appear inconsistent with reported symptoms. These activities are often taken out of context or misinterpreted.
6. Emphasis on Treatment Compliance
Missing sessions or refusing certain treatments, even for valid medical reasons, may be cited as noncompliance and used as grounds for termination.
Why Mental Health Claims Are Often Misunderstood
Many mental health conditions involve fluctuations in symptoms. A person may function relatively well on certain days and be unable to leave their home on others. Insurers tend to misinterpret these fluctuations as improvement, exaggeration, or lack of severity.
Additionally, many mental health conditions are invisible. Symptoms such as panic, cognitive dysfunction, dissociation, or suicidal ideation cannot be captured through imaging. Without objective markers, insurers apply skepticism rather than clinical understanding.
Insurers also misunderstand how work environments trigger or heighten symptoms. A claimant may complete daily tasks at home but be unable to tolerate workplace pressures, interactions, or cognitive demands. Insurers often ignore these distinctions.
Common Reasons Insurers Use to Deny Mental Health Disability Claims
Mental health based disability denials often rely on recurring themes.
1. Alleged Insufficient Objective Evidence
Insurers claim the condition is not measurable, even when treating providers offer clear clinical assessments.
2. Lack of Specialist Treatment
Insurers argue that treatment by a primary care provider, rather than a psychiatrist, is insufficient.
3. Gaps in Therapy or Missed Appointments
Even when caused by symptom severity, insurers use these gaps to question the legitimacy of the condition.
4. Failure to Show Functional Impairment
Insurers claim symptoms are not severe enough to interfere with work, even when they clearly do.
5. Overreliance on Brief Office Notes
Short therapy notes may not capture the depth of impairment. Insurers use their brevity to argue improvement.
How to Strengthen a Mental Health Disability Claim
While insurers heavily scrutinize mental health claims, there are several steps claimants can take to strengthen their evidence and reduce the risk of denial or termination.
1. Maintain Consistent Care with Qualified Providers
Regular treatment with psychiatrists, psychologists, or licensed therapists helps demonstrate the seriousness of your symptoms.
2. Ensure Documentation Includes Functional Information
Providers should describe how symptoms affect concentration, stamina, mood, and stress tolerance.
3. Be Honest and Direct During Appointments
Underreporting or overreporting symptoms creates misleading records that insurers use against you.
4. Follow Reasonable Treatment Recommendations
This includes medications, therapy, and evaluations. If you cannot tolerate a treatment, have your provider document the reason.
5. Keep a Symptom Log
Daily notes showing things like mood fluctuations, panic episodes, cognitive difficulties, or insomnia can help build a detailed record.
6. Work With an Experienced Disability Insurance Attorney
Mental health claims often fail not because the condition is insufficient, but because the insurer exploited documentation weaknesses. A skilled attorney can help create a strong record from the beginning.
What To Do If Your Mental Health Disability Claim Is Denied
A long term disability denial is not the end of your claim. You have the right to appeal, and many mental health denials are overturned when the appeal is prepared correctly.
Steps to take immediately:
- Request your entire disability claim file.
- Review the insurer’s reasoning with a long term disability attorney.
- Strengthen medical evidence with updated records and detailed opinions.
- Address gaps, misunderstandings, and misinterpretations in the documentation.
- Build a comprehensive administrative appeal before deadlines expire.
Under ERISA, the appeal stage will likely be your only opportunity to submit additional evidence proving your disability. Once the appeal decision is issued, the record is closed.
How Dabdoub Law Firm Can Help
Mental health disability claims require precision, strong documentation, and experienced legal strategy. Dabdoub Law Firm was built to win disability insurance cases, including those involving depression, anxiety, PTSD, bipolar disorder, or other psychiatric conditions.
We help clients nationwide with:
- Filing mental health disability claims
- Appealing denials or terminations related to mental health limitations
- Challenging misuse of the twenty four month policy limit
- Preparing detailed ERISA appeal records
- Litigating disability claims in federal court
- Negotiating lump sum settlements
You pay no fees or costs unless you win your case. If your mental health disability claim has been denied or is being closely scrutinized by your insurer, contact Dabdoub Law Firm at (855) 276 3760 to speak with an attorney today.