Apr 16, 2025 - Long Term Disability Insurance by Seltzer & Associates
While filing a successful claim for long-term disability insurance benefits is almost always a challenge, it is particularly difficult when the disability affects mental or emotional health rather than physical health. Documentation, which is so crucial in disability claims, can be more difficult to obtain and more frequently subjected to challenge by insurance companies.
Proving your limitations in a disability claim involving mental health impairments requires a concerted effort and an understanding of the evidence and arguments that insurance claims evaluators find the most persuasive. In our decades of experience helping professionals obtain disability benefits for mental health disabilities, we’ve learned the most effective strategies for filing claims and appealing denials. While every claim is unique, here are some general considerations to keep in mind when documenting symptoms and limitations in mental health disability claims.
Understand the Legal and Medical Requirements
The obligations of your disability insurer are, in large measure, dependent on the terms set forth in your insurance policy. State laws establish certain general obligations, such as a duty to act in good faith, but the important issues to address first involve analyzing the specific details of your policy. (If your insurance company fails to honor the terms, then you may have a legal claim for bad faith down the road.)
Take a look at what the policy requires you to demonstrate in order to receive disability benefits. Usually, a policy will require proof showing how and to what extent your condition impairs your ability to work. Depending on the policy details, you might need to show that you are unable to perform any occupation, or it may only be necessary to show that you cannot perform the occupation you were practicing at the time of the onset of your disabling condition. Evidence to demonstrate your impairment could include not only your diagnosis for a qualified healthcare professional but also records showing specific ways in which your symptoms negatively affect your job performance and daily life.
It is important to understand the precise medical documentation your insurance company will be looking for. This may not be spelled out in the policy, which is one reason it can be so helpful to work with an attorney who is familiar with claim requirements in disability insurance cases. At Seltzer & Associates, for instance, we’ve been succeeding with disability insurance claims since 1980, and our team has experience working in the insurance industry, so we have a comprehensive understanding of the documentation necessary for different types of disability claims.
Evidence of your disability should include:
- Comprehensive assessments of your symptoms, treatments, and your response to treatments
- Details of your treatment plan
- Progress notes from consistent follow-ups
It is important to show the severity of symptoms and demonstrate that the condition is ongoing despite consistent treatment efforts.
Identifying and Documenting Symptoms
With mental health conditions, symptoms are not as obvious as they are with physical conditions, so successfully documenting symptoms is a crucial part of preparing a successful claim for long-term disability benefits. It is important to understand how mental health conditions can manifest and how they impact your ability to function at work and in your personal life.
For example, anxiety might manifest in a number of ways, such as feeling tense and nervous, an increase in heart rate, rapid breathing, gastrointestinal problems, panic attacks, having a sense of impending doom, fatigue, and flashbacks. These can make it difficult to concentrate or to think about anything other than the present worry. Obviously, the ability to concentrate and focus on the task at hand is essential for any professional to perform their job properly. In fact, if a medical professional, such as a physician or nurse anesthetist, were to try to work while their ability to concentrate was impaired, it could potentially put patients in danger.
In addition, anxiety can also interfere with sleep and cause individuals to go to great lengths to avoid factors that could potentially increase their anxiety. All of these issues can make it impossible for a professional to perform competently.
Some symptoms, such as increased heart rate, have physical effects that can be measured. Many do not. Regardless of the type of manifestation, it is important to document duration, intensity, and frequency of each symptom. It will be more effective if, instead of simply notating feelings of anxiety, you can describe the specific effects of the anxiety, how long they last, and how the anxiety interferes with your ability to perform specific functions. If you had to read the same paragraph five times because your mind kept focusing on another concern, make note of that. Details can be crucial.
Methods That Can Be Used for Documentation
While records from doctors and other professionals are extremely important in documenting your impairments, those records represent only a tiny fragment of your time and experiences. Self-reporting will provide a much more complete picture of a mental health condition and the impact it has had on your ability to function.
It can be very helpful to maintain an ongoing journal or symptom diary in which you record observations as (or immediately after) they happen. You might record observations verbally on your phone or other device, where they can later be transcribed. Or you might type in observations or handwrite in a dedicated journal. Noting the date, time, and severity of each incident can give your records more weight as evidence. The more detail you can include, the better. (There is no such thing as too much information in this case.) Note what you were doing and how the incident affected your ability to complete tasks during and after the incident.
In addition to recording your own observations and ensuring that you have a complete roster of professional assessments and medical records, it can be helpful to have observations from third parties such as friends, family, and professional colleagues. People who have witnessed the changes in your condition and ability to function can provide valuable insights into the impact that your disability has had on your life and professional performance.
For example, a professional associate might explain that your anxiety has interfered with your ability to concentrate and contribute to collaborative projects and during meetings. Or a member of your family might describe the ways that your PTSD prevents you from connecting and engaging in family activities or performing essential household tasks. If you can get friends, family, and colleagues to provide written statements describing the effects, that can provide helpful support for your claim. When these statements provide details about specific episodes, including the duration or frequency of episodes, the documentation becomes even more valuable.
Seltzer & Associates Can Work With You to Create Comprehensive Documentation of Your Limitations
Obtaining and organizing the documentation needed to demonstrate the extent of your disability can be an overwhelming task, particularly when a mental condition such as depression prevents you from focusing and following through on tasks. Allow the experienced and compassionate team at Seltzer & Associates to assist.
We will work to ensure that you have a comprehensive package of documentation prepared to satisfy the requirements of disability insurers. Our goal is to take the financial burden from your shoulders so that you can focus on healing and recovery. We can analyze your records, gather additional documentation as needed, and prepare a persuasive showing to demonstrate your eligibility for benefits. If the insurance company acts in bad faith, we know how to succeed with an action in court to get the benefits you deserve.
Whether you are just starting the claims process or you have submitted a claim and been denied, we invite you to contact our team online or call us at 888-699-4222 to schedule a free consultation to learn more about the ways we can assist during this trying time.