Mental Illness: When Does it Qualify as a Disability?

mental illnesses and disability claims

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Disability Claims

While on disability leave from her job with the City of Toronto, Victoria Muir was asked by her employer to see a doctor. However, they did not want her to see her doctor. The doctor who two years earlier had initially diagnosed her with anxiety, panic and depression. They were demanding a second opinion.

Not long after her visit with the City’s third-party doctor, Muir received a letter saying the city no longer agreed with her doctor’s claim that she was “unable to return to work” and her disability compensation was being terminated.

To Muir, the message from her employer came across loud and clear: We think you are lying.

The enduring stigma of mental illness

For many people, mental illness is a problem that other people have to worry about. As human beings, we tend to compartmentalize, and imagine that our lives will never be touched by mental illness as a coping mechanism to avoid statistics that suggest otherwise. However, according to the Canadian Mental Health Association (CMHA) the fact remains that one in five Canadians will personally experience mental illness in their lifetime.

Mental health conditions, like depression and anxiety, can become so severe that they interfere with a worker’s ability to do their job. Even though some forms of mental illness are now officially recognized as disabilities in Ontario, there is still a stigma attached to such conditions. A stigma that creates obstacles to improving workplace mental health, only making the problem worse.

According to the Mental Health Commission of Canada, mental health disability claims cost employers $20 billion annually. With a third of all disability claims arising from mental health problems they account for 70% of all disability payouts. There are also the issues of absenteeism and diminished productivity to contend with. It is estimated that on any given day mental health issues lead half a million Canadians to miss work.

Mental illness can affect anyone. It doesn’t care about age, gender, orientation, heritage, socio-economic status, or geographic location.

According to the Centre for Addiction and Mental Health (CAMH), mental illness trails only heart disease as a leading cause of disability and early death. Our growing awareness of mental health issues has made claims for mental illness “the fastest growing category of disability costs in Canada” (according to CMHA). By 2020, the World Health Organization says depression alone will be the number one health burden worldwide.

The personal impact of mental illness

Mental health issues can arise for any number of reasons. Sometimes it is hard-wired into your DNA, at others it is a byproduct of another condition such as heart disease, cancer or multiple sclerosis. Then there are issues arising from sudden life altering events, like an automobile accident.

Insinuating itself into your very thought processes, mental illness can have an impact on all aspects of your life—personal, interpersonal and professional. It can affect you emotionally, cognitively and socially.  It may even be a detriment to your physical health. A persistent mental health issue can also have a negative effect on:

  • Your work;
  • Your family life;
  • Your ability to cope with social stress; and
  • A need for time off.

Additionally, the financial costs of psychiatric treatment and counseling can add up quickly. Although psychiatric costs are covered by OHIP, the long wait-times to see a psychiatrist drive many to seek help from private therapists.

And on top of everything else, if you file a disability claim because of a mental illness, it can be very difficult to get the compensation you deserve. With mental health issues accounting for almost three quarters of all disability claims, insurance companies are desperate to minimize payouts whenever and wherever possible.

Juliet’s story

After working for a bank for over 25 years, Juliet (we have changed her name to protect her identity) found the stress and pressure of her job too much. She suffered a mental breakdown. When the insurance company tried to deny her claim, it took a Herculean effort from her doctor to provide the documentation necessary to get her disability reinstated.

The claims process merely added to Juliet’s anxiety, due to her constant worry that the insurance company would find another excuse to stop her payments. If anything, it only made her suffering worse.

Psychiatrists call this “re-victimization.” This is the process by which a lack of awareness and sensitivity regarding mental health issues leads to unnecessary trauma for people who already have plenty to worry about.

Barriers to mental health disability claims

It is hard enough to get disability compensation for a physical injury. If you are unable to work because of a mental illness, like depression or anxiety, you will face even more challenges while trying to prove your disability claim.

As the number of claims for mental health issues continues to rise, insurance companies have made managing these claims a top priority. The sad reality is that insurance companies are in business to make money for their stock holders, not to protect their customers. For this reason, every mental health disability claim is thoroughly scrutinized for any reason to deny payment.

The invisible nature of mental illness makes it particularly challenging. Even friends and loved ones can have moments of doubt as to whether this is a “real” illness. Insurance companies could flat-out accuse you of fabricating the whole thing. The burden of proof will fall to you, your doctor and your lawyer. On top of that, you may be asked to see a doctor of the insurance company’s choosing, as happened with Muir. Since these doctors receive compensation for this, it is in their best interest to give the insurance company whatever ammunition they need to deny your claim.

Even if an insurer approves your disability claim, it is in their best interest to keep your claim short-term rather than long-term. To this end, many recipients of mental health disability claims find their benefits being terminated with little or no warning. To prevent this from happening, it is a good idea to keep on top of all of your appointments. Failure to take your treatment seriously will be taken as a sign that your condition is not as severe as you claim. Check in with your doctor to make sure that everything is being properly documented.

Also keep in mind that regardless of what happens in detective novels, movies and TV shows, the best clients of private investigators are always insurance companies. If you’re claiming disability for mental health reasons, your insurer will most likely hire a PI to take surveillance video of you. They will likely also investigate you online, looking through your social media for any evidence they can use to deny your claim.

Ralph’s story

It is not all doom and gloom, though. There is solid evidence that at least some employers are sensitive to mental health issues in the workplace and are doing what they can to make things better.

Ralph Goldfinger, CEO of Canada Sportswear, has firsthand knowledge of the stigma involved in mental health issues. His older brother Marvin suffered from schizophrenia for many years. In an interview with CBC news, Goldfinger said, “The best preventive approach to mental health is to be observant. You have to create fairness in the workplace, you have to create an open-door policy.”

It is an innovative approach—making employee mental health a priority in hopes of preventing the sort of crisis that could lead to disability claims—and perhaps one that more employers should embrace going forward.

Filing a mental health disability claim

If a mental health issue keeps you from doing your job, you might qualify to receive financial compensation through a mental health disability claim. However, getting the compensation you deserve can be tricky.  Therefore, it is imperative that you consult with a qualified lawyer who can help make sure you get the maximum benefits possible.

Depending on your circumstances, you could be eligible to make a disability or accident tort claim or take some other legal action. A qualified personal injury lawyer will be better able to help steer you in the right direction. They will also assist you in gathering the necessary evidence to help prove your case and walk you through the entire legal process from making your initial claim to collecting a just and fair settlement.

Do you deserve compensation for a mental illness?

A crucial first step to winning a mental illness disability claim is having the right team on your side. Not just a qualified team that works hard to get you the settlement you deserve, but a caring, compassionate and empathetic team that will do everything in their power to help improve your quality of life.

If you’re thinking of making a mental illness disability claim, or if you’ve had a claim denied, contact the dedicated team at Mackesy Smye today.

Get Started Today with a Free Consult

To learn more about the barriers to making mental health disability health claims, and for great advice on what to do if making a claim yourself, book your no-obligation consultation today and see how the team at Mackesy Smye can help with your disability claim today.

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