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Can you receive disability for mental illness?

Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted...

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella...

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UPDATED: Mar 19, 2020

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If you have been diagnosed with a mental illness, then you may qualify for disability. Much like any condition that may lead to a disability, there are several criteria that you will have to satisfy in order to qualify for disability.

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It can be difficult to prove disability because of mental illness but it is certainly not impossible. Read on to learn what you may encounter if you apply for disability due to a mental illness.

Private Insurance Companies

If you have disability insurance coverage with a private insurance company, then they will have their own methods of determining whether or not your mental illness falls under their criteria. In many cases, an insurance company may restrict mental illness entirely from their disability allowance, while others may simply exclude certain mental illness.

In most cases, if mental illness is covered by your private insurance, then the only excluded mental illnesses will be those that can be controlled by medication. If an exclusion is specifically mentioned and your doctor doesn’t believe that your condition can be controlled with medication, you will not be able to get coverage. You can file an appeal with your insurance company, but as long as your mental illness is listed in the exclusion area, then they can legally refuse you disability for that illness.

Another consideration that your insurance company will make is whether you have a pre-existing condition. For example, if you were diagnosed with schizophrenia at age 13, then your private insurance won’t likely cover you under the plan.

The exception is if you have had the same plan prior to your diagnosis. If you have been exhibiting symptoms for a period of time but your illness was undiagnosed, then you can still file under your private insurance plan.

Unfortunately, you cannot purchase disability insurance once your illness has been diagnosed. What’s more, if you suspect their may be a problem and you purchase disability insurance, there may be restrictions on how soon you can collect. It is important to read the fine print on your insurance policy before you commit to paying premiums for something that won’t cover your illness.

SSD and SSI

Social Security Disability is the place that everyone turns to if they don’t have disability insurance or their insurance has denied their claim. The real problem is that mental illness is one of the toughest conditions to get approval for in terms of disability.

This isn’t because the government isn’t sympathetic to your plight, the problem is proving that your mental illness is debilitating and that it prevents you from doing any type of work, and that is the catch. Because mental illness is generally so unpredictable, in many cases it simply does not meet the minimum requirements of SSD, making it next to impossible to get disability payments.

Medical Evidence

This doesn’t mean you should give up; on the contrary, you are simply going to have to try harder. In order for you to get approval for SSD, you are going to have to do several things. The first of which is to provide endless medical evidence of your condition and how it affects you. No, you don’t go to the library and do research; this medical evidence is going to have to come from your doctor/psychiatrist.

It is your doctor who is going to have to provide not only your medical records but also the data associated with your specific mental illness. The longer your symptoms are in place the more likely you will be able to get SSD payments. You will have to prove that your disability will continue more than 12 months or that it has already exceed 12 months in order to qualify.

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Clinical Interview and Annual Assessment

In addition to your medical evidence, you are going to have to submit to a clinical interview so that they can do an assessment of severity. This is where many people run into a brick wall. If you have a mental illness that doesn’t present with visible symptoms then you may end up having a difficult time convincing the right people that your illness inhibits you from normal functions.

If you are approved for SSD you will be required to submit to an annual assessment to determine if your condition has changed. Interestingly, this occurs no matter what your mental illness happens to be. For example, even if you have a family member who had an accident that caused their IQ to drop to 50, which is legal mental retardation, they will still be required to submit to an annual review. In some cases, a doctor that meets the government’s approval can provide this assessment; otherwise it will be the individual’s assigned local caseworker.

It is important to note that in order to qualify for SSD; you will have to have paid social security taxes for a specified amount of time. This time will vary depending on how old you are. If you have a child with a mental illness, your earnings will be used to determine their SSD payments. If you don’t have sufficient time invested in Social Security taxes, then SSI will become the source for your disability payments. This is reserved for individuals who meet certain poverty levels or adults whose mental illness has always prevented them from working.

Lastly, you need to understand that the government doesn’t count your inability to work your old job as an inability to work. For example, if you were an engineer and your disability makes it impossible for you to do that job, then the government will determine whether you could do something else. This could be working as a janitor, in a fast food restaurant and more. If they determine that you can do something, then you will be denied for SSD.

Many people choose to hire a professional to help them navigate the wonderful world of government benefits because the criteria can be so specific and overwhelming as well. There are lawyers who will help you through this process as well as lawyers that will appeal your case for you if you are denied. The downside, of course, is that they don’t offer these services for free.

The Bottom Line

The bottom line is that your best bet is to have private insurance coverage in place that covers mental illness. Although they will require medical proof of your condition, their criteria won’t be nearly as strict as the government’s criteria. If you are concerned about mental illness but haven’t been diagnosed with anything, now is the time to check your insurance policy for any restrictions or exclusions. Don’t wait until after a diagnosis, as it will be too late.

If you don’t have any insurance at all, now is the time to act. By using our free quote tool, you can determine which insurance company offers you the most benefits for the least amount of money. The process is quite simple and it will take all of the guesswork and stress out of choosing the most affordable disability insurance.

You don’t want to be without the appropriate coverage should the worst happen and you find yourself in a situation where you can’t work. Answering a few simple questions will get you the answers that you need.

Get started by entering your zip code and comparing disability insurance quotes now!

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