What To Do If Your Medical Leave Application Is Denied

Learn what to do if your medical leave application for burnout is denied, including how to review the forms, correct missing information, and appeal the decision.

Watch the 3-minute video below to find out more.

Why Medical Leave Applications for Burnout Are Sometimes Denied

Sometimes, an insurance provider will deny a medical leave application. If this happens to you, do not panic. Applications are denied more often than you might expect.

In my experience, an incomplete application is the only reason I have seen for a medical leave application to be denied. A denial does not mean that the insurance company believes you are malingering or faking your condition.

The process is similar to applying to attend a university. If an application is incomplete, the school will not admit the applicant. The same principle applies to an application for medical leave. If required information is missing from the form, the insurance provider will not approve it.

Ask Your Physician to Review the Application

You can ask your physician to review the form and determine why your application was denied. You can also obtain a copy and review it yourself for any missing information.

The problem may be as simple as a field that was left incomplete.

Make Sure the Psychiatric Diagnosis Is Included

A common problem occurs when a physician records that the person is anxious and depressed but does not include an official psychiatric diagnosis on the form.

When someone goes on medical leave for burnout, the appropriate diagnoses are Generalized Anxiety Disorder and Major Depressive Disorder, Moderate Episode. These diagnoses need to be recorded under the psychiatric diagnosis heading.

The application must include the words “Generalized Anxiety Disorder” and “Major Depressive Disorder, Moderate Episode.” If these diagnoses are not written on the form, the application will be denied.

Ask a Psychologist to Review the Form

You may feel too overwhelmed or uncertain to review the application for errors and omissions yourself. If so, you can ask a psychologist to examine it for you.

A psychologist should be able to identify the problem within about 10 minutes. What matters is having someone with the appropriate expertise review the form.

When I review an incomplete application, I write a letter to the insurance company explaining that the form was not completed properly and providing the correct diagnoses or missing information. After I submit the letter, the application is generally approved.

Try Not to Panic About a Delay in Income

Try not to become anxious or upset while waiting to receive your first cheque from the insurance company. Most people rely on a regular pay cheque to keep their finances running smoothly, but several weeks or even months may pass before your first payment arrives.

If your income is temporarily interrupted, you may need to put some expenses on a credit card or access your line of credit. Calculate how much interest you are likely to pay while you wait, and then take a deep breath. The cost of using credit temporarily will probably be small—perhaps several hundred dollars.

Anticipate that there may be a financial cost associated with going on medical leave, and then accept it.

You Can Submit a Second Appeal

If your first appeal is denied, you are allowed to submit a second appeal.

During the second appeal, the insurance company will commonly involve a psychiatrist. The psychiatrist will ask you about your condition and any treatment you are receiving from your physician or a psychologist.

For example, the psychiatrist may ask why you are not taking a psychotropic medication such as an antidepressant. If you have not received a prescription, your physician can prescribe one, and your application should then be approved.

Considering Next Steps

If your medical leave application has been denied, begin by asking your physician to review the form and identify any missing information.

If the process feels overwhelming or too complicated, reach out to a psychologist for help.

Related Articles

• This article explains the process of beginning short-term medical leave and completing the required paperwork.
• This post describes why medical leave applications may be denied and who to turn to for help with an appeal.

Watch Part 6

Medical Leave for Burnout? Disconnect from Work During Recovery