You have a mental health disability. You need coverage and time off work. Brace yourself.

Too many times, Anne Huebner's patients opt to use their much-needed therapy appointments to fill out disability applications.

It's a daunting process, one that usually doesn't reward her patients with good news, said Huebner, a licensed psychologist based in Brookfield.

People diagnosed with severe and persistent mental illness and trauma are more often denied disability coverage than those with physical impairments, according to the few insurance companies that choose to disclose annual reports on approved and denied claims rates. Such disclosures are not required by law.

Progress toward health coverage parity, in which mental health issues are covered in the same way as physical health issues, has been extremely slow. Insurance denials and sudden terminations of benefits happen in part because such disabilities aren't always visible, and psychological pain is deemed subjective. More than that, how we understand mental illness is far behind how we understand physical illness.

People who are struggling with mental illness enough to require a leave from work often have trouble with short- and long-term memory, concentration and motivation. Huebner regularly supports patients with debilitating trauma and other behavioral health conditions through the process of making claims for short- and long-term disability coverage, Social Security Disability Insurance payments, and worker's compensation.

"They're often frustrated with everyday tasks and, of course, frustrated they have to fill out these forms that don't make sense to them" Huebner said. "Their symptoms will worsen, they'll put the process aside. It seems the process discourages people who are already struggling."

Through forensic evaluations, Huebner educates people on the process. It involves a lengthy interview process, record reviews and assessments to better understand someone's behavioral, psychological and intellectual capabilities. But, in doing this work, she also has learned that the process can be harrowing for the individual.

"I will tell people right away, 'This is going to be very hard.' We'll work through that as much as possible," Huebner said. "But some people may change their mind when faced with all that paperwork. Then we have to talk about what other things they can do. Can they move? Can they live with a relative?"

Many of her patients struggle with the wording on the application. Huebner compared it to going to a car mechanic and knowing only vaguely what's wrong with your car. If you say the car isn't working, but you don't know which part and why, it's not as though you'll be turned away. But that's what can happen to people struggling with their behavioral health condition who apply for disability. The odds are often stacked against them.

How independent medical exams work

When they're conducted appropriately, independent medical exams can last up to five to six hours to complete depending on the medical specialty involved, said Steven Rothke, a clinical neuropsychologist based in Northbrook, Illinois. Rothke, who's licensed in three states including Wisconsin, said it's an intense process that evaluates the impairment level of the patient in addition to whether the information being provided is valid (accurate) and reliable (consistent).

"Unlike, when taking an X-ray where all you have to do is sit still, in a neuropsychological evaluation you have to pay careful attention and try your best to respond to questions or tests," Rothke said. "For example, these evaluations often include the need to carefully attend to and repeat a list of words being read to you, in which your best effort is required."

Rothke, board-certified by the American Academy of Clinical Neuropsychology, works comfortably with both insurance companies and attorneys representing employees. And being in the middle, he can see the difficult position of both employees and insurance companies.

Insurance companies have to be sure that a claimant is disabled if they’re to pay out a portion of their income. Employees have to show that white-knuckling through destabilizing mental health symptoms isn't working — that they need help, and the space and time to receive treatment. 

He’s looking to not only answer whether someone’s diagnosis is disabling, but whether the answers someone is supplying are reliable and valid. 

"One way that this is determined is by the use of validity tests and the examiner's attention to claimants reporting symptoms that seem over the top or embellished," Rothke said.

The examiner is also reviewing all medical, psychiatric, psychological and hospital records, Huebner said. Sometimes, she gets into education, employment, military and police records, if present, to evaluate the facts about the person's history of illness and injuries.

Fraudulent claims are rare

Skepticism about moving to mental health parity is often based on the fear that it would invite more fraudulent claims, often referred to as malingering, or the act of feigning symptoms to shirk work duties. Currently, people with behavioral health disabilities can only be covered for 24 months, but coverage for physical disabilities can go up until retirement age.

Most people who apply for disability see their conditions as destabilizing and all-encompassing. Rothke's job is to determine, through evaluations, whether someone's conditions render them incapable of working.

"Exaggeration can exist, even in people with genuinely disabling conditions, and part of my job is to determine whether that potential exaggeration means the results of an exam are not accurate," Rothke said.

In Huebner's experience, she hardly ever encounters malingering cases.

"It can happen. But, generally speaking, with the people that I've seen, so much of their circumstances have changed since they became sick that they can't get out of — like losing their life savings and resources — and they're worse for it," Huebner said, "That is pretty obvious."