Mental Health Disability Claim: Why Am I Denied?


In 2012, SSA provided benefits to nearly 15 million disabled adults and children. Currently, state agencies determine disability based on medical and other evidence considered relevant in an applicant’s case record — which may include standardized psychological tests. — Rick Nauert PhD

If you ever applied for a mental health disability benefits due to anxiety, depression, or other mental illness, there’s a chance the insurance company can deny our claim. As much as what you experience is real and challenging, there are certain standards that the law follows, and if you miss out on one, you might have trouble claiming your disability benefits. There are several factors that could affect your claim, and you don’t want that to add to your depression.

5 Factors Affecting Your Mental Health Disability Claim:

You Do Not Seek Professional Help From A Psychiatrist

To validate your claim, you need to be seeing a psychiatrist or a specialist in mental illness treatment. If you fail to do so, it could be a real problem on your part because it could mean that your condition is not that serious. The insurance company needs to see that you at least consult a psychiatrist on your treatment.

With unseen disabilities, there is no way others can offer extra help, or sensitivity, unless you mention the problem. This is true not only for physical disabilities, but for psychological ones as well. — Nicole S. Urdang, MS, NCC, DHM

Given your condition does not get better, the insurance company may use this as a reason to deny your benefits since you must seek help and you failed to do so.

  • You need to request your doctor for a referral to a psychiatrist for a consultation.

You Do Not Have A Regular Care From A Family Doctor


It is the policy of an insurance company to require that the client is getting “regular care” from a doctor which means they will see to it that you are seeing your family doctor regularly, not just for a single consultation but on a regular basis which then depends on your mental illness or treatment plan.


The reason why it is imperative that you be seeing a doctor is that it is a sign that you have the desire to get better, and you are not using your mental health condition as a way to get benefits. You need to show the insurance company that you are doing all you can or that you have sought different options for the improvement of your condition.


  • It would help if you never skip an appointment with your doctor unless the reason is valid as an emergency or a life-threatening situation. You also have to ascertain that you are monitoring your prescription medications.

You Do Not Seek Recommended Treatment From A Psychologist

When you have a mental illness such as anxiety and depression, psychological treatment and medications are the recommended course to gain improvement. Your family doctor will prescribe it when deemed necessary and failure to adhere means you are not sincere in improving your mental health.

  • Like seeing a psychiatrist, seeing a psychologist is a must if your family doctor recommended it; otherwise, there is a considerable chance you would not get the benefits. If you could not afford psychological treatment, request for a referral to an outpatient program covered by health insurance.

Instead of removing the diagnosis from the chart at the end of treatment, they often place the phrase, “In remission” onto the end of the diagnosis instead. — 

Your Healthcare Providers Do Not Meet The Standard


It is the discretion of the insurance company whether the treatment you are receiving from either psychiatrist or psychologist meets their standard, meaning you have to make sure that your healthcare providers are credible or accredited by the insurance company.

It may be challenging on your part to distinguish who is reliable or not because we can assume that all doctors are professional. However, if they don’t follow the best practices for the treatment of your condition, the insurance company may cite this as the basis for the denial of your claim.

  • You are always free to ask for a second opinion, and you can also ask your psychiatrist regarding the best treatment options for your illness.

You Do Not Have The Appropriate Documentation Of Your Treatment


There should be appropriate documentation of the treatment you are receiving such as logs, medical charts, or patient files; otherwise, your treatment plan does not exist. It means that no matter how credible your health care provider is if he doesn’t give a report or documentation of your appointments, it could be all for nothing.

  • You can bring this up on the initial consultation. Although it is seldom that practitioners forget about creating reports, it is still for the best that they are aware of your claim.

Anxiety and depression are both challenging mental health disabilities. These can be somewhat underrated but dangerous when left untreated. These can also cause you not to function correctly, therefore affecting your ability to earn a living. When you have either of these conditions, you deserve the right to disability benefits. You have to know which things to avoid to make sure your claim doesn’t get denied.

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