Mental Health Disabilities and Long-Term Disability Claims

Approximately 1 in 3 Canadians experience mental illness in their lifetimes. It’s absolutely crucial to prioritize your mental and physical health and recognize signs of mental health issues. Symptoms of mental illness can include long-lasting sadness or irritability; extremely high and low moods; constant or excessive fear, worry, or anxiety; withdrawing from social activities; or drastic changes to eating or sleeping habits.

If you experience these symptoms, speak with your doctor right away. Your doctor or a specialist may recommend a treatment plan that includes taking long-term disability leave. If your work offers a health plan, it may offer long-term disability benefits (LTD), and you can apply for financial support during your leave.

What are LTD Benefits?

Disability benefits are monthly payments that replace employment income for people who can’t work because of a disability. You have to be covered under an insurance policy that provides disability coverage. There are short-term and long-term disability plans. Short-term disability lasts for up to 6 months and, if needed, the long-term plan takes over the payments after that.

The amount of disability benefits you receive and how it’s calculated is stated in your policy. Disability benefits can cover anywhere between 60 – 80% of your income.

Applying for Long-Term Disability Benefits

To be eligible for short or long-term disability benefits, your mental illness must leave you unable to perform the essential tasks of your job. This is referred to as being “totally disabled.” LTD claims for mental health issues can include conditions like (not a complete list):

• Anxiety
• Depression
• Mood disorders such as bipolar and depression
• Substance abuse
• Schizophrenia
• Personality disorders
• Eating disorders
• Post-Traumatic Stress Disorder (PTSD)

In your application for LTD benefits, your doctor will have to fill out a section that details how your mental illness prevents you from completing your duties at work and include all relevant information and supporting documents.

It’s vital that you speak honestly with your doctor and provide them with a full description of your tasks at work, preferably with a job description provided by your employer.

Unfortunately, despite a physician’s statement and opinion, insurance companies routinely deny LTD claims – especially mental health disability claims.

It’s a good idea to consult a disability lawyer in Toronto to assist you with your application or if your claim is denied.

What Will Cause an Insurance Company to Deny a Claim?

Insurance companies, like all businesses, try to maximize their profits and denying claims helps them increase their bottom line. When assessing an application for LTD benefits, they will look for any reason to justify a denial. Some of the more common reasons for a denial include:

• The employee applying for mental health disability benefits did not see a doctor soon enough or was not seeing them regularly before the application.
• The application did not meet the criteria for a “total disability.”
• The symptoms an employee experiences result from a “toxic” workplace and should be handled through workplace procedures (e.g., HR or health and safety).
• There was a lack of medical evidence to support the claims made in the application.
• The employee failed to disclose a pre-existing condition.
• The employee is not or did not follow the treatment plan.
• Evidence collected by an investigator contradicts information in the application.

If your claim is denied, or you were receiving benefits, and the insurance company notified you that they are terminating payments, speak to a disability lawyer right away. It’s crucial that you don’t give up your claim; many insurance companies will not pay benefits unless they are contacted by a disability lawyer.