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PHILADELPHIA — More often than not, effective management of disability insurance claims related to mental illness requires a specialized understanding of the comorbid relationships they share with physical medical conditions.
To help them discern the legitimacy of employees' claims for short- and long-term disability benefits due to depression, anxiety and other “nonvisible” conditions, employers and their insurers should seek guidance from independent forensic mental health care providers, a panel of experts said Thursday at the American Conference Institute's 17th National Advanced Forum on Litigating Disability Insurance Claims in Philadelphia.
“Obviously, these kinds of mental and nervous conditions are complex, especially when they incorporate the comorbid physical conditions associated with them or even separately indicated,” Nicole Blohm, a partner at Meserve, Mumper & Hughes L.L.P. in Los Angeles, said during the panel discussion. “When you've got a case like that, it's very important that you get an independent forensic physician involved.”
More than two-thirds of adults with clinically diagnosed mental disorders also reported suffering from one or more medical conditions, while 29% of adults with a medical condition presented with a comorbid mental health condition, according to a 2011 study by the Robert Wood Johnson Foundation in Washington.
“Generally, these are the kinds of cases where there are a lot of competing potential explanations for what's going on, and it's frequently our task to sort through via records reviews and evaluations,” said Charles Saldanha, a forensic psychiatrist at Forensic Psychiatric Associates Medical Corp.
“Really, we're looking at whole constellations of symptoms. What we're looking for are the areas of intersection, where symptoms might be explained by a treatment effect or a physical or medical condition.”
Building an objective body of evidence that supports or refutes an employee's claim to disability coverage for a mental or nervous condition likely will entail a “multi-modal examination” process, which can include a review of all records for relevant physical and mental health treatments received leading up to the claim date, as well as personality, neurocognitive and symptom validity tests, experts said.
“We try to balance things more towards the science, but there is also a certain art involved in pulling all of these separate components together and weaving them into a narrative,” Henry Conroe, a clinical assistant professor at Rush Medical College in Chicago and regional medical adviser to the U.S. Social Security Administration.
“Really, we're looking at whole constellations of symptoms,” Mr. Saldanha said. “What we're looking for are the areas of intersection, where symptoms might be explained by a treatment effect or a physical or medical condition.”
Employers are unlikely to succeed in reducing the prevalence of depression and other mental disorders in the workplace without changing employee attitudes on the conditions themselves and the available treatments, experts say.