A mental health disability lawyer can help if your short-term or long-term disability benefits have been denied, delayed or cut off.
Insurance companies often challenge claims involving depression, anxiety, post-traumatic stress disorder and other mental illnesses because symptoms may fluctuate or may not appear on a blood test, scan or physical examination.
The insurer may accept your diagnosis but argue that your condition is mild, your treatment should allow you to work or your daily activities prove that you have recovered.
Samfiru Tumarkin LLP represents people with denied and terminated disability claims throughout Canada, excluding Quebec.
On This Page:
- How a Lawyer Can Help
- When to Contact a Lawyer
- Why Claims Are Denied
- Evidence for Your Claim
- What Happens Next?
- Frequently Asked Questions
How Can a Mental Health Disability Lawyer Help?
A disability lawyer can review your denial letter, insurance policy and medical evidence to determine why the insurer refused or terminated your benefits.
A lawyer may help by:
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Explaining the definition of disability in your policy
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Identifying weaknesses or inconsistencies in the insurer’s decision
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Determining which medical and functional evidence is missing
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Connecting your symptoms to the demands of your occupation
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Addressing arguments about treatment, medication or specialist care
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Responding to surveillance, social-media evidence or insurer assessments
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Communicating and negotiating directly with the insurance company
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Starting legal action when appropriate
Connecting Mental Illness to Your Occupation
A disability claim should explain why your symptoms prevent you from performing your actual job safely and consistently.
For example:
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Poor concentration may prevent accurate financial, legal or technical work
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Panic attacks may prevent travel, presentations or customer interaction
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Impaired judgment may make safety-sensitive work dangerous
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Depression may prevent regular attendance, pace and productivity
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Post-traumatic stress symptoms may make specific environments or duties intolerable
A lawyer can help ensure that the claim addresses more than the diagnosis and clearly explains why the occupational demands can’t be met.
When Should You Contact a Mental Health Disability Lawyer?
Speak with a disability lawyer promptly if:
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Your short-term or long-term disability claim was denied
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Your approved benefits were later cut off
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The insurer says there is no objective medical evidence
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You are being criticized for not seeing a psychiatrist
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The insurer alleges that you failed to follow treatment
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Social-media posts or surveillance are being used against you
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You are being pressured to return before your doctor believes you are ready
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Your insurer says you can perform another occupation
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You are considering an internal appeal
You do not need to wait for another crisis, hospitalization or failed return to work before getting legal advice.
Should You Contact a Lawyer Before a Denial?
A lawyer may also provide advice before benefits are formally terminated.
Consider getting advice if the insurer:
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Requests repeated medical updates
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Schedules an independent medical examination
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Questions your treatment or recovery progress
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Pushes you into a return-to-work program
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Warns that the definition of disability is changing
Do You Have to Appeal to the Insurance Company?
An insurer may invite you to submit an internal appeal after denying your claim.
An appeal is not always the best option. The same insurance company that refused the claim will review it, and resubmitting similar information may produce the same result.
You may have other options, including legal action. A disability lawyer can review the evidence, policy and applicable deadlines before you decide how to proceed.
Why Are Mental Health Disability Claims Denied?
An insurer may accept that you have a mental illness while disputing whether it prevents you from working.
Common denial reasons include:
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There is no objective test proving the severity of your symptoms
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Your medical records do not explain your functional restrictions
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The insurer says medication should allow you to return
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You have not been treated by a psychiatrist or psychologist
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Daily activities are treated as proof of work capacity
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The insurer alleges treatment non-compliance
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The insurer says remote or sedentary work remains possible
The Insurer Demands Objective Evidence
Mental illnesses are often diagnosed using clinical interviews, reported symptoms, observed behaviour and treatment history.
The absence of abnormal imaging, bloodwork or another physical test does not automatically establish that you can work.
Your evidence should document symptoms consistently and explain their effect on concentration, judgment, communication, attendance and stress tolerance.
The Insurer Says Your Condition Is Mild or Stable
Words such as “stable,” “improving” or “doing better” do not necessarily mean that you are ready to resume your occupation.
A person may be stable only because they remain away from workplace demands and continue receiving treatment.
The insurer should assess your remaining limitations and whether improvement can be maintained in a work environment.
The Insurer Says You Need a Psychiatrist
You do not necessarily need to be treated by a psychiatrist to qualify for disability benefits.
Family doctors commonly diagnose, treat and monitor mental health conditions. Specialist and therapy evidence may strengthen the claim where available, but wait lists and access barriers should be considered.
The Insurer Says Medication Should Allow You to Work
Medication may improve some symptoms without restoring full work capacity.
It may also cause fatigue, slowed thinking, nausea, sleep problems or other side effects.
Your evidence should document the treatments attempted, their results and any continuing limitations.
The Insurer Uses Social Media or Surveillance
An insurer may rely on photographs, online posts or surveillance showing you shopping, exercising, travelling or attending a social event.
An isolated activity does not necessarily establish that you can meet the cognitive, social and attendance demands of full-time work.
The activity may have been part of treatment, required significant preparation or caused increased symptoms afterward. A lawyer can help place it in the proper medical and functional context.
The Insurer Says You Can Work From Home
Remote work still requires concentration, communication, organization, pace and regular attendance.
Removing the commute or physical workplace does not eliminate depression, anxiety, panic attacks, cognitive limitations or medication effects.
The Insurer Says You Can Perform Sedentary Work
The ability to sit does not establish the ability to perform sedentary work.
Office positions may require sustained concentration, multitasking, interpersonal interaction, deadlines and complex decision-making.
A Failed Return to Work Is Used Against You
A brief or part-time return does not necessarily prove that you can sustain regular employment.
A medically supported but unsuccessful attempt may demonstrate that the hours, duties or workplace demands were not sustainable.
Document the symptoms that returned, the accommodations attempted and why the plan was reduced or stopped.
Your Benefits Are Cut Off After Two Years
Many LTD policies change their definition of disability after approximately two years.
The insurer may accept that you can’t return to your previous occupation but argue that you can perform another suitable job.
It should consider your education, experience, earnings, cognitive limitations, stress tolerance and ability to maintain regular attendance—not merely whether another job exists in theory.
The Policy Limits Mental Health Benefits
Some disability policies contain special limitations or exclusions involving mental or nervous conditions.
The exact wording matters. Exceptions may apply, and the insurer may overlook physical conditions or other diagnoses that independently prevent you from working.
A lawyer can review whether the limitation actually applies to your claim.
What Evidence Supports a Mental Health Disability Claim?
A strong claim should document the diagnosis, treatment, restrictions and specific reasons you are unable to work.
Helpful evidence may include:
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Records from your family doctor, psychiatrist or psychologist
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Counselling and therapy reports
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Hospital, crisis-care or treatment-program records
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Your medication and treatment history
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Medication side effects
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Specific cognitive, social, attendance and stress-related restrictions
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A detailed description of your occupational duties
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Failed accommodations and return-to-work attempts
Document Functional Limitations
A diagnosis such as depression or anxiety does not fully explain why you can’t work.
Medical records should address whether you can:
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Concentrate and remember information
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Make decisions and solve problems
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Communicate appropriately and consistently
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Manage deadlines, conflict and unexpected changes
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Maintain regular attendance and productivity
Follow a Reasonable Treatment Plan
Insurers generally expect claimants to receive appropriate treatment and make reasonable efforts toward recovery.
Attend appointments and follow medical advice where reasonably possible. Document medication side effects, financial barriers, wait lists, lack of available specialists and reasons a treatment was changed or stopped.
Provide a Detailed Job Description
A job title alone may not explain the cognitive, emotional and interpersonal demands of your position.
Describe the pace, deadlines, decision-making, public interaction, travel and safety responsibilities involved.
What Happens After You Contact a Mental Health Disability Lawyer?
During an initial consultation, a disability lawyer may ask about your condition, treatment, occupation and the insurer’s reasons for denying or ending your benefits.
The lawyer may review:
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Your denial or termination letter
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The definition of disability in your policy
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Any exclusions or mental-health benefit limitations
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Your medical and treatment evidence
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Your job duties and return-to-work history
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Important dates and potential legal deadlines
The lawyer can then explain whether the insurer’s decision may be challenged and what evidence could strengthen your case.
How Can a Mental Health Disability Claim Be Resolved?
Depending on the circumstances, a denied claim may be resolved through:
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Reinstatement of monthly disability benefits
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Payment of benefits previously withheld
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A negotiated settlement
There is no standard mental health disability settlement. The outcome depends on the policy, benefit amount, medical evidence, prognosis, age, employment history and other circumstances.
Is There a Fee to Speak With a Disability Lawyer?
Samfiru Tumarkin LLP offers a free initial consultation for denied short-term and long-term disability claims.
There are no upfront legal fees. You only pay if we successfully resolve your disability claim.
Frequently Asked Questions About Mental Health Disability Lawyers
What does a mental health disability lawyer do?
A lawyer reviews your policy, medical evidence and denial letter and helps challenge the insurer’s refusal to pay benefits.
Can an insurer deny a claim because there is no objective test?
An insurer may raise that argument, but mental illnesses are often diagnosed through clinical assessments, symptoms, observations and treatment history.
Do you need a psychiatrist to qualify for LTD?
Not necessarily. A family doctor can diagnose, treat and support many mental health disability claims. Specialist evidence may help where available.
Can social-media posts affect a disability claim?
An insurer may use public posts to question your reported limitations. An isolated activity does not necessarily prove that you can sustain full-time work.
Does a failed return to work hurt your claim?
Not necessarily. A medically supported but unsuccessful return may help demonstrate that the hours or duties were not sustainable.
Do you have to appeal to the insurer first?
Not necessarily. An internal appeal is only one option. Speak with a disability lawyer before deciding how to challenge the denial.
Can a lawyer help before benefits are cut off?
A lawyer may provide advice when the insurer questions treatment, schedules an assessment or warns that benefits may end.
How long do you have to challenge a denial?
Legal deadlines apply and vary by province, policy and circumstances. Get advice promptly to protect your options.
Speak With a Mental Health Disability Lawyer
Managing depression, anxiety or another mental illness is difficult enough. You should not have to fight an insurance company alone while facing financial pressure and uncertainty about work.
Samfiru Tumarkin LLP represents people with denied and terminated disability claims throughout Canada, excluding Quebec.
Some members of our legal team previously worked for insurance companies. We understand why mental health claims are challenged and what evidence may be needed to dispute a denial.
For information about eligibility and available benefits, read our guide to mental health disability benefits in Canada.
Our guide to applying for mental health disability explains how to start an STD, LTD, CPP Disability or DTC application.
Contact us for a free consultation if your short-term or long-term disability claim has been denied or cut off.