A Human Approach to Mental and Nervous Claims

When it comes to mental illness, each person’s experience is highly unique.

It’s also unpredictable; often the path between diagnosis and treatment is far from linear. Like a kaleidoscope the view of one’s mental state can suddenly shift, with new details emerging as symptoms present themselves or improve. It can be difficult – for those on the outside especially – to see the complete picture.

For claim analysts, administering long term disability claims related to mental and nervous disorders requires a certain level of training and experience, plus the right mindset, to be effective in our roles.

I’ve worked extensively with claimants dealing with these disabling conditions over the years, and there’s always something new to learn. Beyond the procedures we need to follow, I’ve found that these claims requires certain “soft skills” that are just as important, but may not be taught or reinforced as much as they should.

Empathy: this may not be seen as a “skill” per se, but it’s key to making an authentic connection with someone. The more you can convey some level of understanding, the more likely you will earn trust, which can lead to more effective dialogue in the long run.

Critical Thinking: in looking at the information presented, does anything appear to need further clarification or validation? Beyond the required information, what are you able to gather in order to understand the full scope of the claimant’s condition?

Communication: it goes without saying that being an effective communicator is important. But in our world we need to do our best to be in direct contact with a claimant, which requires telephone skills. Telephone interviews are an important tool in evaluating all disability claims. Once the telephone interview is complete, you will have a better understanding of what medical information should be requested for review.

More important than anything else about managing these claims is remembering the human behind the file. It is our responsibility as we work with the claimant to put humanity and dignity front and center. After all, it can feel extremely unsettling and invasive to have to talk to a stranger about such a highly personal situation.

Keeping all of this in mind, here are some helpful tips and reminders for administering a disability claim due to a mental or nervous condition.

• Direct contact with the claimant is ideal, but if this is not possible ask to speak with a family member or caregiver.
  
  • If speaking with the family member or caregiver, try to gather as much information as possible to fill in any gaps about the claimant’s condition. What have they observed for any changes, positive or negative, and what examples can they provide?
• Spend time learning the claimant’s history.
  • When were they diagnosed with a mental illness?
  • If they were recently diagnosed, do they feel their symptoms are tied to a life event?
  • If they’ve been treated in the past, what is different about this situation?
• Ask what is in place for an ongoing treatment plan.
  • Obtain the names and contact information for all health care providers that treat their condition. If they are not currently treating with a psychiatrist and therapist, has a referral been made or recommended?
  • Find out more than just a list of medications – have there been any recent medication changes and how are they working?
  • When was their last appointment? When is their next appointment? The more details around their level of treatment and how recent they’ve been evaluated, the better.
• Find out about level and quality of sleep. This is an important component in mental health.
  • Do they track their sleep patterns? Or do they have a spouse/partner that can share their observations?
  • How many hours do they sleep per night? Is it uninterrupted? Do they take naps during the day due to fatigue?
• Respect their concerns around sharing certain information.
  • Remind them this information is being reviewed solely for the purpose of evaluating their disability and will remain confidential.
  • If a counselor or psychologist feels more comfortable, they may prefer to provide a narrative detailing the period of treatment, their assessment of the claimant’s functionality and the rationale behind that assessment.

Remember that mental illness is a broad category that houses many different diagnoses, each with their own symptoms. Above all, remain sympathetic to each claimant’s unique situation in the evaluation of their claim. It can make all the difference in the long run.