A Revised Manual That Will Change the Handling of Mental Illness Disability Claims

Often times, we are approached by clients who are denied disability claims because of mental health issues (i.e., posttraumatic stress disorder, social anxiety, or major depressive disorder). The main reason why these clients are denied disability is because mental illnesses are hard to prove, and it is even harder to prove that such a condition makes an individual incapable of performing his or her occupation. Insurance companies often times prove that an individual is not physically disabled by way of surveillance video; however, there is no equivalent when it comes to “testing” mental illnesses.

However, those with mental illnesses should not be discouraged from filing a claim for disability. This is because courts have previously faulted an insurer’s failure to “give meaningful consideration as to how Plaintiff’s chronic fatigue, as well as memory and concentration problems, would impact upon her performance.” Engel v. Jefferson Pilot Financial Ins. Co., 2009 U.S.Dist LEXIS 89396 (W.D. Pa. Sept. 28, 2009); see Olive v. Am. Express Long Term Disability Benefit Plan, 183 F. Supp. 2d 1191 (C.D. Cal. 2002) (claimant’s ability to focus and concentrate must be considered as an essential occupational duty and must be taken into account in determining whether he/she is disabled).

Generally, the guide used for “proving” mental illness is the Diagnostic and Statistical Manual of Mental Disorders (“DSM”). This manual has been broadly used by psychiatrists and mental health professionals for decades and was just recently revised, as it is now in its fifth edition. Recently, an interesting article appeared in Corporate Counsel, Will the DSM 5 Lead to Crazy Employment Law?, where it discussed how the new edition will impact employment law; mainly because the new edition of the DSM adds new diagnoses, while also broadening already existing diagnoses. For example, the new DSM adds the diagnoses of “social (pragmatic) communication disorder,” where this disorder applies to individuals with “persistent difficulties in the social use of verbal and nonverbal communications.” Essentially, employees who were previously thought of as being shy may qualify under this new “disorder.”

Additionally, the new DSM eliminates the Global Assessment of Functioning (“GAF”). The GAF was a scale (0-100) incorporated in earlier editions of the DSM, which mental health professionals often used to rate an individual’s occupational, social, and psychological functioning. However, this scale has previously been misused by experts and has thankfully been removed from the DSM. Now, experts are not to rely on this numeric scale, but rather, on more substantial, undisputed evidence (i.e., witness statements).

We at Bonny G. Rafel LLC understand that not all disabilities are physical. Even though you may appear “functional,” this in no way is determinative of your ability to perform your occupation. We recognize the existence and reality of mental illness and we are here to help.

By: Alison L. Weitzer