American workers have undergone challenges when seeking paid time off for mental health treatment due to things like medical professionals' assessments and rejections from insurance administrators.
US companies are required by law to take employees' mental health seriously, but a standard medical claim may lessen their chances of sick leave approval.
Insurers who've denied claims have said that the challenge of assessing symptom severity makes it more effective to visit a medical professional who treats patients and understands conditions.
They must also evaluate disability claims and factor in financial considerations against obligations to provide leave for employees when necessary, according to WSJ.
When an employee files a claim, the administrator will ask for evaluations, question the diagnoses, and request recommendations from physicians, therapists and psychiatrists, and ask workers to pay for neuropsychological testing.
Sick leave for mental health is hard to obtain due to the need of medical professionals' assessments and rejections from insurance administrators
COVID-19 played a role in the increase in individuals diagnosed with a mental illness.
Since the pandemic, companies like Google, LinkedIn, and Monzo have offered benefits for its employees to improve their mental health.
Some of the new benefits companies include in their employment packages are access to meditation and sleep apps, free therapy visits, and extra paid time off days.
Despite these benefit additions, work leaves due to mental health has continued to soar in the US.
Mental health-related work leaves increased by 33 percent in 2023 compared to 2022, according toComPsych last February.
Female employees' work leave requests were a crucial part of this tally, as 69 percent of absences for mental health reasons were taken by women.
'Our data shows that millennial and Gen X women are most likely to need a mental health-related leave of absence,' Dr. Richard A. Chaifetz, Founder, CEO and Chairman of ComPsych said in a press release.
'HR teams must invest in resources and programming that relates to issues commonly faced by these demographics: from the pressures of managing teams, the stress of buying a home for the first time, acclimating back at work as a new parent, or worrying about care for aging relatives.'
Insurers who've denied claims said that the challenge of assessing symptom severity makes it more substantial to visit a medical professional
Disability claims for mental illness have also continued to increase in the US.
Around seven to 10 percent of long-term and short-term disability claims in recent years are related to mental health.
However, information on the reasons behind claim denial is not always available because officials are not required to provide that information to regulators, including the Labor Department.
Sedgwick claims administrator released their 2023 statistics, which confirmed that it turned down about 30 percent of mental health claims.
David Setzkorn, head of Sedgwick’s workforce, told the WSJ that insufficient medical documentation was the primary reason for its denials.
'How do you medically prove some of these things? If I broke my arm, I’ve got an X-ray that shows a broken bone,'. Phil Lacy, head of the health and productivity practice at consulting firm Marsh McLennan Agency told WSJ.
'But claims with subjective symptoms are very difficult, and it’s hard to get at the level of detail that helps you understand the severity.'
A study showed that 69 percent of work absences for mental health reasons were taken by woman in 2023
Another issue involves the courts and their decision to prohibit financial penalties for companies that turn down disability claims that should have been approved.
Lawyers even refuse to take on disability claim cases if the payouts without applying financial penalties are low.
Florida lawyer Eddie Dabdoub told the WSJ that just receiving and appealing claim denials can increase a client's symptoms if they are battling a mental illness.
Dabdoub recalled a time when he was the attorney for a sales representative at Salesforce who had bipolar disorder, depression, and anxiety.
The client had applied for long-term disability benefits last year under the company's plan, which is administered by MetLife.
While waiting for a decision, the sales representative participated in two outpatient programs and attended a hospitalization program as advised by medical professionals.
MetLife ended up not making a decision about the disability claim within a mandated 45-day window, which ultimately counted as a denial.
According to WSJ, Salesforce declined to comment on the matter, and a MetLife spokeswoman said the company doesn't comment on litigation.
Information on the reasons behind claim is not always available because officials are not required to provide that information to regulators
US employee Justin Gimotea began working as a social media manager for MillerKnoll furniture and design firm in 2020.
His responsibility load increased over time, and it was common for him to work 60-hour workweeks, according to the WSJ.
Gimotea had been battling various mental disorders, including generalized anxiety, for years prior to starting his management position.
Work pressure began to increase his symptoms, and per his doctor's recommendation, Gimotea took a leave of absence in 2023.
He filed a claim for temporary disability benefits to cover 70 percent of his salary, but his employer's insurance administrator, New York Life, rejected it months later.
According to Gimotea’s case, the insurance administrator, New York Life, was 'contradicting medical advice.'
The social-media manager returned to work in December 2023, but MillerKnoll superiors let him go a month later.
Around seven to 10 percent of long-term and short-term disability claims in recent years are related to mental health
Gimotea sued the company and New York Life for employment discrimination, which was settled last April.
New York Life has denied Gimotea’s allegations, according to WSJ.
