We’ve come a long way in our understanding and attitudes towards mental health issues, specifically in the workplace. Governments at both the federal and provincial levels emphasize the importance of awareness around mental wellness and the impact of the workplace on mental health.
That said, we still have a long way to go. When a mental illness prevents someone from being able to work, the system for claiming disability benefits for a mental illness is complicated and can feel like it’s designed to refuse claims.
When discussing mental health and disability claims, it’s essential to understand the difference between mental health and mental illness. A person can be in poor mental health and not be mentally ill, while someone suffering from a mental illness can otherwise have good mental health.
As one of the top disability and employment lawyers in Toronto, we’ve become experts in mental health and disability claims in Ontario and are well-versed in the intricacies involved. Use our guide to get a better understanding of mental health claims and the legalities involved.
Disclaimer: The information in this guide and everywhere else on this website is for general information only and is not intended to provide legal advice of any kind. No lawyer-client relationship is created by accessing or otherwise using Ertl Lawyers’ website or by communicating with a lawyer or staff member. If you need legal advice, please get in touch with our staff at Ertl Lawyers law firm. We’re more than happy to speak with you.
What is Mental Health?
Mental health refers to the state of one’s mental well-being. At a high level, this means our emotional, cognitive and social abilities. In other words, our thoughts and feelings, connections with other people, our capacity to manage the stresses of life and our ability to work productively and realize our potential.
Like physical health, mental health fluctuates throughout our lives and needs attention and effort to maintain its well-being. Mental and physical health are linked to a degree, and the steps we take to improve one can positively affect the other. Exercise, for example, aids in weight management, reduces blood pressure, improves heart and lung health, and strengthens bones and muscles.
It also boosts energy levels, releases serotonin and endorphins that improve mood and reduces stress, depression, and anxiety. Exercise also promotes better sleep, which is needed for concentration, learning, and psychological resilience (coping with, and recovering quickly from, stress or crisis). Meanwhile, lack of sleep is linked to poor mental health and mental illnesses.
Eating healthy is also known to improve both physical and mental health. Other ways you can maintain or improve your mental health include:
- Using relaxation techniques like meditation, yoga, journal writing, etc., that help you manage stress.
- Being social, meeting with friends and family, volunteering or joining a group.
- Don’t be too hard on yourself for making a mistake or not reaching goals you’ve set for yourself.
- Asking for help from a loved one, seeing your doctor or seeking mental health support in your area.
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What is Mental Illness?
While nearly everyone faces mental health challenges, not everyone will experience mental illness. That said, by the age of 40, almost half of Canadians will have or have had a mental illness.
Mental illness is a disease that affects how a person thinks, feels, behaves and interacts with others and often involves distress and impaired function. Like physical illness, there are many and they affect each person differently. Some well-known mental illnesses include:
- Mood disorders such as bipolar and depression
- Substance abuse
- Personality disorders
- Eating disorders
For more information on mental illnesses, visit this CAMH page. Anxiety and depression are two of the most common disorders cited in mental health disability claims.
Anxiety is the body’s natural physical response to a perceived or real threat. It speeds up the heart and breathing, causes a nervous feeling in the stomach and is accompanied by a burst of energy. Mentally, anxiety can create fear, worry and obsessive thinking.
Everyone occasionally experiences anxiety, but it usually passes quickly. It’s considered a mental illness if feelings of anxiety persist and are severe enough to interfere with a person’s ability to work, study, socialize or complete routine tasks.
There are several types of anxiety, including:
- Generalized anxiety disorder
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder
- Post Traumatic Stress Disorder (PTSD)
- Selective mutism
- Separation anxiety disorder.
- Specific phobia
- Social anxiety disorder
People suffering from anxiety can experience constant nervousness or fear and/or brief, intense attacks that leave them debilitated or terrified.
Clinical depression is an illness that can cause prolonged feelings of sadness, hopelessness, guilt, pessimism and/or low self-esteem. These feelings are present most days and can persist for weeks, months or years.
Depression can also cause other symptoms, including:
- Muscle pain and sickness
- Weight and appetite changes
- Lack of concentration and inability to make decisions
- Feelings of frustration, irritability, or being overwhelmed
- Alcohol and substance abuse
- Loss of interest in work, people or hobbies
- Withdrawing from friends and family
- Suicidal thoughts
These symptoms will usually harm a person’s work performance and social relationships.
Mental Health Disability Claims in Canada
One in three disability claims and 70% of disability costs are for mental illness. However, filing a successful disability claim is challenging and they are routinely denied. Consulting a Long-term disability lawyer to know your rights and how the system works can give you better insights into completing your application.
To qualify for long-term or short-term disability, a mental illness must leave you “totally disabled,” which means that it prevents you from performing a substantial portion of your duties at work. But a doctor’s diagnosis of a disability due to a mental illness alone is not enough to get a disability claim approved.
Unlike a physical injury or disability, mental health disorders are invisible to an outside observer. An employer can see a broken wrist, but signs of depression or anxiety are open to interpretation and can often go unnoticed. And because of the stigma around mental health issues, many sufferers refuse to admit they may have an illness, deny and mask their symptoms and refuse to seek help.
Also, unexpected, traumatic events like temporary layoffs during COVID-19 can trigger mental illnesses, leaving sufferers unaware they need to seek treatment.
But getting medical care for a mental health issue is critical for someone who is disabled and needs benefits because they are unable to work. Not seeking treatment is one of many reasons an insurance company will deny a claim.
Common Reasons Disability Benefits for Mental Illness are Denied & Recommendations
Because of the high costs of mental health disability claims to insurance companies, they look for any deficiency to justify LTD claim denials.
Common reasons for denials include:
Not seeking medical care soon enough and not receiving it regularly.
Insurance companies want to know that a person claiming disability for a mental health disorder sought treatment as early as possible, that the doctor has a treatment plan aimed at reducing the effects of the symptoms and that the employee is and has been actively participating in ongoing treatment.
Diagnosis and/or treatment not provided by a psychiatrist or specialist
An insurance company may insist that if a mental illness is severe enough to be a disability, the employee should see a mental illness specialist. Unfortunately, waiting lists to see a specialist can be as long as 18 months through provincial healthcare programs.
If you are claiming disability for mental illness, it’s vital to get your doctor to refer you to a psychologist and get on the waiting list as quickly as possible if you can’t afford to pay for treatment.
With mental health disability claims, stress in the workplace caused by a specific person, people or the work environment is often cited as a reason for denial. The insurance company will claim that it is an issue for HR or the illness only appears in that situation.
Your doctor must be clear in their diagnosis that you are currently in a state of total disability and unable to work anywhere, whether your current workplace triggered the illness or not.
Not following the recommended treatment plan
Attending all sessions with your healthcare provider, taking prescribed medications and following all instructions is essential to managing your illness and having a chance at getting your claim approved.
Lack of detailed medical documentation
Your healthcare provider should make thorough notes and keep accurate records about the diagnosis, symptoms, pre-existing conditions, healthcare plan, treatments you receive, your response to those treatments and adjustments to medications or counselling sessions.
You can help by keeping a journal of your symptoms and experiences and sharing that information with your doctor to include in their records. Also, keep your own records of all the appointments you’ve attended, medications you’ve taken and efforts you’ve made in your treatment.
Evidence that contradicts your claim
Insurance companies can hire investigators to follow claimants and monitor their social media accounts to confirm that what they’ve stated in their application is consistent with their daily lives. Insurance companies will also use some of these same reasons to stop or revoke benefits after they’ve been approved.
If your claim for disability due to a mental health disorder is denied, or the insurance company notified you that they are stopping benefits, you must contact an employment lawyer immediately as you only have a limited amount of time to file an appeal or a lawsuit.
Better, Faster Results from Mental Health Disability Experts
We know how difficult it is to navigate everyday tasks with an illness or disability. That’s why our mission is to deliver better, faster results to our clients. We’ve helped thousands of clients with disabilities get the benefits they deserve over the years because we know how to deal with insurance companies.
Have a question about mental health or other disability claims? We offer free, no-obligation consultations and fair, flexible pricing, including contingency fees. In other words, you don’t pay unless you win.