Why Mental Health Claims are Challenging

Why Mental Health Claims are Challenging

Mental health claims are challenging for a number of reasons. Number one, unlike many claims that can be revealed through  an X-Ray or MRI or other diagnostics, most of the time with mental health claims we can’t diagnose through objective clinical diagnostic testing. Oftentimes it has to be done through reports from doctors or interactions and subjective information.

Insurance companies don’t want to accept that subjective information, they want diagnostic evidence, what they call objective evidence. So those claims have challenges.

One of the reasons we have been successful in overcoming those challenges is working directly with client’s doctors to have them provide a strong articulation of what we say is “the how and the why.” What about their job that makes them unable to do it based on their medical condition?

Mental health claims have other challenges, because even when you’re successful with these types of claims, they may be subjected to a limited benefit period. Oftentimes, these claims are often payable only for 24 months. So a claimant who may navigate this process may have a limited claim for benefits, unlike a claim for a back problem or cardiac issue or other things that may not be subjected to limited claims. So mental health claims in and of themselves often do not have a longevity to them as well as other claims and have initial problems.

Another way we are able to combat that is through objective testing, through neurocognitive testing, where we’ll utilize a doctor to perform testing on our client and interpret these results and tie that into their functional issues and deficits. That is the way in which we are able to overcome the issues of a lack of evidence in a mental health claim. That is how we are able to have success with these types of claims.