The Challenge of Claiming Long-Term Disability Benefits for Mental Illness

Too often ignored, mental illness is a significant problem that needs to be taken seriously and addressed appropriately.  Many Canadians suffer from some form of mental illness or psychological disorder.  A mental disorder causes mild to intense disturbances and abnormalities in a person’s thoughts and behavior.  Some live with symptoms of mental illness every day without a proper diagnosis or help. According to the Centre for Addiction and Mental Health, mental illness is the leading cause of disability throughout Canada. In Ontario, the disease burden of mental illness is one and a half times higher than that of all cancers combined. The scale and urgency of the issue of mental illness is apparent.

There are many forms of mental illness and the severity of symptoms can differ widely.  Some of the most common in Canada are as follows:

• anxiety and panic disorder, including phobias
• depression and other mood disorders, such as bipolar disorder
• addiction and impulse-control disorders
• post-traumatic stress disorder (PTSD)
• psychosis, such as schizophrenia
• eating disorders, such as anorexia nervosa and bulimia nervosa
• personality disorders, such as obsessive-compulsive disorder and anti-social personality disorder

The degree that a particular disorder affects an individual’s ability to function and cope, differs greatly between people. Treatments may be effective or provide some relief from symptoms for one person but not another.  For example, some people who struggle with depression find that their symptoms are alleviated by a particular prescribed medication but drugs have no effect, in terms of improving symptoms, for others.  Many individuals benefit from psychiatric or psychological therapy. For some disorders, such eating disorders and impulse-control disorders, the patient may need to enroll in a full-time treatment program in a medical facility for six months or longer, and even then, further treatment is usually necessary.

Given the prevalence and huge impact of mental illness, this condition is a common reason for filing a disability claim.  Many people suffering from mental conditions will seek disability insurance for their illness, as the symptoms can be crippling in terms of the ability to cope with one's daily life. Mental illness affects almost every facet of a person's life, including the ability to work and social relationships. Mental illness is often also difficult on family members and friends.

Long-Term Disability vs. Short-Term Disability

Disability insurance offers protection, in terms of providing income replacement and sometimes, payment of other expenses, to a person who is unable to work due to a disability such as mental illness. Disability insurance coverage thus provides some assurance that a claimant will continue to be able to pay their bills and purchase necessities.

Many employers offer disability group insurance to their employees.  As well, individuals may purchase an individual policy. There are two types of coverage: short-term disability insurance and long-term disability insurance. The difference is the length of time in which a disabled person will continue to receive payments. Short-term disability is meant to provide the insured with more immediate payment after they apply for benefits, but it pays benefits for a shorter period of time, typically from 6 months to a year.  Long-term disability insurance provides payments after a waiting period, typically 90-days.   Long-term disability insurance is also subject to conditions; specifically, whether the claimant is able to perform only their current job versus any job for which they have the capability and training.

Unlike recovery from a physical injury or condition such as a broken bone, a sprain or even a surgical procedure, individuals who struggle with mental illness are generally unable to predict how long this disability will significantly affect their lives, so long-term disability coverage often provides the most protection. It is quite common for sufferers to have a prolonged disability due to mental illness, as they seek out treatment and therapy, and try to learn coping strategies. 

Challenges in Apply for Long-Term Disability Insurance for Mental Illness

Insurance companies are more likely to approve short-term disability benefits for reasons of a mental disorder than long-term. The challenge that sufferers face is that the condition is essentially invisible in comparison to a physical medical condition. Insurers also sometimes trivialize the severity and legitimacy of claimant's mental condition. Insurance agents, like many members of the general public, particularly those who have not had personal contact with a loved one who suffers from a mental illness, have limited understanding of how complex and disabling a mental disorder can be.  What’s also not generally understood is that the sufferer has limited control over their symptoms; they do not choose to have the condition and most yearn to be free of their suffering.  Of course, for some insurers, placing doubt on the legitimacy of symptoms provides an excuse for challenging a claim purely from the perspective of the insurer's profit.

The big challenge is when the insurance company perceives a condition, including mental illness, as mild, self-inflicted or illegitimate, they are more reluctant to accept a claim for benefits.  Insurers may contract the services of private investigators to conduct surveillance of people applying for or receiving disability benefits. Private investigators will discretely follow a claimant around and monitor their daily activities for signs of fraud. They also increasingly monitor social media accounts to detect inconsistencies in a claim of mental illness. For example, suppose an insured individual claims disability due to severe depression, but the individual’s Facebook page contains many images and posts that provide clear evidence of that the individual is active in social events and enjoyable activities. Insurance companies can use this information as a basis to deny a claim and cease payments.

Another tactic that insurance companies use to challenge a claim is to utilize their own medical 'experts',  who review the medical records that you provide your insurer and strongly critique the assessments provided by your physician. The isurance company's expert may provide an opinion that is contrary to the assessments by your doctor and the insurance company will often attempt to use these biased assessments as a basis to deny a claim.

What You Should Do

If you are suffering with a mental disorder, not unlike a physical injury, you need to seek appropriate medical help and follow through on the treatment recommended by your physician and/or therapist. Assessments completed by a respected and expert medical professional are vital evidence for the legitimacy and severity of any mental or physical disorder.  It is also a good idea to keep a daily record or diary of your feelings and how your condition affects your daily activities.  This record can provide your doctor with details that may be helpful in your treatment and also serves as evidence for your case. 

Don’t suffer alone.  Tell loved ones and trusted friends what you are going through.  Similarly, if a loved one is suffering from a mental disorder, don’t make judgements and be sure to let them know that you are there to support them.  In serious cases, some individuals suffering from a mental disorder have thoughts of taking their life, but both the sufferer and loved ones who learn of these thoughts, should seek medical help as soon as possible for the sufferer.

Be aware of the potential pushback that you may receive in filing a claim for long-term disability insurance. Remember that you need to contribute to your successful claim by participating in medical assessment and treatment.  Also, carefully limit the information you share on social media and be very honest with the insurance company about your condition.

The experienced lawyers affiliated with the ILO group have helped many individuals struggling with a mental condition in successfully filing a claim for disability benefits.  In some cases, a mental condition such as depression, anxiety disorder or PTSD arises from a car accident or another traumatic event.  Concussions and other forms of brain injury are a common cause of pyschological injuries such as depression and personality disorders. Our substantial experience in getting owed compensation for individuals suffering from a serious injury or condition works in your favour, as we can provide expert legal advice on effective strategies for obtaining needed compensation, including income replacement.