‘I couldn’t believe it’ — why disability claims for mental health are often a struggle

When Dr. Wei-Yi Song filled out the insurance paperwork for a pregnant 28-year-old female patient who, at 34 weeks of gestation, was suffering from depression, he thought her case would be “a slam dunk.”

The woman had a long history of depression so severe it required shock treatment and was clearly unable to perform her job, said Song, who is currently serving as the president of the Canadian Psychiatric Association.

And yet, the insurance company initially rejected the claim.

“I couldn’t believe it,” Song told.

After following up with the insurer and filing additional paperwork, Song was eventually able to get the claim approved, he said. But the case illustrates the challenges that still remain when employees file a workplace disability claim because of a mental health issue, he added.

One in three workplace disability claims in Canada is related to mental illnesses, which also accounts for 70 per cent of total disability costs, according to the Mental Health Commission of Canada.

Insurance companies are, for the most part, keenly aware of the need for mental health-related benefits in the workplace and have become significantly better at handling such claims, according to several sources consulted by. But insurers are also under pressure to keep costs under control and continue to rely on standards and processes that don’t always fit with the realities of mental health illnesses, according to some of the sources.

The basic problem with mental illness is that it’s less visible than a physical ailment. When a worker loses a hand due to an accident, it’s hard to dispute that they have developed a disability, said disability law services toronto, a Toronto employment lawyer.

But when dealing with problems like depression or anxiety, the medical evidence is far less straightforward than, say, an MRI or a blood test. And the issue is not just assessing whether someone suffers from a certain disorder but how far they are along the spectrum, according to disability law services. The key question is: what extent is the illness interfering with an employee’s ability to do their job?

Long term disability insurance canada, who specialize in disability claims, said the opinion of a general practitioner (GP) isn’t always enough to convince insurers to accept a long term disability insurance claim. Employees have a much stronger case when they can present a diagnosis from a specialist, but that can prove difficult to do in a country where seeing a psychiatrist can take up to 18 months.

Disability Law Services Toronto, an HR consultant with 15 years of experience working in the disability insurance industry, offered a different perspective. Insurers usually accept reports from family doctors — as long as there is a referral to a specialist, she said.

“It’s not ideal, but it is acceptable for a claim,” she said.

But GPs, she said, must provide an actual medical diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, which psychiatrists in North America use for a standard classification of mental disorders long term disability.

“I’ve seen things like ‘inability to cope’ — that is not a diagnosis”.

But even a specialist’s diagnosis isn’t always a silver bullet. Said doctors are sometimes focused on describing symptoms rather than how a certain disorder interferes with a patient’s ability to perform the essential duties of their work. Medical practitioners, he suggested, should work off of the patient’s job description.

The Canadian Life and Health Insurance Association (CLHIA) said in a statement it has worked with the Canadian Medical Association to develop a standard physician questionnaire for mental health-related long term disability insurance Canada claims.

“The attending physician, typically their general practitioner, can easily complete the form,” it said.

And in an effort to facilitate treatment and potentially speed up employees’ return to work, some insurance carriers have partnered with third parties that provide quicker access to counsellors, long term disability forum, long term disability, psychologists or psychotherapists. This can be helpful especially during the months that often pass between when a patient receives a referral to a specialist and their first appointment, she added.

But employees would have to pay out-of-pocket for the services if they don’t have coverage under their standard workplace health benefits.