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March 2010
Proving Mental Impairments for Disability Claims
Sometimes medical providers and therapists throw up their hands and ask “how do I prove those things?” The process is actually simple, and establishing functional impairment can mean the difference between winning and losing.
The first step is a diagnosis. Social Security law tracks the 1994 Diagnostic and Statistical Manual (DSM IV)1. The standards are familiar to those who work with mentally impaired clients. For example, to prove depression, you have to show at least four clinical signs. Examples would be sleep disturbance, decreased energy, suicidal ideation or appetite change. Similar findings are needed for other mental illnesses.
Most cases also require documented functional impairment. For the depression example above, two functional impairments must be established. Some disorders are considered severe enough to prevent gainful activity without any additional assessment of functional limitations. For others, the degree of functional limitation must be documented precisely. If necessary, information may also be obtained from non-medical sources, such as family members and others, to supplement the record of impairment severity and longevity.
Functional impairment measures these factors:
Two or more impairments at the “marked” level must be present. “Marked” is one of the four measures for degree of limitation, and is defined here by Social Security as “more than moderate but less than extreme.”
Social Security says a “marked” limitation may arise when several activities or functions are impaired, or even when only one is impaired, as long as the degree of limitation is such as to interfere seriously with ability to function “independently, appropriately, effectively and on a sustained basis.”
The mental impairment regulations were extensively revised several years ago. Although the detail required to prove a case appears daunting, we can show you exactly how to develop and present evidence that will maximize your client’s chances of winning.
Keep in mind that mental illness such as depression is commonly an element of other illnesses and should be documented to strengthen a case. Please call us if we can help move your client or patient toward disability aid and treatment covered by health insurance benefits.
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So what is the best strategy for your clients as you help them navigate through this quagmire? If there is a silver bullet, it is to win a case early by submitting thorough and comprehensive information. Of course, appeals should be filed promptly - a claimant can add three to six months to the delays just by waiting the full 60 days allowed for appeal.
We are passionate about ensuring everything is right the first time. We work with medical treatment providers to be certain all the records are in the file, and all the appropriate data has been gathered. We have many years of experience with the application and appeal process, and long relationships with many medical facilities locally. We monitor appeal deadlines so that no unnecessary time is lost.
We never charge a fee for an initial consultation. We can take this complicated matter off your desk and provide your clients with an experienced guide along a difficult path.
To receive this newsletter by mail: Email your name and mailing address to us here: Subscription request Thank you.