Medical Evidence and Long-Term Disability Claims for Psychological Illness

Long-term disability claims may come as a result of a person being unable to work due to physical injury or illness or psychological illness. Claims for psychological illnesses include anxiety, depression, post-traumatic stress disorder and other types of mood disorders. Mood disorders include bipolar disorder and schizophrenia.

It is important during any type of long-term disability claim to remember that your insurance company is looking for medical evidence of how and why your illness or injury prevents you from working during the adjudication of your claim.

What type of medical evidence is your insurance company looking for when assessing your claim?

Clear restrictions and limitations

Your insurance company is trying to determine how and why your illness affects your functional abilities and activities of daily living. Some examples would be that your condition may cause you to experience cognitive impairment, difficulty concentrating or focusing, memory difficulties, and/or difficulty with social interactions.

Consistency

Do your medical records reflect ongoing reporting of the same or similar symptoms? This would show how your illness is constantly affecting you and your functioning.

Treatment

Do you see your family doctor on a regular basis and has your doctor prescribed medications or made a referral to a mental health professional or a program? Regular appointments show that you are trying to get the help that you need, and are actively participating in your recovery.

Compliance with treatment

If medications were prescribed, have you started to take them? If a referral was made to a mental health professional or a program, are you participating in the program or attending counselling sessions? Most policies contain a clause that says you have a responsibility to seek appropriate care and treatment and need to be under the care of an appropriate physician/specialist for your condition. If there is a long waiting list to see a specialist, you should ask your family physician if there is any help you can get while you wait to be seen by a psychiatrist or wait for a spot in a program.

As psychological illnesses are considered to be “invisible illnesses”, there are no x-rays or blood tests to provide your insurance company with. This is why it is very important that you have documentation of your symptoms and treatment, as it is how you will show your insurance company how your illness affects your functioning and ability to work.