Even as public awareness and understanding increase, challenges remain for those living with mental health conditions – including in the realm of long-term disability (LTD) insurance.
According to a large benefits consultant, around one-third of LTD claims in Canada last year related to mental health issues or psychological disabilities such as depression, anxiety, post-traumatic stress disorder and personality disorders.
While the survey says nothing about the success rate of those claims, I know from my experience in the field that employees forced off work because of a mental health issue face some of the toughest battles to get their claims approved.
But the fight rarely stops there for workers with psychological impairments. Those who manage to get access to much-needed LTD benefits are much more likely than their physically disabled counterparts to have claims terminated within the first two years. At this time most group LTD policies require injured workers to show that they are totally disabled from performing the essential tasks of any job that they are qualified to do in order to continue receiving payments.
This difference can be explained in part by the prevailing view among insurers and some medical professionals that these disabilities can be remedied with medicine or via treatment strategies such as cognitive behavioural therapy and dialectical behavioural therapy.
Another factor is the invisible nature of many psychological conditions and the lack of objective evidence available to claimants suffering from them. These impairments do not show up as clearly as a bone fracture on an X-ray, which means workers are forced to rely on more subjective self-reported evidence of their disability.
Following is my list of the top six things claimants dealing with psychological impairments can do to improve their chances of success when applying for LTD benefits.
1. See a medical professional
Ensuring that you are under the regular care of professionals such as your family doctor, a psychologist or social worker is not only good for your mental health, it could also help your LTD claim.
There are no strict rules about the frequency of visits, but in general, I would expect claimants to see a healthcare provider at least once a month, depending on the nature of their issue and the advice of their medical specialists.
2. Follow medical advice
Beyond seeing your treating professionals regularly, it’s also important to follow their recommendations. To maximize their chances of approval, LTD claimants should try to work with their healthcare providers to get treatment plans in place, and then make a genuine effort to follow them.
3. Get a psychological assessment
Not all medical professionals are created equal. Mental health issues fall outside the comfort zone for many, so it is worth searching for a healthcare specialist who can perform psychological testing.
In addition to creating a set of records that could be helpful to your case, the process may also result in a formal diagnosis of a psychological disorder. LTD policies do not generally require claimants to identify a specific condition to receive benefits, but attaching a label to your problem can be helpful for both the insurance company and the insured person as they attempt to understand the nature of the issue, as well as possible treatment options.
4. Keep detailed records
The invisible nature of psychological impairments means that corroboration and claimant credibility will be the keys to the outcome in your case. As a result, the more records and reports you can provide to your LTD insurer about the progression of your mental health problem, the better.
Claimants may have to take the lead when describing their limitations and the impact on their day-to-day functioning, particularly when visiting medical professionals who are less experienced in dealing with psychological issues. Ideally, your treatment providers will be willing to complete detailed narrative reports on your visits and turn them over swiftly when your insurer requests.
5. Proactively seek out treatment
Disabled workers with a psychological element to their LTD claim often find themselves in a catch-22 situation.
They need access to treatment, but may not have the resources to pay for private therapists or the ability to endure the months-long wait to see a government-funded psychiatrist. Claimants covered by an employer’s group insurance program also have limited psychological counselling coverage, which is often capped at $500 or $1,000 per calendar year.
However, disabled workers should not let a lack of funding be a barrier to treatment. Programs run by community-based groups are often a less expensive option, while OHIP coverage may be available for other types of counselling.
At the very least, claimants should continue to see their family doctors, who may be able to offer short-term solutions.
6. Set your social media to private
Many people use social media to escape from reality, posting exclusively positive updates that can create a misleading impression of their lives to the world.
The danger for LTD claimants taking this approach is that their insurers may monitor their publicly available social media accounts.
It’s understandable why a person dealing with mental health issues may not want to offer a fully representative picture of their overall well-being online, but that will not stop an insurer from seizing on postings that seem to contradict the version of themselves presented in an application for benefits.
The simplest way for LTD claimants to avoid this complication is to deactivate their accounts or change their settings to keep posts private.
If you are considering making an LTD claim for a mental health issue or psychological disability, feel free to contact me or another member of Oakville’s long-term disability team at Edwards Pollard LLP either online or call (289) 529-0404.
