Top Reasons Why Mental Disability Claims Are Denied

by | Published on Oct 5, 2015 | Medical Record Review

A medical record review company assisting disability lawyers would be handling hundreds of medical records on a regular basis, including mental health records of individuals applying for mental disability claims. The Social Security Administration (SSA) decides all disability claims almost entirely on the basis of the claimant’s medical records. To determine if the claimant qualifies for disability allowance, attorneys would first want a detailed medical record review. The records evaluated would include:

  • Records from therapists, counsellors, psychologists and psychiatrists
  • Hospitalization records
  • ER records
  • Pharmacy records

When sufficient medical records are not available, the SS may decide to send the applicant for a psychological evaluation.

It is difficult to win a claim for mental disability mainly because the evidence is largely subjective, and cannot be documented via testing procedures and other clinical modalities. So a disability lawyer would advise the claimant to provide Social Security with a comprehensive report of how the illness affects his/her daily life. The medical records available should clearly highlight the trauma experienced by the claimant. The SSA should be convinced that the applicant has a mental disability that prevents him/her from working in any job for at least 12 months. Many claims, especially those filed on the basis of mental disabilities are denied or face considerable delay in obtaining approval.

Here are some of the top reasons why the SSA may deny a mental illness disability claim.

  • No clear, specific diagnosis by a specialist: This is when there is no psychiatric diagnosis clearly mentioned in the treatment records.
  • The applicant is employable: Even when the medical documentation says that the claimant is unable to return to his/her previous work, the SSA may conclude that they can perform other jobs, especially if they are young. Applicants must therefore ensure that they have all the appropriate medical records and other proof showing clearly how they are unable to perform all kinds of work-related activities.
  • Treatment history is lacking: The SSA would review copies of all the medical and psychiatric treatment records of the claimant. The treatments received, their outcomes, specific symptoms of the mental illness and how they affect the claimant’s ability to work will all come under their scrutiny. The claim may be denied if the applicant has received no treatment whatsoever, or has received inconsistent or minimal treatment. In any case, objective medical evidence is necessary to prove mental disability.

It is clear therefore that when applying for SSDI or SSI benefits, claimants must have the necessary medical documentation, evidence of disability and treatment history to support their mental disability claim at the application as well as appeal levels.

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