The exact mental health criteria required to qualify for LTD will depend on the terms of the specific policy. However, similar requirements for mental health LTD claims tend to be widespread, even though they may not be universal. The challenges you are likely to encounter in seeking LTD benefits for depression and anxiety, or for a variety of other psychiatric conditions, can likewise tend to settle into a few general patterns, even though there will be some variability among policies in terms of how these challenges appear.
Some of the most common areas for these challenges to fall into include:
- Coverage exclusions for pre-existing conditions
- Limitations on duration of long-term disability for mental illness
- Acceptable medical evidence and documentation of psychiatric disorders
Understanding some of the common ways these challenges emerge can also make it easier to develop effective strategies for addressing them.
Pre-Existing Conditions and Mental Health Qualifications for LTD
A significant challenge some individuals may experience in claiming long-term disability for mental illness is that many mental health conditions are chronic, even life-long. Autism and attention deficit hyperactivity disorder (ADHD), for example, are often diagnosed in childhood. Bipolar disorder is considered a permanent diagnosis, which has an average age of onset at 25 years. This can mean that the career stage at which an individual joins a long-term disability insurance policy may determine whether the condition is considered pre-existing. The National Alliance on Mental Illness (NAMI), meanwhile, notes that schizophrenia is typically diagnosed in early adulthood, with a gender disparity in the age of symptom onset that can also result in a difference in the likelihood of schizophrenia presenting as a pre-existing condition for men vs. women.
Complicating Factors
The question of pre-existing conditions, however, is more complicated than simply whether an individual received a diagnosis prior to joining their current LTD plan. A 2023 report prepared by the Advisory Council on Employee Welfare and Pension Benefit Plans (the ERISA Advisory Council) to provide the Department of Labor (DOL) with updated guidance regarding the coverage of disabilities related to mental health conditions under employer-sponsored long-term disability plans subject to the Employee Retirement Income Security Act of 1974 (ERISA), notes that LTD benefit coverage usually begins after the employee has been working for a minimum period of time outlined in the terms of the policy.
Most of these group long-term disability plans explicitly exclude pre-existing conditions from coverage. However, the definition of “pre-existing” may be determined by a look-back period, which in many cases is no more than a year. Treatment or testing during that look-back period will generally mean that the employee is not eligible to receive LTD benefits if he or she becomes disabled during the first year of employment. It is also important to note that the report specifically highlights the fact that employees may still qualify for benefits if the disability begins after at least one full year of employment, even if the condition that leads to the disability was diagnosed before employment began.
Steps To Take
Becoming familiar with the specific policy terms that define when your eligibility for benefits began, and how long the look-back period over which a pre-existing mental health condition is excluded from coverage, is an important step toward securing LTD benefits for depression and anxiety. Depression and anxiety are among the more common mental health reasons for seeking long-term disability for mental health illness. The same also generally applies to other mental illnesses for which there was an extensive period between receiving your diagnosis and being enrolled in the long-term disability plan. The effects of that gap may also be affected by the length of the period between enrollment and becoming disabled.
Keep in mind, as well, that while there are differences between group LTD plans, the differences between a long-term disability plan you purchase for yourself and the standards that are broadly used among group plans may be even more pronounced. The details of the specific policy in which you are enrolled will establish the parameters under which your mental health qualifications for LTD are assessed.
Limited Duration of Long-term Disability for Mental Illness
A more intractable problem for many individuals who meet the mental health qualifications for LTD is that most group LTD plans, as documented by the ERISA Advisory Council in 2023, only offer 24 months of coverage for disabilities caused by mental health conditions. This is true even though the same policies often offer coverage up to retirement for disabilities identified as arising from purely physical causes. This raises some questions regarding how truly “long-term” long-term disability for mental illness may truly be.
Legislation introduced to the United States House of Representatives in June 2025, in response to the findings of the 2023 Advisory Council report, seeks to provide a legal framework for extending the mental health parity requirements established for group health insurance plans under the Mental Health Parity and Addiction Equity Act (MHPAEA), as described by the DOL, to long-term disability insurance plans offered through employers. If passed, such legislation would likely alter the limitations on coverage duration that apply to mental health qualifications for LTD, but not to similar qualification criteria for disabling physical conditions. In the meantime, however, steps you can take to address your financial stability include:
- File for Social Security Disability Insurance (SSDI).
- Familiarize yourself with your LTD plan’s specifications regarding temporary recovery. Look for options regarding a “phased in” return to work or trial period, and check if there are additional qualifications for LTD reinstatement if you are able to return to work but suffer a relapse.
- Work with your own mental healthcare provider to develop possible strategies that might enable you to return to work with supportive accommodations, and determine whether those accommodations are likely to fall within the parameters of employer requirements mandated by the Americans with Disabilities Act (ADA).
Many mental illnesses are chronic, but they are also often well-managed. Usually, the goal of mental health treatment is to alleviate symptoms and enable the patient to return to normal activities, although ongoing maintenance therapy or accommodations may be needed. The threat of financial instability can certainly make it difficult to focus on recovery, but understanding that many people do re-establish a sense of normalcy and the ability to maintain employment, even after a severe mental health crisis, may offer some reassurance.
LTD Benefits for Depression and Anxiety: Proving Disability With an Invisible Illness
Many conditions that are purely mental are not discernible to the naked eye. However, many of these conditions do manifest tangible physical effects that can be observed and documented by medical professionals with appropriate diagnostic equipment. Some mental health conditions, such as many neurological disorders, may be associated with abnormalities in brain activity or structural development.
Even for those mental illnesses in which medical researchers have found evidence of such cerebral differences, the tests that might detect the relevant abnormalities are often not part of the standard diagnostic protocol for a given disorder. This is because it is not uncommon for a deviation from the norm in neural activity to have multiple possible causes. Often, to the frustration of mental health professionals and their patients alike, the primary tools available for diagnosing psychiatric disorders are patient self-reportage of symptoms.
This reliance on subjective reporting can make it harder for claimants to demonstrate the extent of their condition to insurers or administrative agencies. Without clear, objective evidence, many disability claims related to mental health are subjected to heightened scrutiny. This can create significant barriers for individuals who are already struggling to manage their symptoms. For this reason, thorough documentation and support from qualified medical professionals are especially important when pursuing benefits for mental health conditions.
Complications in Medical Evidence for Mental Disorders
Clinical observation and interviews may at least result in reporting external to the patient, but they can at most recount behavior. A clinician may then attribute these behaviors to be symptoms of a disorder, often based on its relation to other symptoms the patient manifests and their collective correspondence to a clinical diagnosis. Many mental health patients are familiar with the frustration of seeing friends and family treat an individual’s observable dysfunctions as behavioral quirks that could be controlled with effort.
Insurance claims processors may be less likely to rely on these common social assumptions, but it can nonetheless be difficult to collect documentation of the kinds of evidence evaluators tend to prefer in assessing an individual’s mental health qualifications for LTD. The invisible nature of mental health conditions can therefore present administrative difficulties in meeting insurance company standards for medical evidence.
Tips for Documenting Your Mental Health Qualifications for LTD
While imperfect, documentation of your mental health assessments can generally be expected to play an important role in securing long-term disability for mental illness. Keep careful records of all your mental health appointments, and make a special effort to be consistent in documenting both your prescribed treatment protocols and the measure you take in adhering to them. You may need to show evidence that you have complied with the prescribed regimen. Expect to need an attending physician statement from the psychiatrist or other mental health provider overseeing your care. The specific types of medical evidence accepted by your long-term disability insurance provider in proving mental health qualifications for LTD may vary depending on the policy, so it is important to refer to the terms of your policy often and follow them carefully.
Seek Support Throughout the Long-Term Disability Process
Establishing mental health qualifications for LTD can be an exhausting, frustrating, and at times, even a demoralizing process. On the other hand, securing long-term disability for mental illness can provide you with the financial stability you need to focus on your treatment and recovery, even if finding an effective regimen takes longer than you would like.
Whether you need LTD benefits for depression and anxiety, for the symptoms associated with a lifelong condition like bipolar disorder or schizophrenia, or for any other mental health condition that negatively impacts your ability to function in the workplace, it is important to seek support from people you trust to prioritize your interests. Work closely with your mental health professionals, and consider consulting with an attorney practicing in disability law if you are encountering obstacles in the disability claims process so that you can gain the benefit of professional assistance in navigating the requirements.
