Long-Term Disability Claims for Mental Health Conditions in Alberta

Many Canadians have an extended benefits policy with an insurance company. Under the policy, you pay regular premiums, and in return, the insurance company will pay for certain health services or benefits.

An important benefit under most insurance policies is long-term disability (“LTD”) coverage. This means that if you are unable to work, the insurance company pays you benefits, typically 60% of your salary, until you can return to work.

Depending on the wording of your policy, the reason for your being unable to work can either be a physical and/or mental disability. As discussed below, LTD claims based on mental health seem to face extra challenges compared to claims that are physical.

Common Mental Health Conditions in Alberta

In Alberta, and across Canada, an increasing number of people suffer from mental health challenges. According to Statistics Canada, in 2022 more than 5 million people met the criteria for a mood, anxiety or substance use disorder. And younger Canadians are facing more challenges as the share of Canadians 15 years and older with generalized anxiety disorder doubled, from 2.6% in 2012 to 5.2% in 2022.

Documenting Your Psychological Symptoms

Properly documenting your mental health challenges is often critical to succeeding in your long-term disability claim. Many psychological conditions are “invisible” to outside observers because there is no objective evidence like you get when you X-ray a broken bone. A person applying for LTD has the challenge of relying on their self-reported feelings to make a claim. A person’s credibility will be one of the most important factors in making a successful claim.

A good first step to building your case is to see your family doctor and tell them about your mental health challenges. While general practitioners can offer some counselling and recommend medications, for serious mental health challenges they likely will refer you to a specialist. Counsellors, psychologists, and psychiatrists focus on this area of health and have more expertise and tools to assist you to address your concerns.

Once challenge with some mental health issues like depression and anxiety, is it is challenging to be proactive and meet with your medical team. It is important to get help when you are struggling for you and your LTD claim. When speaking with your family doctor or mental health professional, it is important to be open and honest about your struggles. Not only will it help with your recovery, but it will also help build the foundation of your LTD claim. The records made by your doctor and mental health professionals tell the story of your journey. Withholding information or minimizing your challenges will only be used against you when you make your claim.

It is also important to follow the medical advice you are given. Showing a genuine desire to get better improves your overall credibility. Taking recommended treatments may also be a condition to continue receiving LTD benefits.

One thing not to do is post to social media. You can be sure that, if you make an LTD claim, the insurance company will perform a social media search and look for any pictures or posts that could possibly contradict your claim. Keep your accounts and posts private. Even with security settings on private, assume an insurer has access to your posts and are not looking at them in a favourable light.

Negotiating with Insurance Providers over Mental Health LTD Benefits

Before you submit a claim application, confirm that psychological conditions are covered for LTD by your specific insurance policy.

The insurance policy may be confusing to read. It is a contract and was written by lawyers. There are many definitions such as “total disability” and “change of definition” unique to the insurance business. You may find it challenging to understand your rights and responsibilities under the policy without having your own lawyer who is experienced in LTD claims.

As discussed above, you may find it difficult to negotiate with the insurance company. Your insurer may not believe you because your mental illness cannot be objectively proven. It is easier for the insurance company to deny coverage in these cases. This is why it is important to document your mental health challenges by seeing your doctor and other treatment providers. Their opinions on your mental health can be used to justify your application.

Appealing Denied LTD Claims for Anxiety, Depression, or PTSD

If your initial LTD application is denied, there is typically a right to appeal that decision internally, meaning your insurance company will review its own findings. The likelihood of succeeding on the appeal depends on the reason for the initial denial. Often the insurance company seeks additional documents. If additional documents exist and were simply not provided with the initial application, either because of a mistake or the documents did not exist when the application was made, then it is possible that the appeal may succeed.

We recommend you consult a lawyer prior to making an appeal. In some cases it is wise to commence a lawsuit. This way your application can be heard by an independent decision-maker – the courts.

Proving the Seriousness of Mental Health Disabilities

To succeed with an LTD claim for a mental illness, you will most likely require a independent psychological assessment and report. This assessment will likely be done by either a psychologist or a psychiatrist. While these reports are expensive, they can be central to proving your disability and getting the money you are entitled to receive.

In most cases, the psychologist will review all of the relevant records from your doctors and mental health professionals (which is another reason why it is important to be open and honest when speaking to these people) and will meet with you personally. The psychologist may also ask you to complete some forms and conduct tests.

The psychologist will then write a report. In the report, the psychologist will give an opinion on your psychological condition, such as having major depressive disorder or post-traumatic stress disorder (PTSD), depending on your situation. They will also give their opinion on how your condition impacts your ability to work and your ability to perform the activities of daily life. Depending on the psychologist’s conclusions, the report may justify you being on LTD indefinitely. There will likely also be treatment suggestions to improve your situation and get you back to work at some point in the future.

These reports are very important. If an insurance company ignores or downplays a report’s conclusions or suggestions, it could expose the insurance company to punitive damages.

Mental Health Issues Preventing You from Working? Call Us Today

Applying for long-term disability benefits on your own is frequently challenging and your mental and other health conditions only add to the difficulties. Facing the denial of your long-term disability claim can be overwhelming. The experienced long-term disability lawyers at our firm, Preszler Injury Lawyers, are here to help you in Alberta.

We understand the claims process and fight for your rights with insurance companies. Our goal is to ensure you receive the support you fairly deserve while you concentrate on taking care of yourself and your health. If your LTD application was denied, please contact us today and we will work together to appeal your case and secure the LTD benefits you are entitled to.

Call us toll-free at 1-888-494-7191 or fill out our Case Evaluation form to book a free initial consultation.