Long-Term Disability Evaluations for Private Insurers

AAPL Practice Resource for the Forensic Evaluation of Psychiatric Disability

“…In the absence of objective evidence to support a medical disability claim (e.g., chronic fatigue syndrome), carriers may sometimes suggest that the disability stems from an untreated psychiatric disorder (e.g., depression), which may limit the duration of benefits depending on the terms of the contract. Newer policies may limit the duration of benefits for "subjective" or "self-reported" syndromes, which can limit the duration of benefits, even without raising psychiatric questions (113).…”

“…Knowing the conditions of the evaluee's disability policy and the policy's definition of disability can help evaluators understand and anticipate potential areas for distortion of their opinions (113)(114)(115).…”

“…Conducting independent evaluations. In addition to performing a comprehensive psychiatric examination, evaluators are asked to determine function before claims of disability, workplace, and other environmental disincentives to returning to work, claimant veracity, and claimant motivation (113). Evaluators inquire about circumstances of any prior periods of disability.…”

“…The report should address evaluee's remaining capacity for specific functional tasks of the evaluee's duties. A comprehensive and objective report should make it easy for a reader to comprehend the causal connection between the symptoms and consequences of a diagnosed illness and its direct effect on the evaluee's capacity to work (113,120).…”

“…The written report. Often the written report is the only work product of the private disability IME (113,120). Many times, the referral source will not provide feedback to the IME evaluator after the report is submitted.…”