Mental health disability claims are denied far more frequently than physical disability claims, creating serious challenges for individuals seeking benefits. In a recent interview on Main & Wall, disability benefits attorney Mark DeBofsky shared his thoughts on why this disparity exists and what can be done about it. Drawing from his expertise, including his appointment by Illinois Governor J.B. Pritzker to study mental health parity issues in insurance, Mark provides valuable insights on the hurdles claimants face and how they can fight back.
Watch Mark DeBofsky’s Full Interview Here:
In this interview, Mark DeBofsky discusses the denial of mental health disability claims, the challenges claimants face, and the steps they can take to improve their chances of success.
Table of Contents
Why Are Mental Health Disability Claims Denied More Often?
As Mark explains in the interview, one of the biggest obstacles mental health disability claimants face is the lack of objective medical evidence for mental health conditions. Unlike physical conditions, which can be supported by diagnostic tools like MRIs or lab results, mental health issues often rely on subjective assessments and patient reports. Insurers may exploit this lack of “hard evidence” to deny claims.
In Mark’s words:
“With physical claims, you often have evidence like MRIs or X-rays, but that kind of evidence is generally lacking in mental health claims. Insurance companies often take advantage of the absence of objective proof.”
This fundamental difference makes it easier for insurers to deny mental health-related disability claims, even when the individual’s condition is severe and disabling.
How to Strengthen a Mental Health Disability Claim
In the interview, Mark emphasizes that claimants can strengthen their mental health claims by providing thorough and detailed medical documentation. The more specific the information your treating mental health professional can provide, the stronger your case will be.
Here are some key steps Mark recommends for a stronger claim:
- Detailed Clinical Information: Your doctor or therapist should explain how your mental health condition affects your ability to work, including your capacity to focus, interact with colleagues, handle stress, and manage workplace tasks.
- Medical Treatment Records: If you’ve undergone treatment in an intensive outpatient program, partial hospitalization, or even a full hospitalization program, make sure to include those records in your claim.
- Symptoms Impacting Work: Highlight how specific symptoms—like anxiety, depression, or cognitive impairment—directly impact your ability to perform your job.
As Mark noted:
“The more detail that the treating mental health professional can provide, the likelier it is that the claim will get approved.”
What Can You Do If Your Claim Is Denied?
If your mental health disability claim is denied, you are not without options. As Mark explains in the interview, ERISA (Employee Retirement Income Security Act) gives you important rights when dealing with workplace disability insurance claims. Here are the steps you can take:
- Appeal the Denial: Under ERISA, you have the right to appeal the denial of your claim. The insurance company must provide a detailed explanation of why the claim was denied, and you are entitled to request the full claim file.
- Submit Additional Evidence: During the appeal, you have the opportunity to provide more comprehensive evidence, such as additional treatment notes, records from mental health programs, and letters from healthcare providers that address the reasons for denial.
As Mark explained:
“The Department of Labor has issued regulations explaining what must go into a claim denial, including a full explanation of the reasons and the claimant’s right to request the insurance company’s claim file.”
The Issue of Mental Health Parity and Benefit Limitations
Mark also touched on a major issue with mental health disability claims: the 24-month limitation. Most long-term disability policies cap benefits for mental health conditions at 24 months, regardless of the severity or chronic nature of the condition. There is no similar limit for physical disabilities, which creates an unfair distinction.
“There is effectively no actuarial evidence to support that kind of distinction between mental health and physical health claims,” Mark says. “Disability insurers don’t fully consider mental health conditions to be real illnesses, which creates serious issues for claimants.”
Despite the growing understanding of mental health in society, insurance companies continue to impose arbitrary limits on mental health benefits, leaving many claimants without the long-term support they need.
Conclusion: Fighting for Fair Treatment in Mental Health Disability Claims
Mental health disabilities deserve the same consideration and treatment as other medical conditions, yet many insurers impose unfair limitations and higher standards of proof. If your mental health disability claim has been denied, you have the right to appeal the decision and fight for the benefits you deserve.
For more insights, watch Mark DeBofsky’s full interview on Main & Wall and contact us at DeBofsky Law for a confidential consultation. We specialize in disability insurance benefits claims and can help you navigate the appeals process to secure the benefits you need.
