Many long-term disability claims denied across the country are claims for mental health conditions affecting an individual’s thoughts and behaviours. Throughout the COVID-19 pandemic, many individuals experienced a decrease in their mental health. Often described as an invisible disability, mental health conditions are notoriously difficult to prove, despite sometimes being connected to, or a symptom of, other physical conditions within the body.
It is important to continue to advocate for individuals experiencing mental health conditions which prevent them from meeting the demands of their job or engaging in their daily activities. It is important to increase awareness and decrease the stigma surrounding these claims, given the urgency and scale of these matters.
Experiences Which May Impact a Claimant’s Ability to Work
Approximately 30 per cent of short-term and long-term disability claims across Canada are attributed to mental health illnesses. However, these claims are often denied due to their inability to be objectively substantiated and easily quantified.
While each person’s experience with their own mental health is unique to them, some common experiences may prevent someone from being able to perform their job-related duties. A claimant may experience an inability to work in a variety of ways, including difficulty engaging with co-workers and customers, lack of interest in activities, experiencing low energy, difficulty focusing on tasks or making decisions, and physical symptoms. Therefore, a claimant may be required to take time away from their workplace in order to seek appropriate treatment.
Unique Challenges for Mental Health Claims
Several diagnosed mental health conditions, such as post-traumatic stress disorder, anxiety, depression, and panic disorders, can detrimentally impact someone’s life on their own or as a result of another injury, illness or condition. However, because these conditions are often not visible to others, nor do they show up on typical medical testing, such as x-rays, CAT scans or physical assessments, they can be more difficult to assess, diagnose and treat. The prognosis of mental health conditions is also much more complex to anticipate than a physical injury recovery.
As a claimant, having a supportive medical team can be another challenge. Aside from financial factors, as some treatments may not be covered by medical benefits, the ongoing stigma felt by many can be a hindrance in obtaining proper testing and treatment. Often an initial claim denial will be due to the insurance company determining an insufficient amount of supporting medical information to establish entitlement to disability benefits; however, for claimants, this is far from the truth.
Difficulties can arise when an individual experiences substandard treatment from medical professionals, the treating physician does not properly document their findings, or wait-list times for further specialty treatment takes months or years. Communication is key between a claimant and their treatment team. However, even if a claimant provides ample medical assessments and expert opinions to the insurance company in support of their claim, the insurer may still state that they are unable to substantiate the claimant’s subjective emotional experience.
Aggravating Factors for Claimants
For many, the ongoing cycle and management of continuous paperwork and form requests from insurers will further aggravate their mental health. Some may feel the pressure to return to work due to not feeling heard and believed or due to the overwhelming nature of the invasive questioning and claims process. However, this can create more harm than good as it may lead to the deterioration of their health and strained relationships with family, friends, and employers.
Another concern for claimants with mental health conditions is surveillance and social media. While surveillance may be used during any long-term disability claim, it can impact some individuals more than others, who may become more isolated so as to not worry about how their life may look to the insurance company. However, for individuals with mental health conditions, disabling social media and avoiding outings could have detrimental impacts, as socialization and activity may assist them in helping them prepare to return to work.
Uncertainty of Ongoing Benefit Support
Severe symptoms of mental health conditions, even with treatment, can have an ongoing impact on an individual’s social interactions, relationships, cognitive functioning, ability to respond to change, and ability to maintain regular employment. Even when an initial claim has been approved, a claimant may live in fear of their benefits being cut off, putting additional stress and concern of financial strain. In the event of a benefit denial or termination, it can be greatly beneficial to seek assistance from a long-term disability lawyer to help navigate you through the subsequent processes rather than force yourself to return to work when you are not ready.
Contact Long-Term Disability Lawyers at Cuming & Gillespie LLP in Calgary for Advice on Long-Term Disability Claims
The long-term disability lawyers at Cuming & Gillespie LLP have significant experience assisting clients with long-term disability claim denials for mental health conditions. Our team understands that taking a medical leave from work can create many uncertainties for you and your family. We will review your claim and help you determine the best way to pursue your claim further. Our lawyers will manage your claim to allow you to make your health your first priority. To schedule a consultation, contact us online or call us at 403-571-0555.