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Mental Health and Long-Term Disability Claims: Legal Considerations

A mental health condition can become so severe that a person needs to stop working because of it.


Mental health issues must be taken seriously. If you’ve been diagnosed with a mental health condition that leaves you unable to work for an extended period of time, you may be eligible for long-term disability benefits. Those benefits will cover a portion of your income, so you aren’t suffering financial strain on top of living with mental health issues or psychological illness.


Long term disability lawyer

There are unique challenges associated with mental health disability claims. In today’s blog post, we will discuss some of those challenges and the legal aspects involved in mental health long-term disability claims.


Challenges associated with qualifying for mental health LTD benefits

Qualifying for long-term disability benefits can be difficult. The application process is complex and can be tough to navigate on your own. Many legitimate long-term disability claims are denied by insurance companies, whether it be a missed deadline, mistake in the application form, or a lack of medical evidence to prove your disability to the insurer.

In addition to those common challenges, mental health LTD claims come with their own set of unique considerations that can make qualifying for benefits even more difficult:


1.      Meeting the criteria of “disability” as defined by your insurance policy

To be eligible for LTD benefits, your condition must meet the criteria of “disability” as defined in your insurance policy. Most insurance policies cover mental health conditions and psychological issues such as depression, anxiety, Post Traumatic Stress Disorder (PTSD), eating disorders (anorexia nervosa, bulimia), and Obsessive Compulsive Disorder (OCD). It’s essential to check your policy definitions to find out if it provides coverage for the condition you are experiencing.


It's also important to understand that being diagnosed with a mental health condition is not enough on its own to qualify for LTD benefits. You must also prove to the insurance company that you are disabled by your condition as defined by the policy:

·       Some LTD policies define disability as “own occupation” disability, which in this context means that your mental health condition prevents you from performing the essential duties of your occupation.

·       Other LTD policies define it as “any occupation” disability, meaning you aren’t able to perform any occupation because of your mental health condition.

·       It’s also common for a policy to start with the own-occupation definition and then switch to the more strenuous “any occupation” or “total disability” test at a certain point (usually after two years of receiving LTD benefits).  

To qualify for LTD benefits, you must meet all definitions and conditions in the policy. An experienced long-term disability lawyer can review your LTD insurance policy and explain the definitions and requirements you must meet to succeed in your benefit claim.


2.      Demonstrating an “invisible illness”

LTD insurers require objective medical evidence to support the nature of the disabling condition and the functional impairment it causes. Unfortunately, mental health issues are not easy to demonstrate. You can’t show mental health issues with an X-ray or blood test. For that reason, insurance companies tend to be highly suspicious when assessing benefit claims relating to mental health conditions.

Medical evidence must be as objective and detailed as possible. A bare-bones note from your doctor saying you are unable to work won’t cut it. The LTD insurer needs sufficient information to evaluate the nature of your medical condition and how it prevents you from working. For mental health LTD claims, you should:

  • Ensure that your physician’s report contains details of the restrictions and limitations to your ability to work.

  • Ask your doctor for a referral to a counsellor, psychologist, or psychiatrist if you are not already seeing one. A mental health specialist can help treat your condition and can also provide a valuable opinion on the disabling nature of your condition to support your LTD claim.

  • Continue seeing your GP and any counsellor or mental health specialist on a regular basis.

  • Follow your prescribed treatment plan.


Our Barrie long-term disability lawyers are skilled at gathering and properly presenting medical evidence to support LTD claims and appeals of LTD denials. One of our disability lawyers can review your case and advise you on the evidence needed to put forward a strong submission to the insurance company. If necessary, we can refer you to specialists to obtain an expert opinion to support your claim. 


3.      Overcoming a pre-existing condition clause

Most LTD insurance policies contain a “pre-existing condition” clause which essentially means that it will not provide coverage for conditions that existed before you became a policyholder. The exclusion of coverage for pre-existing conditions can cause serious problems in mental health LTD claims. Insurance companies are often quick to deny LTD claims where there was a previous diagnosis or treatment for the same or similar mental health condition.


The insurance company is not always correct in its interpretation of the policy. For example, the policy may specify that the condition is only pre-existing if you underwent treatment for it within a certain time period. A skilled LTD claim lawyer can review your policy so you understand the specifics of any pre-existing limitation clause, and can advocate on your behalf if the insurer unjustly denies your claim. When faced with an unjustified denial, your options include requesting an internal appeal of the decision and starting a lawsuit against the insurance company.


Get Trusted Advice From A Long-Term Disability Lawyer 

Barrie disability lawyers at Littlejohn Barristers can assist you by answering all your questions regarding your long-term disability benefits claim. We have extensive experience with LTD claims and LTD denials and can help you surmount the challenges that come with mental health LTD claims.


Littlejohn Barristers has a team of lawyers who have experience in disability insurance and will review your case with you. There is no up-front fee or cost involved in any initial meeting.


Let us help you get the benefits you deserve. Call us today at 705-725-7355 to set up a free initial consultation with one of our long-term disability lawyers in Barrie or Collingwood.

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