Mental health disability claims make up the largest portion of disability claims filed each year in Canada, and those numbers continue to increase amid the pandemic.
Social isolation and relationship breakdowns, amplified by restrictions and lockdowns, COVID-19-related health concerns and financial worries have wreaked havoc on people’s mental health. Those most in need of mental health support have struggled to find treatment due to a medical system strained by an increasing demand for services.
Many Canadians who have stopped working due to their mental health have had their disability claims denied by private or group insurers, whether because of a lack of medical evidence or a lack of proper treatment as mandated by insurers, even in the face of supporting medical evidence from treating physicians.
Here are three things to know when submitting a disability claim for a mental health condition, based on my experience as a disability lawyer.
READ MORE: 3 things that can help reduce stress when dealing with a long-term disability insurer
- Get a specialist on board
Disability claims rely on an assessment of functional impairment. Insurers want to know that the claimant is unable to perform the essential duties of their occupation and, later, any occupation.
That’s why it’s helpful to have a knowledgeable physician complete the medical report for a mental health disability claim, detailing the claimant’s functional impairment by explaining what prevents the claimant from working.
Mental health disability claims are often denied on the basis that there is no objective evidence of the claimant’s reports of functional impairment. So it’s important that the initial physician’s statement details restrictions and limitations to the claimant’s ability to work.
If possible, have a statement completed by a psychiatrist who specializes in the assessment and treatment of mental health issues. If a claimant does not have a treating psychiatrist, which may be the case due to the current overburdened healthcare system, ask your family doctor for a referral to a psychiatrist so you can at least show you’re on a waiting list.
Since mental health treatments often involve counselling, claimants may also want to ask to be referred to a psychologist or similar healthcare professional. This specialist can then also provide a supportive opinion on the claimant’s functional impairment.
READ MORE: 5 things every employee should know about long-term disability and how to get benefits
- Follow providers’ recommended treatment plans
Disability policies require claimants to be under the regular care of a physician and to participate in an appropriate treatment program.
Insurers often focus on the treatment prescribed, whether the claimant is following the treatment and whether the treatment is appropriate for the particular mental health issue. So I always tell clients to follow their doctor’s treatment plan.
It’s also important to see your doctor on a regular basis, and if appropriate, for the doctor to adjust the plan if the mental health issue does not respond to previous treatments.
At my firm, Samfiru Tumarkin LLP, we have seen many mental health disability claims denied by insurers on the basis that the claimant is not under the regular care of a physician or is not following the prescribed treatment
We’ve also seen claims denied because the claimant is not being appropriately treated in the opinion of the insurer, even when the claimant may regularly see a specialist such as a psychiatrist.
In these cases, the insurers do not accept the opinions of the treating specialists, despite the fact that the treating specialists have had the benefit of assessing the claimant and are best positioned to determine treatment needs and to provide an informed opinion on the claimant’s functional impairment.
READ MORE: Invisible illnesses: Can I still get long-term disability even if I don’t look sick?
- Talk to a disability lawyer immediately if your claim is denied
Dealing with an insurer who has the power to make decisions on a claimant’s financial support at a time when the claimant is unable to work can be very stressful.
In situations where the disability is due to a mental health problems, a denial of a disability claim, termination of disability benefits or any other negative interaction with the insurer may put a claimant at risk of having their mental health condition get worse.
If your claim is denied, your benefits are terminated or you have a question about your rights, talk to an experienced disability lawyer. Many teams of disability lawyers, like ours, offer free consultations and speak to vulnerable claimants to discuss their options every day.
Do you need help with your disability claim for mental health issues? Has your long-term disability claim been denied?
Contact the firm or call 1-855-821-5900 to get a free consultation from a long-term disability lawyer in Ontario, Alberta or British Columbia. Get the advice you need — and the compensation you deserve — from the most positively reviewed disability and employment law firm in the country.
Martin Willemse is a disability lawyer and partner at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in employment law and long-term disability claims. The firm provides free advice on Canada’s only Disability Law Show on TV and radio.