Hi, I’m Nick Ortiz. I’m a board certified disability insurance attorney.
Today I’m here to talk to you about severe depression disorders and long-term disability claims. You may be here because you’ve stopped working because of a severe depression disorder, and you’ve applied for long-term disability benefits and the insurance company has denied your claim. You’re wondering what it is that you need to provide to the insurance company in order to prove up your case
Well, just being diagnosed with a condition does not necessarily mean that you’re entitled to benefits. What the insurance company is looking for is evidence of the severity of your condition, and how it limits your ability to work activity. So, the most important thing that you can do is provide evidence of the impact that your condition has on your daily life, which shows why you can’t do work activity.
The insurance company is looking for medical records from your treating providers, which in the case of depression maybe a psychiatrist, psychologist, a licensed mental health counselor, a therapist, or something along those lines. They’re looking to see that in the notes, the treating provider shows that your condition is so severe, that you cannot do your activities of daily living, or work activity.
For example, it may show that your depression is so significant that you can’t leave the house, you can’t be around other people, you can’t maintain attention and concentration for two hour intervals. That you’re easily off task. That you have a ton of projects that you’re working on, none of which have been completed. The insurance company is looking for those types of findings to show why it is you can’t do the work activity and why you’re eligible for benefits under the plan.
They’re looking for a continuity of treatment, which means they’d like to see the frequency of treatment. Generally speaking, in a depression disorder they’re looking to see visits once a week or every two weeks. One to two times a month is about average they’re looking for. So, if someone’s only going once every six months, then that seems to show a less significant impairment.
Put another way, you know that a depression disorder can vary in severity from very minor or mild, to very severe. Some people, they might be able to take some medication, go to see their counselor, and they’re able to function pretty well on a day to day basis. So, their condition might be a little bit more mild and still be able to perform work activity.
But then, there are others who they may be seeing their counselor once a week, taking all their medication like they’re supposed to, and yet their depression is so significant that it really paralyzes them from being able to do things around the home and in a work setting.
So the question is, where are you on that scale? The more evidence that you have that shows that you’re on the more severe side of that scale, the better. One of the ways that you can identify your level of impairment is through a medical source statement, or an attending physician statement that identifies the extent and severity of your impairments that you have.
The insurance company may provide you with this type of form, but we have custom forms that we use in our office. But, this is the type of evidence the insurance company is looking for. So, if you’ve been denied, they’re probably telling you there’s insufficient evidence to support your claim.
What the insurance company is not looking for is a generalized statement from your doctor that you cannot work. What they want to know is, what’s the rationale behind that conclusion that you cannot work? And more specifically, what are your impairments in terms of your abilities to say, be around other people, to be around co-workers, to be around the general public, to respond to criticism in a work setting and things like that. So again, the more evidence that you can provide with respect to those areas, the better.
If the insurance company has denied your case, you do have legal rights. They should spell out for you what you need to do to appeal, and if you need assistance with that appeal, then you may consider hiring an experienced depression long-term disability attorney to help you in your case. Our office has experience in handling depression cases, and we would look forward to speaking with you to see what we could do to assist you in your claim.
If you’d like to talk to an experienced attorney with our office here today, then I encourage you to give us a call at 850-898-9904. I’m also making available a book that I wrote called The Top 10 Mistakes That will Destroy Your Long-Term Disability Claim. You can download a free copy today if you visit www.freeltdbook.com. Thank you for listening, we’ll look forward to hearing from you.