Long-term Disability Claims and a Toxic Work Environment

Your doctors told you that you can’t return to any work right now, but your long-term disability insurer denied your claim.  They say you have “workplace issues” or a “toxic work environment”.  Are they right?  Does it matter?

Situational disabilities vs. generalized disabilities

A situational disability is one that is triggered only in specific situations.  This could be a place or perhaps it could be the presence of a particular person. A situational disability is only there in specific situations and goes away when that situation is no longer present.

A generalized disability is one that is there in all situations.  Even if it was first triggered by a particular situation (a bad work environment, marital discord, etc.) it is now always present and is a factor in all facets of life.

The “toxic work environment”

One of the more common explanations given by LTD insurers for why they have denied your claim is because they found that your symptoms are the result of “workplace issues”.  Sometimes, they will call it a “toxic work environment”.  But either way, what they are saying is that you are not really disabled.  Instead, you just have a difficult work environment.

Why does a toxic work environment matter for my long-term disability claim?

Long-term disability policies are just that – insurance policies that pay your benefits when you become disabled from your own occupation. They are not “toxic work environment” insurance policies.  In other words, if the problem is not that you have a mental health issue, but instead, just a bad work environment, a standard LTD policy would not be required to pay benefits.

If I have a bad work environment, I won’t receive long-term disability payments?

Hold on!  It isn’t that having a toxic work environment disqualifies you from getting LTD benefits.  Rather, it is entirely irrelevant.  Whether or not you have a toxic work environment, the analysis is still the same.  Do you have a disability that prevents you from working in your own occupation?

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What is the difference between “occupation” and “job”?

Your occupation is a general description of what you do for a living, where a job is what you do for your own employer.  My occupation is a “lawyer”, but my job is a “disability lawyer at Samfiru Tumarkin LLP.”

The distinction is very important for LTD cases.  When defining the term “totally disabled”  under the policy – which is the test used to determine if you are entitled to benefits – the analysis is not whether you can return to your job, but rather, whether you can return to your occupation.

If your mental health issues are simply the result of a bad work environment (i.e. a situational disability relating to your job), and you would be otherwise able to perform your occupation for a different employer, you are likely not going to be deemed disabled for the purposes of the policy.  You would not be entitled to LTD benefits.

However, even if your workplace could reasonably be called a “toxic work environment”, this does not mean you aren’t entitled to benefits.  If you are suffering from a mental health disability that would prevent you from doing your occupation with ANY employer, then it does not matter if your workplace has a “toxic work environment”.  Even if the workplace was the sole trigger for your disability, if you are now disabled from doing your occupation for any employer, you would be entitled to long-term disability benefits.

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I have a generalized condition but they said it was a work issue

Insurers are always looking for any information they can use to justify denying a claim.  Far more often than not, if they see that a disability has been caused or contributed to in any way by the work environment, they will label it a “workplace issue” or “toxic work environment” and deny the claim.  While this is by no means an appropriate analysis under a standard long-term disability policy, far too often insurers will deny benefits to those with generalized conditions if there is any sign of a workplace issue.

Remember – just because the insurer tells you that you aren’t entitled to benefits, doesn’t mean they are correct.  If you have a generalized disability and have had your benefits denied, we can help you get the benefits you are entitled to.