More Ontarians seeking mental health treatment since COVID start: CAMH

According to a recent study reported by CBC News, mental health issues are on the rise in Ontario. More people are accessing mental health support than they did at any other time during the COVID-19 pandemic.

Of the people polled for the study, a staggering 25% reported seeking help for mental health-related issues, up from 17% one year ago, and 9% the year before that.

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Long-term disability and mental health issues

Mental health issues, such as anxiety and depression, if severe enough, can absolutely disable someone from being able to do their own occupation, or any occupation. This means that mental health issues can absolutely entitle someone to long-term disability (LTD) benefits through their insurance provider. You may have a benefits plan through your employer, or one that you acquired separately (i.e. if you’re self-employed).

Who qualifies for LTD for mental illness?

In determining whether a person would qualify for LTD, the most important factor is the severity of their symptoms. Just like physical pain, anxiety and depression are very commonplace in our society – and not all instances will rise to the level of a full disability.

If your symptoms are severe enough that they prevent you from functioning, and significantly impair your ability to perform your duties at work, you should qualify for LTD benefits. This is also true if your symptoms make it unsafe for you to work (such that they may cause harm to yourself or others, or you exacerbate your condition).

More severe cases of anxiety and depression often result in formal diagnoses, including:

• Generalized Anxiety Disorder: GAD
• Major Depressive Disorder: MDD
• Post-Traumatic Stress Disorder: PTSD

A formal diagnosis is not typically a requirement under most LTD policies.

Getting approved for LTD benefits

To get approved for LTD benefits in Ontario, the first step is to apply. The application will typically include three parts:

• One part for you to fill out.
• One part for your doctor to complete.
• One part for your employer to fill out.

Once all three parts are submitted, you may receive a decision right away. Sometimes the insurance company may ask you, your doctor, or your employer for additional information or documentation before they’re ready to make their decision.

Support from your doctors

It’s important to note that with mental health issues, there is no objective diagnostic test (like an x-ray, an ultrasound, or a blood test) that can definitively show an insurance company that you have depression or anxiety. Instead, these diagnoses are largely based on what you self-report to your doctors (although there are other indicators).

In order to get approved for disability benefits, or to win your case, you’ll need the support of your health care professionals. You will also need to show that you are following the treatment recommendations of those mental health professionals (which could include medication, therapy, dietary or lifestyle changes, or at-home exercises such as mindfulness meditation).

Do you need to see a specialist?

You do not necessarily have to see a specialist, such as a psychiatrist or a psychologist, in order to qualify for LTD, since most policies do not explicitly require that. But the support of a specialist can certainly strengthen your application and in turn your chances of being approved. In addition, most policies do require that you be appropriately treated for your condition; so if your family doctor refers you to a specialist, you should attend the appointment – or the insurance company may argue that you’ve failed to satisfy this requirement.

What should you do if your claim is denied?

If your claim is denied you should contact a disability lawyer right away. You essentially have three options at that point:

• Accept the denial.
• Appeal internally with the insurance company
• Bring legal action against the insurance company through the courts.

If you are in a union, depending on the wording of your collective agreement, the third option may be to file a grievance through your union, as opposed to bringing a legal action through the courts. Before making your choice, you should discuss the specific facts of your case with an LTD lawyer for guidance.

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• Fighting an LTD denial if you’re unionized

Disability lawyers can help

If you have any questions about the claims process for LTD benefits, or experience issues of any kind after you apply through your insurer, do not hesitate to contact Samfiru Tumarkin LLP. Our long-term disability lawyers in Ontario have years of experience assisting individuals with their LTD benefits – especially when claims are denied or cut off by the insurance company.

An LTD lawyer can help you:

• Understand the strengths and weaknesses of your case.
• Prevent you from making costly missteps when interacting with the insurance company.
• Decide whether to accept the denial, to appeal, or to bring an action (or a grievance). If you decide to bring an action, they can handle your case for you.

If necessary, we can fight back against the insurance company on your behalf, get your benefits reinstated, or secure the compensation that you are legally owed.