Case Study: Mental Health

When we submit a disability application for a client we always hope it’s approved as applied with no modifications or exclusions.  However, reality is that some applicants have pre-existing health conditions.  One of the most prevalent health issues for our clients is the treatment of mental health conditions, such as anxiety or depression.  This is one of the largest claims in the disability insurance industry, especially among physicians…even more prevalent within certain specialties such as Anesthesia and Emergency Medicine.  Further, most companies limit mental nervous and substance abuse claims to 24 months of benefits for these two medical specialties because of the high prevalence for mental health claims.  In this blog post we examine real life situations that we have experienced.  Please note that results vary on many factors and we do not guarantee the same outcome for future applicants. 

1. Client is a healthy individual, but acknowledges during the past few years that he/she took medication during short periods to help with the stress of studying for boards.  With no current treatment or medication and no official diagnosis of a stress condition, client was approved with no modifications or exclusions.
2. Client is a healthy individual, but takes medication to help with general anxiety diagnosed by his/her primary care physician.  The client has maintained consistent dosage and anxiety is handled well with medication.  Underwriter approved this client as applied, but with a mental nervous and substance abuse exclusion.  However, this exclusion is reviewable and could be removed after 3 years if client eliminates the need for medication and treatment. 
3. Client is a healthy individual, but takes medication to help with general anxiety diagnosed by a psychiatrist that he/she has been seeing for years.  Based on the psychiatry records, the client has shown at times that he/she needs the support of medical advice and medications to cope with stress and anxiety.  However, these issues do not limit the client’s lifestyle.  As a result, he/she was approved for a modified benefit period (10 year benefit), mental nervous and substance abuse exclusion and no additional riders such as cost of living (COLA) or future insurability.  This policy is not reviewable in the future for policy improvements per the underwriter’s notes. 
4. Client is a healthy individual, but has taken medication for depression.  In addition, medical records show a consistent history of depression and medication.  As a physician with stressful duties and history of depression, the underwriter denied this application because the risk was too great for the insurance carrier.  

While no client is the same, we have experienced many different mental health situations.  Our goal is to pre-screen our clients’ health histories to determine the best path to coverage.  Of course, while our intentions are always for the best, we are not underwriters and do not have access to medical records, lab results or other sources of information to assess risk.  If a client is uncertain about applying for coverage because of the possibility of a limited offer or a decline, we can submit an informal inquiry to an insurance underwriter to review a client’s file and offer their opinion of possible outcomes.  This helps give us and the client more information to make an informed decision. 

Utilize our years of experience working with physicians and dentists in obtaining the best disability insurance policy for you.  We can’t promise a certain outcome, but we will simplify the process, provide timely updates and actually make it an enjoyable experience. 

Contact us today!

Written By:  Jeffrey Marsico, CLU & David Marsico