About Bipolar Disorder
Bipolar disorder is a mental health condition associated with severe changes in mood, energy, and ability to complete day to day activities. Type I bipolar diagnosis typically requires extreme manic episodes that may require immediate medical care. In Type II bipolar mood fluctuates up and down, but the ups are not as extreme. The symptoms of bipolar disorder are more severe than the normal ups and downs most people experience.
Approximately 2% of Canadians, which is more than 750,000 people, will suffer from bipolar disorder at some point in their lives. There is no known specific cause of bipolar disorder, but there are many known risk factors, including genetics, emotional trauma, stress, and in some cases substance abuse. Men and women are equally likely to be diagnosed.
Because bipolar disorder involves both manic episodes and depressive episodes that cycle, people often experience a broad range of symptoms. Manic episodes may include racing thoughts, increased spending, and engaging in high risk activities. Depressive episodes may be associated with loss of interest in normal activities.
Bipolar disorder is one the world’s leading causes of disability. If you are unable to work due to symptoms of bipolar, long term disability (LTD) benefits may be available if you are covered under a group plan through your workplace, an individual policy, or your professional association. If your LTD claim is approved, the insurer will pay a portion of your income so long as you continue to be disabled and meet the other policy requirements, such as participating in appropriate treatment. Unfortunately, many LTD claims are denied, either at the initial application stage or after a period of benefit payments.
Understanding Long Term Disability Benefits
Long term disability coverage is an insurance product that is meant to replace a portion of your income while you are unable to work due to illness or injury.
Submitting a claim requires completing various forms and providing those to the insurance company. Your claim is more likely to be approved if you also provide medical records in support of disability. These records may include clinical notes from your family doctor and/or psychiatrist, hospital notes, prescription records, and other documentation.
When completing your application for disability benefits, you should focus on your level of function, not just your diagnosis. For example, if you have a cognitively demanding job, your inability to focus, concentrate, and multi-task may make work impossible. If you have a physically demanding job, your symptoms may make it dangerous to be around machinery or heavy equipment. If your work requires socialization, this may be intolerable for you. These are examples of restrictions and limitations the insurer will want to understand before it approves your claim.
Why Are Some LTD Claims Denied?
Insurance companies would not make money if all claims were approved. Insurance adjusters are the gatekeepers, tasked with approving meritorious claims, but also denying claims that may not meet the policy requirements. Insurance adjusters are not medical professionals, nor are they lawyers. They make mistakes and many claims are improperly denied. Of course, the more claims that are denied, the more money the insurance company makes, so there is a financial incentive to deny.
When deciding which claims deny, the insurance adjuster will often be suspicious of claims that are supported by less objective evidence than conditions such as cancer, Parkinson’s, or MS. That means mental health claims, including bipolar disorder, are more likely to be denied. This is not because bipolar disorder is not disabling, it can just be harder to prove and therefore easier for the insurer to deny.
What To Do If Your LTD Claim Denied
If your long term disability claim has been denied, you likely have two options: appeal or lawsuit. Unionized employees sometimes also have the opinion of union representation, depending on the wording of the collective bargaining agreement. Unionized employees should seek legal advice before making any decisions.
An appeal may seem like a good option, and some insurance adjusters may even encourage you to appeal. But the reality is most appeals are denied. Insurance companies only offer appeals because they have to. There is no objective decision maker on an appeal. If the insurer already has a good understanding of your diagnosis, treatment, and reported functional limitations, why would it change its mind? There are absolutely no consequences to an insurer denying an appeal. Because appeals can take months, people are often too exhausted to fight anymore after a denied appeal. Learn more about LTD appeals here.
The second option after LTD claim denial is a lawsuit, which does not mean you are going to court. In fact, when the insurance company is sees you have taken legal action, there about a 99% chance it will settle with you. The LTD insurer knows that if it were to go to court, it would very likely lose. Especially if the underlying disability is caused by something as severe as bipolar disorder. Most lawsuits settle for payment of past benefits owed, plus a lump sum for future benefits. Sometimes lawsuits settle for past benefits owed in addition to being put back on claim.
If your long term disability claim has been denied, the most important thing you can do is seek legal advice from a well respected long term disability lawyer before making any decisions. Most long term disability lawyers offer free consultations. It costs you nothing to better understand your options.
About The Author
Michael Jordan is a long term disability lawyer with more than 18 years experience litigating long term disability claims. He is a founding partner of the Bay Street firm Jordan Honickman Barristers, and is one of just 25 lawyers in all of Canada ranked by Lexpert as a “Leading Legal Practitioner” in long term disability law. Michael represents clients across all of Ontario, with satellite offices in Ottawa and London.
Direct Cell: 416-460-6823