Mental illness is a common cause of workplace absences. In any given week, at least 500,000 employed Canadians are unable to work due to mental health problems, according to Statistics Canada. Many of these individuals will recover quickly and resume working. For others, a longer recovery may require applying for Long Term Disability benefits under a group or individual policy. Unfortunately, many legitimate mental health claims are denied. There are several reasons for this.
Why Mental Health LTD Claims Are Denied
First, the burden is on the person claiming disability to prove their claim. Because depression, anxiety, and other mental illnesses cannot be seen, or objectively assessed, they are more difficult to prove than some other medical conditions such as cancer, heart disease, or traumatic injuries.
Second, there is still a stigma associated with mental illness. Despite improvements in recent years, some individuals, including some insurance adjusters, cling to outdated and false notions that psychological symptoms are not real or disabling. Some may assume laziness, malingering, or that the affected person just needs to “snap out of it”.
A third challenge is the lack of resources to treat mental illness in Ontario, especially outside of large urban centres such as Toronto, London, Ottawa, and Hamilton. In many smaller communities, it takes several months to see a psychiatrist. Long Term Disability insurers sometimes interpret the lack of treatment by a psychiatrist as evidence of a mild condition that is not disabling, when in reality the necessary treatment simply isn’t readily available.
These and other factors can lead to Long Term Disability claims being unfairly denied.
How A Long Term Disability Lawyer Can Help
The good news is that these denials are often weak, and can be effectively challenged. Long Term Disability lawyers are well equipped to dispute denied mental health claims, and in almost every case a fair settlement can be achieved.
1) Appeal or Lawsuit
The first step is to determine whether to appeal the denial or commence a lawsuit.
Long Term Disability appeals are rarely successful. The exception to this general rule is when there is new information, such as a medical report from a treating specialist, such as a psychologist or psychiatrist, that has not already been provided to the LTD insurer. Even then, most appeals are denied. Before embarking on an appeal, consult a Long Term Disability lawyer first. There is no fee and no obligation, even if you decide to not retain a lawyer.
The second option is to commence a lawsuit. The lawsuit seeks payment of past disability benefits owing, an order that benefits be reinstated, and sometimes for extracontractual damages, which could include punitive, aggravated, or general damages. Unlike appeals, lawsuits have a very high success rate. In the vast majority of cases disability insurers would rather settle out of court than risk losing in court. The insurer’s entire business model hinges on maintain the believe that they pay claims. Usually settlement of Long Term Disability claims includes payment of both past and future benefits.
2) Maximizing The Settlement Value
Getting the insurer to the bargaining table is one thing, but maximizing the quantum of the settlement is another. The best Long Term Disability lawyers conduct a line by line analysis of the LTD file to find errors and sometimes evidence of malice. The lawyer will gather additional evidence, obtain expert reports, and manage the litigation, all with a view to maximizing the client’s recovery.
3) The Role Of Experts In a Disability Claim
The role of experts is particularly important for claims arising from depression, anxiety, and other mental health conditions. As noted above, there is a shortage of psychiatrists in Ontario. Psychologists are not affordable to most, and family doctors often don’t have the time to provide counselling. In these circumstances, it is very difficult to secure necessary treatment, let alone finding a doctor to fulfill the LTD insurer’s seemingly endless requests for information. Even then, care providers are usually not familiar with terms like “total disability”, “own occupation”, and “any occupation” as they relate to contracts of insurance. Sometimes getting a treatment provider to write a report can be like pulling teeth.
Long Term Disability lawyers have access to a roster of top psychiatrists, psychologists, neuropsychologists, and psychovocational assessors. They are all experts in their field, and very familiar with the legal issues that arise in Long Term Disability claims.
If your Long Term Disability claim has been denied, contact Michael Jordan today to find out how he can help secure your benefits.