In part three of our series on disability claims and COVID-19 (see Part 1 here and Part 2 here), we turn our focus to claims for mental health conditions during the current health crisis.
Has the COVID-19 pandemic caused or aggravated your mental health condition? Is your mental health suffering, making it difficult to work, either as an essential worker or even working from home? Are you wondering whether you should apply for Short-Term or Long-Term Disability (STD/LTD) benefits through your employer or through a private disability policy?
Be assured that these are all very real and pressing questions and concerns. In this article, we will address these concerns and provide you with information and insights which we hope will assist you in your decision making and ease at least some of your stress.
How has the COVID-19 pandemic affected our mental health?
The COVID-19 pandemic has been a time of extreme stress and anxiety for nearly all of us. Some of us have lost our jobs and our incomes. Others have been stretched beyond our limits, either in our roles as essential workers or while working from home while juggling the needs of our families. Still others have been exposed to or contracted the virus or have loved ones who have become ill. Plans have been put on hold. Finances have been depleted. Social isolation or abusive relationships have begun to take their toll. The effects of this pandemic have been felt far and wide and in almost every household and by almost every person.
For all of us, there would seem to be no escape from the constant and pervasive onslaught of grim media reports from all corners of the world. Uncertainty and fear have become the driving force behind much of what we do and what we think about. To make matters worse, many of our usual social and therapeutic supports have not been readily available to help us deal emotionally with the added stress of living through this pandemic.
While this is certainly a difficult time for all of us, many of us may also be struggling with severe mental health-related conditions, including depression, anxiety, panic disorder, and other conditions. These conditions may be due to pre-existing mental health conditions or due to the onset of new mental health conditions, which may or may not be directly or indirectly related to the COVID-19 pandemic.
Whether you are suffering from the aggravation of an ongoing mental illness, the recurrence of a prior mental illness or you are experiencing mental illness for the first time, your mental health is bound to be affected by the COVID-19 pandemic.
What are some of the issues I may face in applying for disability benefits due to mental health conditions during the COVID-19 pandemic?
This article will focus on issues related to applying for short-term and long-term disability benefits for a mental health condition during the COVID-19 pandemic.
We will aim to address the following issues which you may be facing if you are struggling to work due to a mental health-related condition which may or may not be related to the COVID-19 pandemic and for which you are considering applying for STD or LTD benefits:
- Should I apply for STD or LTD if I can’t work due to a mental health condition?
- How will the insurance company assess my claim if it is based on a mental illness caused or triggered by the COVID-19 pandemic?
- What if I can’t see a doctor to get diagnosed or treated for my mental health condition?
- What should I do if my disability claim is denied or terminated?
What are disability benefits and should I apply for STD / LTD if I am struggling to work due to my mental health?
If you have been working or if you are not working but remain an employee, your employer may have a group disability insurance plan (STD and/or LTD) and you may have the option to apply for disability benefits under that plan. Similarly, if you are self-employed, you might have a private or individual disability insurance policy.
The purpose of this disability insurance is to provide you with an income (usually a percentage of your pre-disability earnings) in the event that you are not able to perform the duties of your job due to an illness or injury. In addition to physical illness/injury, mental health-related conditions are considered to be an illness/injury under disability insurance policies.
This means that you may be eligible for disability benefits if you suffer from a mental health condition that prevents you from performing the essential or main duties of your job. Some common types of mental health conditions that might prevent you from working include:
- Addiction Issues
- Panic Disorder
- Post-Traumatic Stress Disorder
- Bi-Polar Disorder
- Workplace Stress and Burnout
Often these and other mental health conditions cause cognitive limitations and restrictions that impact your day-to-day functioning, including your ability to work. Some of these cognitive limitations and restrictions include:
- Low motivation
- Inability to focus or concentrate
- Poor memory
- Low motivation
- Poor impulse control
- Inability to manage stress
- Impaired psychomotor functioning
- Difficulty finding words
- Emotional regulation
- Anger or tearfulness
- Panic attacks
- Side-effects of medication
If your cognitive (mental and emotional) functioning has deteriorated to the extent that you are not able to do the duties of your job, you should seriously consider submitting a claim for disability benefits; either through your employer’s group insurance plan or through a private/individual plan, if you have one.
What if I become disabled from a mental health condition but continue to work?
There are very serious risks to you and to others if you attempt to continue to work with a mental health-related disability that is impacting your ability to do your duties. Obviously, the nature of your job and the type of work that you do will determine what the impact might be if you continue to try to work while disabled. In some cases, you could cause harm to yourself or to others.
Often, continuing to attempt to work while disabled will aggravate your mental health condition and prolong your recovery. Working may cause you additional stress and anxiety and take time away from treatments necessary for your recovery.
Continuing to work while suffering from a disabling mental illness could also jeopardize or strain your relationship with your employer. For example, if you are not able to perform the duties of your job or if your condition is interfering in your ability to communicate with others, you could be fired from your job. Termination of your employment could then result in the loss of your health benefits which could impact your treatment options and extinguish your right to claim disability benefits under your employer’s group benefit plan.
If you attempting to work with a mental health-related disability but you are finding it difficult to perform your duties OR if you have been terminated from your employment as a result of your mental health, OR if you are considering submitting a claim for disability benefits due to a mental health condition, we encourage you to contact us to discuss your options.
When I apply for disability benefits, will the cause of my mental health disability matter? What if the reasons for my mental health condition are related to the COVID-19 pandemic?
If you have a history of mental illness, it would be reasonable that the COVID-19 pandemic may have triggered your pre-existing mental health condition or aggravated an existing condition that was previously well-managed. If you do not have a history of mental illness, it would also be reasonable that COVID-19 has caused your mental health condition.
Whatever the case, it is important to remember that in the vast majority of disability insurance claims, the cause of your mental health condition is not relevant to your disability claim. This means that whether the cause of your condition arises from the circumstances around the COVID-19 pandemic OR whether it is due to some other unrelated cause, does not matter. What matters to the insurance company in assessing whether you are disabled is your “functionality”. This means that the insurance company is concerned with whether you are functionally able to perform the duties of your job. In mental health-related claims, this generally means whether you have the “cognitive functionality” to do the duties of your job.
While the success or failure of your disability claim may not turn on the cause of your disability, the insurance company may aim to better understand the severity of your condition by looking at its cause. For example, if you have a history of mental illness it might be understandable that the added stressors of the COVID-19 pandemic would cause aggravation or recurrence of your previous mental illness, resulting in a severe and disabling condition. Similarly, if your disability is due to symptoms of PTSD, it may be helpful for the insurer to understand how the COVID-19 pandemic triggered a prior trauma causing your current symptoms of PTSD.
If I have a pre-existing mental health condition, could my claim for disability benefits related to COVID-19 be denied?
While the cause of your disability is not normally relevant, there is one instance in which it is very relevant. If you have not been covered under your group disability insurance policy for at least 12 months prior to becoming disabled, the insurer will want to know if your disability is related to or caused by a pre-existing condition. Most group insurance policies have a pre-existing condition exclusion clause which will exclude (or allow them to not pay claims for) disabilities arising from a condition that you had prior to becoming insured under the policy.
Pre-existing condition exclusions can be particularly problematic with mental health-related disabilities. For example, your claim could be denied if you have a history of depression and anxiety for which you were receiving treatment during the “pre-existing condition period”, as set out in your policy. If you were then to become disabled within 12 months of your coverage taking effect and making a claim for PTSD (perhaps triggered by the pandemic), despite having worked continuously up until that time, the insurance company might deny your claim by arguing that your PTSD was caused or contributed to by your pre-existing conditions of depression and anxiety.
If your claim is denied based on the “pre-existing condition exclusion”, we encourage you to not give up but rather contact MK Disability Lawyers immediately to discuss your options and review the basis for the denial.
What if I can’t see a doctor during the COVID-19 pandemic to get diagnosed or treated for my mental health condition?
The ability to seek treatment for mental health conditions can be a challenge at the best of times. However, during the COVID-19 pandemic, seeking diagnosis and treatment for your mental health condition might, in some circumstances, prove impossible. Some doctors and treatment providers have closed their offices and are not seeing patients at all. Others may be speaking to and providing treatment to patients on the telephone or by video conference. Some patients and doctors might feel uncomfortable with the telephone and video formats for diagnosis and treatment and might decide to wait until in-person appointments are possible again.
Waiting until after the COVID-19 pandemic is over and in-person appointments are once again possible poses a whole host of added risks. The most serious of which is allowing your mental health condition to go undiagnosed and untreated which could result in serious consequences for your health and prolong your recovery. The other issue is that without a diagnosis and treatment by a specialist, the insurance company might not be inclined to accept you are disabled or approve your disability claim. If your claim is not approved and you remain disabled from working, your personal financial situation could deteriorate quickly, adding more stress to your life and further aggravating your condition.
It is important that you do seek out treatment and submit your claim forms to the insurance company as soon as possible. This means starting with your family doctor or specialist (such as a psychologist, psychiatrist, therapist) if you are seeing one. If your family doctor or specialist is not seeing patients in person, scheduling a candid telephone discussion with your doctor about your symptoms will be key. Your doctor might then be able to provide you with some supportive talk therapy (CBT or cognitive behavioural therapy), prescribe medications, suggest other treatments and/or make referrals or recommendations for treatment providers who specialize in mental health conditions. You should also send your disability insurance claim forms to your doctor or specialist via email or fax, for him/her to complete and send to the insurance company, as soon as possible.
The insurance company may or may not be more lenient during the COVID-19 pandemic, with respect to their assessment of your disability claim in terms of the information they will accept from you proving you have a disabling condition and that you are receiving appropriate treatment. However, the reality is that your benefits are payable pursuant to a contract of insurance. If you are not able to satisfy the insurance company that you meet the definition of disability under the contract/policy and that you are continuing to fulfil other conditions of payment, such as receiving appropriate treatment, the insurer is within its right to deny or terminate your disability benefits. Therefore, it is critical that you make every effort to seek out a diagnosis and treatment for your mental health condition within the current COVID-19 restrictions.
If you are finding it difficult to prove your claim to the insurance company and your claim has been denied or terminated for any reason, it is important to contact us as soon as possible to discuss your options and how to demonstrate you are disabled to the insurance company.
What should I do if my claim for STD / LTD benefits for mental health conditions related or unrelated to COVID-19 is denied or terminated?
If the insurance company calls you or sends you a letter to tell you that your STD / LTD benefits have been denied or terminated, it is important that you act quickly. The longer you go without an income the more difficult things will become for your financial situation and the resulting stress may aggravate your existing mental health condition.
Sometimes the insurance company (or administrator) might offer you the opportunity to provide additional information as part of an internal appeal of the denial/termination of your claim. This may be an option for you if you have not previously provided all the information you and your doctors had related to your claim.
If you have already provided everything and you are not medically or functionally able to return to work, then your only option will be to hire a lawyer to sue the insurance company for your disability benefits. It is important to remember that there are limitation periods for commencing a lawsuit and you do not want to have your claim dismissed based on suing too late.
If you are considering applying for STD/LTD or if your STD/LTD has been denied or terminated, or if you have any questions regarding making a claim for STD/LTD benefits due to a mental health condition that is related or unrelated to the COVID-19 pandemic, we encourage you to contact MK Disability Lawyers to discuss your options and your approach.
If you would like to discuss your Long-Term Disability claim with an experienced lawyer, MK Disability Lawyers LLP is dedicated exclusively to the practice of LTD litigation. We have represented disabled clients in various professions against all major life/health insurance companies in Canada. We would be happy to provide you with a free consultation.
The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor-client relationship between you and the blog publisher. The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction. If your disability claim has been denied and you require legal advice, contact a lawyer specializing in disability law.