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Ongoing treatment is a critical factor in mental health disability claims, often serving as a foundational element in both the approval and continuation of benefits. Insurance companies and Social Security evaluate not only the severity of the mental health condition, but also the consistency and effectiveness of the treatment plan. Here’s why ongoing treatment is so important in these claims:
1. Evidence of Severity and Stability of the Condition
Regular treatment records provide critical evidence of the claimant’s mental health status over time. This documentation demonstrates to insurers or the Social Security Administration (SSA) that the condition is persistent and interferes with the claimant’s ability to work. Without a documented treatment history, insurance adjusters or SSA examiners may argue that the condition is not severe enough to warrant benefits or that any symptoms are manageable.
2. Demonstrate Compliance with Treatment Recommendations
In mental health disability claims, insurers and the SSA often scrutinize the claimant’s adherence to prescribed treatment. Consistent treatment participation—whether through therapy, counseling, or medication management—signals a proactive approach to symptom management. If a claimant stops treatment without documented reasons (such as financial hardship or accessibility issues), it can raise questions about the claimant’s commitment to managing their condition, potentially leading to a denial or termination of benefits.
3. Document Fluctuations in Symptoms
Many mental health conditions, such as depression, bipolar disorder, and PTSD, fluctuate over time. Ongoing treatment provides a record of these changes and helps establish that the condition is unpredictable and interferes with daily functioning. A history of ups and downs, despite treatment, strengthens the argument that the claimant cannot reliably maintain employment.
4. Objective Medical Support for Functional Limitations
Mental health claims are often based on subjective symptoms such as mood, anxiety, and cognitive challenges. By working closely with mental health providers, claimants can obtain comprehensive records detailing their limitations in daily tasks, relationships, and work-like environments. This objective evidence becomes invaluable when presenting a case to insurance companies or during Social Security disability hearings.
5. Provide Insight into Prognosis and Treatment Adjustments
Ongoing treatment allows providers to make informed adjustments to medications and therapies as needed. Such adjustments indicate to insurers and SSA examiners that the claimant, despite trying different approaches, still faces significant limitations. This pattern of treatment trials and adjustments can highlight the complex nature of mental illness and the difficulty of achieving functional stability.
6. Countering Insurance Company and SSA Stereotypes
Some insurers or SSA examiners may have a bias against mental health conditions, assuming they’re less debilitating than physical disabilities. Consistent treatment demonstrates the claimant’s commitment to managing their condition and counteracts the assumption that they aren’t doing enough to improve. For individuals dealing with mental health issues, these records make a strong case that they are taking every possible step to manage their disability, thereby reinforcing the legitimacy of their claim.
7. Supporting Continued Benefits During Review
Mental health claims, especially those involving long-term disability insurance, are often subject to ongoing review. Insurers and the SSA periodically review claims to determine whether a claimant’s condition has improved. Documented evidence of regular treatment provides support that the condition remains disabling and that the claimant is still eligible for benefits, thereby protecting against premature termination of coverage.
Get Help with Your Mental Health Disability Claim
In mental health disability claims, an active and well-documented treatment history is often as important as the diagnosis itself. It provides clarity, continuity, and the evidence needed to support the claim, giving individuals the best chance of obtaining and retaining the benefits they deserve.
At the Ortiz Law Firm, we provide all of our clients with custom Residual Functional Capacity (RFC) forms, obtain statements from doctors and third party witnesses, and gather updated medical records to support each claim. We’re dedicated to helping people secure the benefits they deserve, whether through long-term disability insurance or SSDI. Contact us online or call (888) 321-8131 to schedule a free case evaluation today.