Disability Insurance Continues To Deny Valid Mental Health Claims

Disability insurance is designed to provide people with income when they can’t work due to their disability. Today, the number of recipients is at an all-time high, with approximately 75 disability recipients per one thousand U.S. workers. It’s clearly costing taxpayers more and more money each year.

Although there are people who take advantage of the disability insurance system using claims of mental illness, there are legitimate claims that are overlooked. For instance, some people suffer from depression so severely that they can’t interact with other people. For some, this makes holding down a job impossible.

Most people can’t go a month without a paycheck, without running into financial trouble. Without a paycheck, rent, car payments, student loans, credit card bills, and household expenses pile up quickly.

People battling mental health issues need financial help just as much as those with physical disabilities. However, they often can’t get the disability benefits they need because unlike a physical disability, their needs are harder to prove.

Symptoms of mental disorders are subjective and can’t be proven with blood work or x-rays. Symptoms are often self-reported, and diagnoses are made based on observation. Unless a person has a long history of mental instability, getting disability insurance is difficult.

This problem is long standing

For decades, people suffering from debilitating mental health issues have been unjustly rejected for disability insurance claims. Insurance companies have been able to get away with denying legitimate claims, in part, because it’s an invisible disability, even when backed up by a psychiatrist. There’s also a tendency for people, including claims examiners, to discredit the validity of mental illness.

Krysten Laib applied for disability insurance while she took a leave of absence from her job as a nursing assistant. She was counting on long-term disability insurance to support her while she took the time to recover. Her insurer denied her claim, despite validation from her psychiatrist. Twenty-five days later, Laib committed suicide by jumping off of a bridge.

Insurance companies are in business for profit, and although it’s not right, it seems like they deny as many people as they can, hoping they won’t fight back.

Insurance companies rely on the fact that most people don’t understand how to file (and win) an appeal. The system isn’t designed to make it easy for the average person to navigate. It’s understandable that so many would just give up. However, many people do fight back – with a lawyer.

While many are unjustly denied, others misunderstand the criteria they need to meet in order to qualify for long-term disability benefits. Becker Law explains the basic criteria for qualifying is “a medically diagnosed condition that will keep you from any gainful work for at least 12 months or you must have a terminal condition to qualify for benefits.” Additionally, you must have worked a job covered by Social Security and contributed to the Social Security system for a certain period of time.

Those qualifications aren’t difficult to meet, but since proof of mental illness is subjective, those applicants have the deck stacked against them.

Sometimes insurance denies claims due to suspected fraud

Of course, there’s always the potential for fraud where insurance is concerned. People fake disabilities all the time. Just a couple of years ago, retired police officer Terry Johns, 56, of Corona, CA, was caught committing insurance fraud by collecting nearly $250,000 in pension and salary payments while on leave due to what he claimed was a bad back.

Johns was caught engaging in activities he shouldn’t have been able to perform with his reported health condition. He’s reportedly facing up to 12 years and 6 months in prison for workers’ compensation fraud, attempted perjury, and two counts of insurance fraud.

It’s a tough situation for all

Insurers are in a difficult position, so its understandable that they’d be more cautious about approving claims that can’t be easily verified. It seems like the best solution is for people to start establishing a history of their mental illness long before they need to apply for a claim.

Melissa Thompson
Melissa Thompson writes about a wide range of topics, revealing interesting things we didn't know before. She is a freelance USA Today producer, and a Technorati contributor.