Mental Disorders and Qualifying for Disability Benefits
Can I get disability benefits if I am suffering from the effects of a Mental Disorder?
Author: Attorney Greg Reed
Qualifying for disability due to mental disorders is certainly possible but difficult. A claimant’s credibility and a record of treatment will be important in gaining approval for benefits.
According to John Hopkins Medicine, 26% of Americans 18 and older suffer from some type of mental disorder in a given year, and many people suffer from more than one mental illness.
Mental illness is a range of mental health conditions that affect mood, thinking and behavior. Mental disorders include illnesses such as schizophrenia, depression, anxiety, addictive behaviors and eating disorders. It’s not uncommon for people to experience some mental health concerns from time to time, but a concern becomes a mental disorder when it impacts an individual’s ability to function, causing problems at home, school or work.
Can my mental disorder qualify for disability benefits?
Yes and no.
Whether or not an individual with a mental disorder is considered disabled will depend on a variety of factors: severity of symptoms, medical evidence supporting a diagnosis, effectiveness of treatment, the individual’s age and education, and the type of work the person has done in the past.
Social Security recognizes several mental disorders as impairments which may qualify for Social Security Disability benefits in it’s Blue Book under Section 12 Mental Disorders.
The listings are divided into 11 categories:
- Neurocognitive disorders (12.02) – Alzheimer’s, dementia, inability to concentrate, remember or understand
- Schizophrenia spectrum and other psychotic disorders (12.03)
- Depressive, bipolar and related disorders – loss of interest in life, appetite and sleep disturbances, decreased energy, suicidal thoughts
- Intellectual disorder (12.05) – mental retardation, inability to care for personal needs
- Anxiety and obsessive-compulsive disorders (12.06) – panic attacks, paranoia, agoraphobia
- Somatic symptom and related disorders (12.07) – preoccupation with having or acquiring a serious illness that cannot be explained by a medical disorder
- Personality and impulse-control disorders (12.08) – borderline personality disorder, instability in interpersonal relationships
- Autism spectrum disorder (12.10)
- Neurodevelopmental disorders (12.11) – hyperactive and impulsive behavior, difficulty sustaining attention and organizing tasks
- Eating disorders (12.03)– anorexia, bulimia
- Trauma and stressor-related disorders (12.15)– PTSD, experience or exposure to actual or threatened death, serious injury, or violence
Qualifying for Social Security Disability benefits with a mental disorder can be difficult for a variety of reasons.
Much of the medical evidence supporting a diagnosis of mental illness is subjective and can’t be measured. There are no tests to determine most mental disorders; instead medical providers must rely on the history of a patient’s behaviors. Additionally, claims examiners who review cases are not mental health professionals and know little about mental health conditions. A claimant’s credibility and record of treatment will be important in gaining approval of disability benefits. Treatment includes psychiatric counseling, medications, and hospitalizations. The more specialized your doctor is and the more convincing his statements and opinions, the better the chances for approval of your claim.
Social Security considers a variety of factors when granting disability benefits for a mental disorder:
- Does the applicant meet Social Security’s definition of disability?
- Does the applicant’s mental health condition match a Social Security impairment listing and meet its criteria?
- What treatment is the applicant receiving and what is their prognosis? (It should be noted here that applicants with a mental disorder may have difficulty adhering to a treatment plan and making and attending appointments which harms their case).
- Has the applicant been hospitalized for their disorder?
- Can the applicant perform their former job? Can the applicant understand basic instructions? Are they abele to concentrate, maintain pace and interact with co-workers and the public?
- If the applicant is not able to perform their former job, is there other work the applicant is capable of (even if they haven’t performed that job before)?
In determining whether an individual can perform another job, Social Security will look at the applicant’s education and age. Social Security classifies education level in the following manner:
- Illiterate, or unable to communicate in English
- Marginal – 6th grade level or below
- Limited – 7th – 11th grade level
- High School and above
The older you are, the less educated you are, and the fewer transferable skills you have, the more likely Social Security will find you disabled.
As disabling as a mental illness is, it is not easy to prove depression, anxiety or a debilitating compulsion. When applying for Social Security Disability benefits you should:
- Submit accurate and comprehensive health records.
- Keep a journal of how your illness affects your daily activities at home and at work.
- Follow your prescribed treatment plan.
- Ask your medical providers, counselors, family and friends to write letters describing how your mental disorder affects your daily tasks, employment and social life.
- If Social Security has not asked you to submit an ADL questionnaire, request the form or print it out and submit it. An ADL questionnaire is a form that lists common activities that self-sufficient individuals may be expected to perform, such as mowing the lawn, grocery shopping, dressing, and going to work. Social Security uses this questionnaire to gauge how an impairment affects an individual’s behavior and to determine if that individual is capable of earning a minimum amount of income each month (SGA).
If you have a mental disorder, yet your disability does not match a Social Security listing, you may still be eligible for Social Security Disability benefits if you have another impairment; for example, back problems.
Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book. However, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. Social Security will also evaluate how your limitations affect your ability to work (called a medical-vocational assessment), taking into account whether or not you are able to drive, your age, and level of education.
If you are 55 or older or have another medical condition you may get approval.
Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.
Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.
Social Security also has basic financial requirements.
You must satisfy some basic financial requirements before you are eligible for Social Security disability benefits.
You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.
What if I don’t qualify for SSDI?
If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
You should file a claim as soon as you become disabled.
Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.
How do I file for Social Security Disability benefits?
You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.
If your initial application is denied, don’t be discouraged. Most are, and you will have the opportunity to appeal. There are four steps to the Social Security appeal process:
- File a Request for Reconsideration with the Social Security Administration to completely review the case.
- If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
- If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
Do I need a disability attorney for SSDI?
If a mental disorder prevents you from working, you may be eligible for Social Security Disability benefits, but qualifying may be difficult because many cases of mental illness are difficult to assess.
Your chances for approval are increased significantly if you have legal representation. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.
If you are suffering from the effects of a Mental Disorder and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? just give us a call, we love to help folks just like you!
Do I need a disability attorney for a long-term disability insurance claim?
Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.
The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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