Tips when claiming Disability Benefits for Mental Illness

Posted by Stevenson Whelton LLP
November 01, 2019

The Mental Health Commission of Canada has reported that by 25 years of age, about 20 percent of Canadians will have developed a mental illness, such as major depression, an anxiety disorder or bi-polar disorder.   And, the World Health Organization (WHO) estimates that neuropsychiatric disorders, the majority of which involve mental and behavioural disorders, are the leading cause of disability in the United States (and the statistics are likely very similar for Canada). 

To decide the burden of a particular disability on a society, WHO looks at the number of years in a lifetime that are lost due to illness, premature death or disability within a population.  And, for a person suffering from mental illness, the impact on the ability to function in home, social and work situations is often substantial and debilitating, and as a result, many sufferers experience a diminished quality of life and reduced life-span. So, it’s not surprising that mental illness is the basis for about one in three disability claims. 
 
Despite the fact that the prevalence of mental illness is now widely known in Canada, persons seeking disability benefits under their disability plan often experience greater difficulties in having their disability claim approved, than persons making a claim due to physical illness or injuries.  And even after a claim is approved, insurance companies sometimes terminate disability benefits prematurely and before the disabled person is well enough to return to work.
 

An 2017 CBC report described the challenges that a Toronto woman was put through while claiming long-term disability (LTD) benefits for anxiety and depression.  She was covered under a benefits plan for City of Toronto employees and the plan’s insurer terminated her LTD payments when a third-party physician disagreed with the claimant’s doctor who had been treating her for over two years.  The letter to terminate her disability benefits implied that she was lying about her level of disability, given that the letter stated that the City didn’t agree that she wasn’t able to return to work. And unfortunately, this circumstance happens all too often to persons disabled due to a mental condition.

If you are suffering from a mental condition that prevents you from performing at work, there are steps you can take to increase the likelihood that your long-term disability claim will be approved.

Recommendations and requirements when making a LTD claim for mental illness

  • Before applying and qualifying for disability benefits, you must be under the regular care of a physician.  This means that you need to have seen a doctor on a regular basis - from bi-weekly to monthly, depending on what’s appropriate for your condition.  You also need to follow your doctor’s advice for treatment to demonstrate that you are genuinely trying to get well.  This includes taking prescribed medication, seeking psychological treatment and pursuing any other treatment alternatives your doctor suggests..
  • Your doctor must keep track of your visits, and monitor and record the effectiveness of prescribed treatments.  This information is important medical evidence that must be included in your LTD application, and if you are in any doubt that your doctor isn’t recording your treatment, he/she needs to be reminded that this information is crucial.
  • A person with a mental health problem should seek, at the very least, a diagnosis from a mental health professional because the opinion of a mental health doctor will be viewed as more credible by your disability insurer, compared to that of a family doctor who often has limited experience diagnosing and treating the condition.  Further, if you haven’t sought treatment from a psychiatrist or other mental health specialist, your insurer may argue that you don’t perceive your condition as serious.
  • If your doctor isn’t providing a good standard of care, including tweaking your medications and recommending specialized treatment as needed, the insurer is less likely to approve your claim.  Similarly, if your doctor doesn’t fully support or believe your complaints of mental health symptoms, they are unlikely to provide convincing evidence of a mental health disability to your insurer.  This is a problematic circumstance and requires that you seek medical care from a doctor who believes in your complaints and has good credentials.
  • To qualify for disability benefits, your condition must meet the criteria of a ‘total disability’.  This term can be defined differently from policy to policy, but it generally means that a person is unable to perform the essential tasks of their current job. Further, the Supreme Court of Canada has asserted that a person may be totally disabled when a reasonable person would recognize that they should not engage in the activities required of their job, even when they are not necessarily physically unable to do so.  This means that a person may be totally disabled if prudence requires that they desist from working in order to get well.
  • After two years, your disability insurer may dispute your claim because the eligibility requirement for LTD becomes stricter at the two-year mark.  In order to eligible at this pointthe symptoms from your mental illness must prevent you from performing any job for which you are reasonably suited, based on your education, training and skills. And, you may be required to undergo further medical assessment to prove that your symptoms meet this standard.  

To summarize, if you can provide medical evidence that your specific symptoms prevent you from performing the important tasks of your job (or any suitable job after two years), or if going back to work will worsen your symptoms or prevent you from recovering, you should meet the eligibility requirements for disability coverage.   However, if you have submitted the required medical evidence with your application and continue to be unfairly denied benefits for depression, anxiety or another psychological condition, get help from an Oakville disability claims lawyer who has experience going up against insurance companies in claims disputes. 

 

 

Sources:

https://www.mentalhealthcommission.ca/English

https://www.cbc.ca/news/canada/toronto/hard-at-work-disability-claims-1.4067689

Disclaimer: Our blog is intended to inform our existing and prospective clients about topics pertinent to their lives. While our goal is to provide accurate and factual information, this in no way should be taken as legal advice or applied to specific cases. It is in your best interest to contact a licenced and practising lawyer for legal representation, as matters of the law are often complicated and cannot be fully assessed without knowing all of the details of a case.