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DO INSURERS CONSIDER DEPRESSION A DISABILITY?

Leanne Goldstein

Depression may be considered a disability if the symptoms you experience as a result of your depression affect your ability to function in the workplace.

Insurance companies often contest disability claims based on depression. This is largely due to the “subjective” nature of claims based on depression. Depression claims are “subjective” in nature as there are no diagnostic tests that can confirm a diagnosis of depression, and the insurers see the condition as largely based on the claimant’s self-reporting of symptoms. It is not uncommon for insurers to deny depression disability claims on the basis that there is no “clinical” or “objective” evidence of impairment.

Insurers base their decision to pay disability benefits on a number of factors beyond your doctor having given you a diagnosis of depression. In doing so, the disability insurance carrier is attempting to determine whether your condition is severe enough to meet the applicable test for disability under your disability insurance policy.

Frequency and Course of Treatment

Among the factors that insurers consider when evaluating disability claims based on depression:

  • The treatment providers you see
  • The frequency and course of your treatment
  • The number of times per week or month you see your psychiatrist and/or psychologist
  • The type of medication you take
  • Whether that medication is being adjusted up or down, and
  • Any hospitalizations, inpatient treatment or attendance at hospital group programs.

If you are not seeing a mental health professional, the insurer may argue that you are not participating in appropriate treatment which could, in certain circumstances, result in a termination of your disability benefits. When considering what constitutes appropriate treatment, it is important to understand that there are different types of treatment providers that treat mental illness.

Psychiatrists are licensed medical doctors and are able to prescribe medications, which they may do at times in conjunction with psychotherapy. Although psychologists hold the title “doctor” they do so because they hold doctorate degrees and not because they are medical doctors. Psychologists cannot prescribe medications but focus primarily on psychotherapeutic techniques which may include cognitive and behavioural interventions. Social workers and psychotherapists also provide treatment for depression in the form of counselling services and emotional support. Insurers consider the type of treatment provider you are seeing when they evaluate the severity of your depression claim.

Activity Levels

In determining whether or not you meet the test for disability under the policy, your insurer may examine your reported symptoms and activity levels. The insurer may undertake a review of your clinical notes and records to determine your functionality. They may even search your social media pages or conduct surveillance on you.

As such, ensure you always advise your treatment providers of the challenges you experience as a result of your depression. Provide detailed accounts of how your symptoms affect your ability to function and ensure that you are always honest and consistent when reporting symptoms to your doctors and the insurance company.

Fluctuations in Condition

Insurers may terminate a disability claim when they see an improvement in your condition. Improvement is, however, relative and a change in condition does not always equate to an ability to return to work. If your doctors are reporting that your condition has improved, ensure they also explain why you remain unable to work despite any perceived improvement in your condition. For instance, someone hospitalized for suicidal ideation may no longer be suicidal once they are discharged from the hospital, but they may still struggle with symptoms such as low mood, social avoidance, lack of motivation, interpersonal challenges and difficulties with focus and concentration. All of these may impact their ability to function at work.

Independent Medical Examinations or “IME”

In most long-term disability insurance policies or plans, the insurance company has the right to send you to a doctor of their choosing for an examination. If you have made a claim for disability benefits based on depression the insurer might send you to a psychiatrist, or the insurer may arrange for a psychological or neuro-psychological evaluation. A neuro-psychological evaluation is more frequently arranged when you report issues with cognitive impairment (memory, concentration, focus) or reduced executive functioning related to your mental illness.

An Independent Medical Examination or “IME” is an assessment that is arranged for you by your long-term disability insurance company.

The role of the IME doctor is to provide an opinion to the insurance company on your symptoms, restrictions and limitations. They are not engaged to provide you with any treatment. The IME doctor may also be requested by the insurance company to provide an opinion on your level of disability, treatment recommendations, and your diagnosis and prognosis.

Insurers often use neuro-psychological assessments to determine the validity of a claim as the neuro-psychological assessor can administer tests with validity indices embedded in them.

If you are being sent for an IME it may be a good idea to speak with a lawyer so you can understand the process and what to expect going forward in your disability claim.

If your long-term disability claim for depression has been denied for any reason[DC1] , you should discuss your circumstances with an experienced lawyer. MK Disability Lawyers LLP are experienced lawyers dedicated exclusively to the practice of disability insurance litigation. We would be happy to provide you with a free consultation. Please contact us online or by calling us at 844-697-4600.The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor-client relationship between you and the blog publisher. The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction[DC2].