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Work related stress can lead to burnout and have a profound impact on both mental and physical wellbeing, potentially leading to a disability.
Many people encounter stress in the workplace, and for some, it becomes overwhelming. Excessive stress can lead to anxiety, depression, sleep disturbances, and even physical symptoms.
More than 75 percent of Canadian employees say they have experienced burnout at some point, according to a survey conducted by Harris Poll.
Sometimes workplace stress reaches the point where it forces people to take sick leave, often covered by short term disability (“STD”) benefits. If symptoms do not improve, burnout can also result in a claim for long term disability benefits (“LTD”). Unfortunately, long term disability insurance providers are reluctant to approve claims related to workplace stress and burnout, unless there is compelling medical evidence in support of disability.
Why Are Burnout and Workplace Stress Claims Denied?
Insurers frequently give two reasons for denying stress related claims.
First, they argue that there is a distinction between workplace stress and a disabling medical condition. While workplace stress can potentially lead to disability, insurers often state that there is insufficient medical evidence to support the claim.
The second explanation given by insurers for denying workplace stress and burnout claims relates to specific triggers. Where a toxic work environment is a factor, and you could theoretically perform the same job duties for a different employer, the insurer is likely to deny.
Test of Disability
Most long term disability policies require you to be completely unable to perform your essential job duties, due to a physical or mental impairment. After two years, the test of disability often shifts from being totally disabled from your “own occupation” to being unable to work in “any occupation” for which you have the necessary training, education, and experience.
These definitions of disability seem difficult to meet, but if you are unable to work and have the support of your treating doctor, you should qualify for benefits.
Common Example
As a long term disability lawyer, I often see some variation the following scenario: An employee has been coping with mental health issues for years, successfully managing her symptoms, and never requiring an extended absence from work. Then, a change in the workplace structure results in increased demands. Sometimes this coincides with abusive behavior from a manager or coworker. With the increased workplace stress, the underlying anxiety is exacerbated. She may describe her symptoms as burnout, which is not generally a medical diagnosis. Her doctor recommends taking time off from work, so she submits a disability claim to her insurer.
From the employee’s perspective, she is not seeking disability benefits to escape a stressful work environment. Rather, she is genuinely disabled from working due to a medical condition, supported by her doctor, with workplace stress and consequential burnout.
From the insurer’s viewpoint, the employee had previously managed her mental health issues while working. If she is capable of performing the same type of work, but for a different team or at a different workplace, the insurer would likely say she does not meet the policy’s definition of disability, and the claim would be denied.
Responding To a Denied STD or LTD Claim
If your claim for short term disability or long term disability benefits has been denied, you likely have a choice between an appeal or taking legal action. In my experience, appeals are rarely successful, especially when the insurer believes the reason for your absence is workplace related. There is no independent decision maker on appeal, so unless there is new compelling medical evidence, the appeal will probably be denied.
When insurance companies are faced with legal action, however, they inevitable want to settle the issue rather than risk losing in court. In fact, about 99% of long term disability cases settle long before trial. Settlements are often for payment of past benefits owing, plus a lump sum payment representing future benefits, plus a contribution towards legal expenses. Most long term disability lawyers take legal action on a contingency fee basis, meaning there are no fees unless and until money is recovered.
Choosing A Long Term Disability Lawyer
It is important to choose a lawyer whose practice is devoted to disability claims. Many personal injury and employment lawyers take on LTD cases, but are not experts in this highly specialized area.
Michael Jordan is ranked by Lexpert as one of the leading long term disability lawyers in Canada, and has more than 70 five star Google reviews. He is known for his personable approach, compassion, client-oriented service, and delivering results.
Contact Michael now for fast free legal advice.
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