Why Are Mental Illness Claims Denied?
Denied Mental Illness Claims
Like many disputed disability claims, mental health claims are difficult to prove and are often considered “invisible” disabilities. People suffering from mental illness also must suffer with the stigma attached to the difficulty that friends, family and co-workers have in understanding why they can’t work: “They don’t look disabled. Everyone gets stressed and upset from time-to-time. Why can’t they just pull themselves together like the rest of us and tough it out.”
These misconceptions and broad-based assumptions may apply to many people, but mental illnesses are serious and often extremely debilitating, and only made worse by society’s inability to accept their legitimacy. Insurance companies are no different from the general public when it comes to perceptions surrounding mental illness, and they have financial reasons for wanting to uphold the misconceptions and assumptions.
Of the disability claims we handle at Share Lawyers, a large number arise out of people struggling with mental illnesses such as Major Depression, Anxiety Disorders, Bi-Polar, Post-Traumatic Stress Disorder, Agoraphobia and many others.
A few common reasons why mental health claims are denied include;
- Insufficient Medical Evidence:
If you can’t see it, then you can’t explain it and notes from family doctors, counsellors, social workers and psychiatrists saying their patient is disabled due to anxiety and depression, in the absence of more compelling medical evidence, which may not exist, just may not cut it with the insurance company.
- Failure to Obtain Appropriate Treatment:
This is often more to do with the unavailability of an appropriate specialist in a timely manner, rather than a failure to obtain appropriate treatment. This type of clause in an insurance policy is supposed to be used to terminate a claim where a claimant is refusing appropriate treatment, such as not taking prescribed medication, or attending rehab for substance abuse, but we often see this reason being mentioned where the claimant has not seen a psychiatrist and is only seeing a family doctor.
- Workplace Stress is Not a Disability:
Where there are elements of issues in the workplace, such as harassment or bullying by a superior or co-worker, insurers often take the position that disability insurance is not designed to pay benefits when the problem is an inter-office issue. Where these types of issues are combined with a diagnosis of a mental health issue, benefits are often payable and this reason alone should not be a reason to lose hope that you may be entitled to recover benefits.
- Long Standing Mental Health Issues:
In certain cases, where the claimant has a history of mental health issues but has been able to work while managing their illness, insurers may suggest that you could work with this in the past and the symptoms are no worse now, so you are not disabled.
While this list is not exhaustive, you can see from the examples noted that insurers are looking for ways to deny claims, which is very frustrating and discouraging for those trying to deal with the debilitating effects of a mental illness, made worse by not having the financial support that was expected to be there. The good news is that in many cases, action can be taken to pursue your disability benefit entitlements.
