Mental illness is a leading cause of disability in Canada.
Would you believe that there are over 500,000 Canadians who are unable to work because of mental health problems? Of the 500,000 that are unable to work, two-thirds are related to mental or behavioural disorders and one-third is due to mental illness. The economic burden of mental illness in Canada, including health care, loss of productivity, is approximately $51 billion every year.
1 in 5 Canadians will experience a mental health or addiction problem this year. By the age of 40, 1 in every 2 Canadians will have (or have already have had) a mental illness. See Centre for Addiction and Mental Health (CAMH) for more information.
The Canadian medical system is overburdened, and in many cases, unable to provide the proper level of care for those suffering from mental health problems. Disability benefits are particularly important for this group given that treatment costs are often very expensive and access to treatment providers is limited.
An Uphill Battle: Mental Illness-Related Disability Claims
Challenge #1: Approving Benefits Costs the Insurance Company Money
It is possible that the decision to deny benefits may be the correct decision. We can’t say that every denial is without merit. There are cases where someone is hurt, or moderately impaired from doing their job, but the level of impairment does not prevent them from doing their job. Some people find it helpful to take a step back from the paperwork and take a good hard look at their ability to get their job done. Others ask a friends, family, or coworkers for feedback. We’ve found that those close to you often have great insight regarding your abilities and struggles.
Challenge #2: How Do You Prove Your Disability?
Proving a disability is hard. This is particularly true if the basis for the inability to work is due to a mental illness. Many denials are based on a work environment issue, rather than the individual’s health.
One of the best steps you can take to build your case is to show that you are unable to complete the regular duties of your position, regardless of whether that was the custom job site or some other place was.
A supportive family physician is very helpful, but it is not always enough. Seeking out a psychologist for treatment is helpful in the event that your claim is denied. The psychologist may also be able to opine on how long your recovery may take before you are able to return to work.
Challenge #3: Approved and then Cut-Off
In some cases, you may be approved for benefits and then promptly denied a few months later. Before your benefits are cut-off you will be asked to attend an Independent Medical Examination. The purpose of this examination is to assess your ability to complete the regular duties of your occupation. A Transferable Skills Assessment may also be completed. The goal of this assessment is to show that other occupations exist which will match your skills and experience.
If either test leads to a finding that you can do your job (either your “own occupation” or “any occupation” based on the terms of the disability policy, you can expect a denial to follow.
The burden will then be on you to prove why the tests are not correct. Overruling the evidence gathered by the insurance company is a challenging process, especially for those without legal help.
Challenge #4: Insurance Denial Tactics
The insurance company is rich in resources and benefits from terminating a benefits claim. The insurance company will have your file assessed by their internal medical consultant to justify their denial. The claim process will move slowly on appeal, despite full-well knowing that a claim denial leaves nearly everyone under enormous financial pressure.
Most people do not plan to need a lawyer for a disability claim. Many are shocked to learn just how common it is in the event of a cut-off. If you are cut off, be sure to act quickly. Time limits apply to many disability appeal processes.
Challenge #5: Hidden Medical Advisors
You may have gone to see a top-quality family doctor or psychiatrist, both of whom support your claim for disability – but the insurance company still denies your claim! How can this be? The insurance company doesn’t have to follow the advice of the doctors you see. They are allowed to rely on advice from another doctor who works for the insurance company.
Final Thoughts From a Disability Lawyer
Mental health affects a significant portion of the Canadian workforce. It’s OK if you suffer from depression, anxiety or another form of mental illness. What’s important is that you get the help you need. One important source of assistance is your workplace disability benefit plan.
We know that disability benefits for mental health conditions can often be a tough, uphill battle. Despite the challenges that an applicant may encounter, some steps can be taken to best position your application for approval.
First, be sure that you have taken steps to meet with a doctor to discuss your health. Then ask them for a referral to a psychiatrist. The psychiatrist referral is critical because his or her opinion will be highly persuasive to the insurance benefits provider.
The disability benefits provider may approve your claim – for the time being – while they request that you attend treatment. They may also ask that you attend a medical examination. The insurance company will make efforts to confirm whether or not you deserve benefits. Expect to be cut-off in the months following a medical examination or the end of the treatment suggested by your psychiatrist. Don’t walk away from your right to benefits only because the insurance company cut you off.
You have two main routes to pursue benefits once you have been cut-off or your application was denied. You can pursue an internal appeal, or file a legal claim. The internal appeal process is of little use if you have no new medical information to provide. Whatever route you choose, be sure to avoid the common mistakes people make when applying for benefits or appealing a decision.
If you are considering whether or not to get a lawyer to help with your claim, consider the following:
- Does the lawyer have a dedicated practice to personal insurance and disability insurance law?
- Does the lawyer have access to in-house physician reviews?
- Do you feel confident in the lawyer’s communication style and commitment to your case?
Do you want to talk about your options? Contact Jeff Mitchell to arrange for a free case review. We will provide a detailed assessment to you along with a plan laying out next steps, should you wish to entrust us with your claim.
Remember – quick cuts-off are common for mental health related disability claims. Be sure to prepare yourself and your loved ones for this possibility. NOVA Injury Law has experience with disability denials. Let us guide you through each step of the process with an efficient and medically-informed approach.