Workplace stress is on the rise in Canada. A 2019 survey by Morneau Shepell, a human resources consulting, found that more than one-third of employees are more stressed out from work than they were five years ago. That same survey revealed that a quarter of workers identified their stress from work as being high to extreme.
Employees often resort to long-term disability (LTD) leave through their insurance policy when anxiety impacts their ability to do their job.
Insurers often deny disability claims, though, even when your doctors say that you are in no condition to return to work. Your insurer may say that you have “workplace issues” or a “toxic work environment” and therefore you do not qualify for long-term disability benefits.
Are they right? Does it matter? Here’s what to know if your disability claim is denied on the grounds of “workplace issues.”
What’s the difference between situational disabilities and general?
To understand why your insurer is focusing on your employment, you first need to understand the difference between situational and generalized disabilities.
A situational disability is triggered only in specific situations. It could be triggered by a place, like your workplace, or the presence of a specific person, such as a supervisor at work or an estranged family. A situational disability only appears in those specific situations and goes away when you’re no longer in that situation.
A generalized disability is one that exists in all situations. Even if it was first triggered by a particular situation, such as a bad work environment or marital discord, it is now always present and is a factor in all facets of life.
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What insurers mean by “workplace issues” or “toxic work environment”
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One of the more common explanations long-term disability insurance companies give for claim denials is that they found your symptoms are the result of “workplace ” or a “toxic work environment.”
Either way, they are suggesting that you are not really disabled. The insurance company believes that you merely have a difficult work environment.
Why does a toxic work environment matter for my LTD claim?
Long-term disability policies are insurance policies that pay your benefits when you become disabled from your own occupation. They are not “toxic work environment” insurance policies. If the problem is not that you have a mental health issue, but rather a bad work environment, a standard LTD policy would not be required to pay benefits.
Can I get long-term disability if I have a bad work environment?
Finding yourself in a toxic work environment does not disqualify you from getting LTD benefits. Whether or not you have a toxic work environment, the question is still the same: do you have a disability that prevents you from working in your own occupation?
READ MORE: Coronavirus: How to use disability insurance if your mental health is suffering
What’s the difference between “occupation” and “job”?
Your occupation is a general description of what you do for a living, whereas a job is what you do for your own employer. For instance, my occupation is a lawyer, but my job is a disability lawyer at Samfiru Tumarkin LLP.
The distinction is very important for long-term disability cases. When defining the term “totally disabled” (sometimes simply called “disabled”) under an insurance policy — which is the test used to determine if you are entitled to benefits — the analysis is not whether you can return to your job, but whether you can return to your occupation.
If your issues are simply the result of a bad work environment (i.e., a situational disability relating to your job), and you would be otherwise able to perform your occupation for a different employer, you are likely not going to be deemed disabled for the purposes of the policy. You would not be entitled to long-term disability benefits.
On the other hand, even if your workplace could reasonably be called a toxic work environment, this does not mean you aren’t entitled to disability benefits. If you are suffering from a mental health disability that would prevent you from doing your occupation with any employer — a generalized disability — it doesn’t matter at all that your workplace is a toxic work environment.
Even if the workplace environment is the sole trigger for your disability, you are entitled to LTD benefits if you are now disabled from doing your occupation for any employer.
Situational conditions and severance pay
If you are experiencing a situational problem, such as workplace harassment, you may be able to pursue a constructive dismissal claim against your employer. If the company fails to address or remedy the toxic atmosphere, you can treat your job as having been terminated. The employment lawyers at Samfiru Tumarkin LLP would then help you secure your full severance package.
I have a generalized condition, but they still said it was a work issue
This is, unfortunately, a situation we see all the time in the disability law practice at Samfiru Tumarkin. Insurers look for any information they can use to justify denying a legitimate disability claim. If they see that the work environment has caused or contributed to a disability, they will often label it a workplace issue or toxic work environment, and deny the.
Just because the insurance company tells you that you aren’t entitled to benefits, however, doesn’t mean they are correct.
If you have a generalized disability and your benefits are denied, the disability lawyers at Samfiru Tumarkin LLP can help you obtain the compensation you are legally entitled to.
Has your long-term disability claim been denied? Is the insurance company threatening to cut off your payments?
Contact the firm or call 1-855-821-5900 to secure assistance from a disability lawyer in Ontario or British Columbia. Get the advice you need — and the compensation you deserve.
James K. Fireman is a disability lawyer and partner at Samfiru Tumarkin LLP, one of Canada’s leading law firms specializing in disability claims and employment law.