Mental Disorders and Other Limited Conditions – Tackling the Challenges of Handling Mental/ Nervous Claims and Establishing Objective Proof of Subjective, “Non-Visible” Disorders

September 15, 2016 2:55pm

Gregory P. McMahon

Koleos, Rosenberg & McMahon, PL

Mark I. Levy MD, DLFAPA
Medical Director
Forensic Psychiatric Associates Medical Corporation

Ronald Roberts Ph.D.
Forensic Neuropsychologist
Forensic Psychiatric Associates Medical Corporation

Mental Illness and Mental/Nervous Limitations

  • Understanding the complexities of the mental illness: Distinguishing between a physical problem in the brain chemistry and a mental symptom
  • Evaluating the medical experts that are key to mental illness claims
  • IME strategies and record review; building a medical record which supports your claim
  • Losing or winning the mental illness claim at summary judgment
  • What are the limitations to the mental illness claims
  • Interpreting the co-morbid condition: When the mental illness arises out of the physical illness; How to deal with co-morbid conditions?
  • Identifying the primary medical condition causing the inability to work
  • Identifying whether there is a cognitive component to a disability claim and whether or not that component should be classified as “mental/nervous”
  • Preparing your client’s claim so that it is properly categorized by the insurance company
  • Recent challenges to the mental/nervous limitations – what types of challenges have proven successful?
  • Issues arising out of the “caused by or contributed to by” language
  • Successfully challenging and changing an initially incorrect benefits determination
  • Substance abuse and the risk of relapse as a viable defensibled isability
  • What kind of policy language is being seen regarding coverage for substance or alcohol abuse? How are these provisions being interpreted? What is the current state of the law on whether such a claimant is entitled to benefits?

Fibromyalgia, Chronic Fatigue Syndrome, Chronic Pain and Chronic Lyme Disease; and Self-Reported Symptoms Limitations

  • Proving the existence of the disorder
  • How to identify the appropriate healthcare professionals to properly diagnose and/or evaluate a subjective condition: Should IME’s be the norm? Are peer reviews sufficient to overcome clinical evaluations by treatment providers?
  • Balancing the need for objective proof versus the subjective disorder: Understanding objective proof of diagnosis v. objective proof of limitations; Testing to objectively verify functional limitations
  • Recent challenges to the application of self-reported symptoms limitations – what types of challenges have proven successful?
  • Distinguishing one claimant’s ability to work with these conditions and another claimant’s inability to work with these conditions
  • Educating courts and/or adversaries who are not medically savvy