Depression, anxiety, and other mental health conditions are among the most common reasons people seek long term disability (LTD) benefits—and also among the most frequently denied. If you are struggling with a mental health condition and cannot work, you already know how difficult daily functioning can be. Proving this to a long term disability insurance company when you file a claim that seeks money from them is an additional battle – and often a difficult one for these types of claims.
A seasoned long term disability lawyer will tell you that these claims require a different level of strategy, documentation, and persistence. Understanding why LTD claims for mental health conditions are frequently denied is the first step toward protecting your rights.
Mental Nervous Conditions in LTD Claims: What Qualifies?
Long term disability policies typically group a wide range of conditions under “mental nervous disorders.” These often include:
- Depressive disorders
- Anxiety disorders
- Bipolar disorder
- Psychotic disorders
- Personality disorders
- Seasonal Affective Disorder
- Trauma-related conditions such as PTSD
- Neurocognitive disorders like early-onset Alzheimer’s or dementia
While these conditions are medically recognized and can be profoundly disabling, LTD claims managers treat them with more skepticism than physical illnesses. The core issue is objective evidence.
Why LTD Claims for Depression and Anxiety Are So Difficult
Unlike many physical conditions, mental illnesses cannot be proven through objective testing like bloodwork or imaging. There is no lab result that “proves” severe depression or debilitating anxiety. Instead, diagnosis and disability rely heavily on clinical evaluations, observations by treating providers, reported symptoms and functional assessments.
Because of this, insurance companies often challenge the credibility of the claim. They may argue that the person is exaggerating their symptoms, that limitations are self-imposed or subjective and the claimant can still perform work duties. This skepticism is one of the biggest reasons LTD claims are denied.
The Critical Role of Medical Evidence
To succeed in a mental health LTD claim, documentation must be both extensive and ongoing. A strong claim typically includes a clear diagnosis, detailed treatment plan and progress monitoring over time by a mental health professional – preferably a psychiatrist with a specialty in the person’s disorder.
In addition, proof of compliance with treatment and functional assessments explaining work limitations will be needed.
It’s not enough to say you are struggling. You must show, through medical evidence, how your condition prevents you from performing the specific duties of your job. For example, if your role requires concentration, decision-making, or interaction with others, your records should clearly explain how your symptoms interfere with those tasks.
Psychiatric Records vs. Psychotherapy Notes: Does the LTD Claims Manager Have a Right to See Your Private Therapy Notes?
One of the most misunderstood aspects of mental health LTD claims is the distinction between psychiatric records and psychotherapy notes.
- Psychiatric records include diagnoses, medications, treatment plans, and functional assessments. These are typically part of your medical file.
- Psychotherapy notes are private notes taken during therapy sessions. They document deeply personal conversations and are given special protection under HIPAA.
These therapy notes are usually required for an LTD claim. If an insurance company demands access to your psychotherapy notes, this raises serious concerns. We have strategies to address such requests, which often impede upon the sanctity of the physician-patient relationship and the utmost sharing of information.
You should immediately contact a long term disability lawyer to determine whether such a request is appropriate—and push back if it is not.
Can Insurance Companies Force You to Take Medication?
Another common question is whether insurers can require you to take prescription medication for depression or anxiety. While policies often require “appropriate treatment,” that does not necessarily mean you must follow every recommended medication plan—especially if you experience severe side effects from the medication, if the medication isn’t working or you have any documented legitimate medical reason to decline.
But you must be aware that refusing treatment without clear medical justification can be used against you. This is why documentation from your treating psychiatrist is critical. The lack of medication, and/or the infrequency of care may be arguments which the insurer argues against the severity of your claim. Working through all aspects of how the insurance company might challenge the claim allows you to proactively insulate and support your claim.
The 24-Month Limitation: A Major Challenge
Most LTD policies impose a 24-month cap on benefits for mental nervous conditions. This means that even if your condition remains disabling, benefits may stop after two years. This limitation reflects long-outdated assumptions that mental health conditions are temporary or easily resolved. In reality, many individuals struggle with chronic symptoms for far longer.
There are exceptions, however. Severe conditions such as schizophrenia or other psychotic disorders are often treated differently. Some policies classify them separately and may allow benefits beyond the 24-month limit. The languages include “Due to” – “Due in whole or in part” – “caused by” – and “caused OR contributed to by.”
The exact outcome depends entirely on the language of your policy. This is where a long term disability lawyer becomes essential—policy interpretation can make or break your claim.
Why Mental Health Is Misclassified
A common tactic used by insurers is to classify a claim as “mental” even when it stems from a physical condition. For example, if you develop depression after a traumatic brain injury, cancer diagnosis or a diagnosis that includes living with chronic pain or gastrointestinal disease, the long term disability insurance company may attempt categorize your claim under mental health—triggering the 24-month cap.
Even a single mention of “anxiety” or “depression” in your medical records can lead to this classification. This strategy is often used to limit benefit exposure, and it is something experienced LTD attorneys watch for closely.
Proving Functional Impairment
The most important element of any LTD claim is proof of impairment. You must demonstrate not just that you have a diagnosis, but that your condition prevents you from working.
Strong evidence includes:
- Detailed functional capacity evaluations
- Neuropsychological or psychological testing
- Statements from treating providers
- Symptom logs documenting daily struggles
- Third-party statements from family, friends, or coworkers
These third-party observations can be especially powerful. They provide a “before and after” picture that reinforces the severity of your condition.
The Importance of Ongoing Treatment for a Mental Health LTD Claim
Long term disability insurance companies want to see consistent, appropriate care. This means treatment from a specialist such as a psychiatrist and not occasional visits to a primary care doctor or a handful of therapy sessions.
A lack of consistent treatment may be interpreted as a condition that isn’t severe enough to quality for benefits, or that the disability has been resolved and the LTD benefits need not be paid. Even if you are struggling to maintain appointments, it is crucial to document your efforts and barriers to care.
Depression and Anxiety vs. Severe Mental Illness
Not all mental health claims are evaluated equally. Conditions like depression and anxiety are often scrutinized more heavily because they rely on subjective reporting. In contrast, severe psychotic disorders like schizophrenia or bipolar disorder involving symptoms such as hallucinations, delusions, disorganized thinking or cognitive impairment can be easier to document and may qualify for exceptions to policy limitations.
Still, every claim depends on the strength of the evidence presented.
When Your LTD Claim Is Denied
Many valid claims are initially denied, but what you do once your claim is denied makes all the difference. If your LTD claim has been denied or terminated, you will need to take action, without delay. This includes gathering additional medical evidence, providing documentation of functional impairment and addressing any weak points in the original application. The appeal may be your one and only chance to add evidence to the record.
This is not something to try to do yourself—Newfield Law Group has represented many insurance company professionals, including lawyers, who thought they could take on the insurance company and win. They realized this is a very specific area requiring experienced help.
Why You Need an Experienced Long Term Disability Lawyer
Mental health LTD claims involve unique challenges:
- Lack of objective evidence
- Privacy concerns
- Policy limitations
- Aggressive insurer tactics
Insurance companies are aware that claimants dealing with mental illness may be more vulnerable. Unfortunately, this can lead to subtle or overt pressure to comply with unreasonable demands.
A long term disability lawyer understands these tactics and knows how to:
- Build a strong evidentiary record
- Protect your privacy rights
- Challenge improper requests
- Interpret complex policy language
- Maximize your chances of approval or successful appeal
The Future of Mental Health Parity in Disability Benefits
There has been growing recognition that mental health conditions deserve equal treatment under disability policies. Proposed legislation, such as the Workers’ Disability Benefits Parity Act of 2025, aims to eliminate disparities between mental and physical health coverage. Unfortunately, the Act has been sitting in committee and no meaningful changes have occurred.
While promising, meaningful change has yet to take effect. For now, policy limitations and insurer practices continue to create significant hurdles for claimants.
Newfield Law Group represents individuals with long-term disability claims throughout the United States. If your mental health disability claim has been denied or you are unsure how to move forward, contact our office for a free consultation.
