Long-Term Disability Claims for Depression, Anxiety, and PTSD
Your condition isn’t a “bad mood” or “just stress.” It’s a clinical illness that has robbed you of your ability to function. So why did your insurer treat your claim like it isn’t real?
Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), PTSD, and Bipolar Disorder are not choices. They are serious, debilitating medical conditions. For professionals in high-stress, high-stakes careers, these conditions can make it impossible to perform. The cognitive “brain fog,” the debilitating lack of motivation (avolition), the uncontrollable panic, and the medication side effects are just as disabling as a physical injury.
Unfortunately, insurance companies are notoriously skeptical of mental health claims. They will use a specific playbook to deny your claim, hoping you are too exhausted and overwhelmed to fight back. At Uscher, Quiat, Uscher & Russo, P.C., we take these claims seriously because we know they are serious. We know how to build the evidence to prove your case.
Why Mental Health Conditions are Genuinely Disabling
An insurance adjuster often thinks, “If you can get out of bed, you can go to work.” They fundamentally misunderstand how mental illness prevents professionals from doing their jobs.
- Severe Cognitive Dysfunction: Depression isn’t just sadness; it’s a cognitive impairment. It causes “brain fog,” memory loss, an inability to concentrate, and a dramatic drop in processing speed. This makes it impossible to manage complex projects, analyze data, or meet deadlines.
- Executive Function Failure: Conditions like MDD and anxiety attack your brain’s “executive functions”—your ability to organize, plan, initiate tasks, and make decisions. A high-level professional job is *entirely* dependent on these skills.
- Avolition and Emotional Blunting: Severe depression can cause avolition (a total lack of motivation) and anhedonia (the inability to feel pleasure). This is not laziness; it is a neurological symptom that makes productive work impossible.
- Physical Symptoms: Anxiety and panic disorders are not just “worrying.” They cause real physical symptoms, including panic attacks, heart palpitations, dizziness, and gastrointestinal distress, that can be completely unpredictable and debilitating.
- Medication Side Effects: The SSRIs, SNRIs, and other medications needed to manage your condition can cause severe drowsiness, “brain zaps,” and cognitive dulling, which themselves can prevent you from working safely or effectively.
The Insurer’s Playbook: How They Deny Mental Health Claims
Disability claims for mental health are all about evidence. The insurer knows your illness is “invisible” and will use that against you.
Tactic 1: “No Objective Evidence” of Your Condition
This is their primary weapon. Since there is no blood test or X-ray for depression, they will call your condition “subjective” and “self-reported.” They will dismiss your psychiatrist’s diagnosis and your therapist’s detailed notes in favor of their own “paper-only” review, claiming you lack “objective proof” of your disability.
Tactic 2: The 24-Month “Mental & Nervous” Limitation
Many (but not all) employer-provided ERISA plans have a 24-month limitation on benefits for disabilities “caused or contributed to by” a mental or nervous condition. Insurers will fight to classify your disability this way to limit their financial exposure. They may even argue that your physical disability (like fibromyalgia) is “all in your head” or “caused by” your depression, just to apply this 24-month cap.
Tactic 3: The “Paper-Only” Psychological Review
Your file will be sent to a psychologist on the insurer’s payroll. This “expert,” who has never spoken to you, will read your file and write a report claiming your condition is “not that severe” or that you should be “cured” with different medication. They will often seize on a single note from your doctor (e.g., “patient reported a good day”) as “proof” you are ready to return to work.
Tactic 4: Social Media Surveillance
This is especially common in mental health claims. They will look for a single photo of you smiling at a family event or having dinner with a friend. They will then use this as “evidence” that you cannot be “depressed” or “anxious,” callously ignoring the reality of mental illness and the difference between a few hours of activity and the sustained demands of a 40-hour work week.
How We Build a Winning Appeal for Mental Health Claims
Your appeal, governed by a federal law called ERISA, is your one and only chance to submit evidence. A weak appeal is fatal. We must build a fortress of evidence to prove your case.
1. We Gather the *Right* Objective Evidence
How do you “objectively” prove a mental health condition? We commission a **Neuropsychological Evaluation.** This is an extensive, multi-hour series of tests administered by a neuropsychologist. It provides hard, objective data on your memory, IQ, processing speed, and executive function. A neuropsych report that clearly shows your cognitive deficits is one of the most powerful pieces of evidence you can have, and it directly refutes the insurer’s “no objective evidence” tactic.
2. We Get Medical Opinions That Matter
We work with your psychiatrist and therapist to get detailed narrative reports. These reports go beyond your chart notes. They detail your diagnosis, your symptoms, your GAF (Global Assessment of Functioning) score, and, most importantly, explain *why* your cognitive and emotional symptoms prevent you from performing the specific duties of your high-stakes professional job.
3. We Fight the 24-Month Limitation
If your physical and mental conditions are intertwined (e.g., your depression is *caused by* the chronic pain from your back injury), we fight to prove that the “root cause” of your disability is physical, not mental. This can be the difference between 24 months of benefits and benefits through retirement age. If your policy has this limitation, it is critical to have an attorney review your case.
Your Illness is Real. Your Claim is Just.
We know that mental illness is a real, disabling medical condition. You are not “lazy” or “just stressed.” You are fighting a clinical battle, and you should not have to fight a legal one at the same time. The insurance company is counting on the stigma and your exhaustion to make you give up. We are here to fight for you.
If your long-term disability claim for depression, anxiety, PTSD, or another mental health condition has been denied, contact us today for a free, confidential consultation. Your fight is our fight.
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