mental health disability claims: how to be seen and heard by insurance companies

mental health disability claims are disproportionately denied by insurance companies, due to the invisible nature of the disease.

by nainesh kotak

published apr 09, 2024

last updated jun 04, 2024

3 minute read

join the conversation

3 minute read

join the conversation

many sufferers of mental health issues shy away from revealing their struggles, leading to an absence of concrete evidence for insurance companies to validate their claims. getty images

work-related stress is a common source of stress for many canadians, and for some people it results in anxiety. this anxiety can cause a person to feel fearful and apprehensive about their performance and their future, and may result in panic attacks, pain, depression and other symptoms that can undermine their ability to work effectively. mental health sufferers who try to seek help through their insurance company by filing a claim, often run into a common obstacle. the number one reason for mental health disability denials continues to be insufficient medical evidence.

the biggest hurdle in mental health disability claims is the stigma around mental illnesses. many sufferers shy away from revealing their struggles, leading to an absence of concrete evidence for insurance companies to validate their claims.

according to a study by the mental health commission of canada (mhcc), in an average week, 500,000 canadians miss work, and 30 per cent of disability claims and 70 per cent of disability costs are associated with mental health issues and illnesses.

the mhcc estimates that of the $51 billion economic cost each year attributed to mental illness in canada, a staggering $20 billion stems from workplace losses.

it also states that: “by improving the management of mental health in the workplace, productivity losses can be decreased by as much as 30 per cent”.

mental health disability claims are disproportionately denied by insurance companies, due to the invisible nature of the disease and incentives for insurance companies to make minimum payouts.

disability lawyers see many clients with denied mental health claims who are unable to perform their duties at work. as with any other type of long-term disability claim, insurance companies are looking for proof of an illness and also related treatment. however, mental illnesses are diagnosed based on subjective complaints, unlike physical ailments which can be proven with scans and tests.

when navigating work-related stress or mental health issues, your family doctor can be your biggest ally. he or she documents your symptoms and their progression, which can be crucial evidence in your claim. when you go to your family doctor or any medical practitioner, they usually make notes about what you say. these notes, in fact, are usually shared with the disability insurer.

here are some tips when navigating a disability claim related to mental health:

break the stigma. it’s important to be open about your mental health struggles, as it’s the first step towards seeking help and successfully filing a disability claim;
engage your doctor. your family doctor can be instrumental in your claim. make sure they are aware of your symptoms and struggles;
keep any personal documents that specifically document the nature of your struggle with depression or anxiety. these can include emails or texts;
be aware that insurers may be perusing your social media accounts to find photos or posts that contradict your claim that depression or anxiety symptoms negatively impact your ability to function;
understand the process. you may need assistance to familiarize yourself with the claims process and all the necessary documentation. because anxiety, depression and other psychological disabilities are far more difficult to diagnose than physical and objectively measurable injuries, familiarity with the legal process is paramount; and
seek appropriate treatment. show the insurer your commitment to recovery by seeking the necessary treatment.

struggling with mental health and a denied disability claim at the same time can be very daunting. it can help to obtain a proper legal opinion outlining your options and may also speed up the process of receiving much-needed benefits.

nainesh kotak, is the founder of kotak personal injury law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. he also serves as the chair of the long-term disability section of the ontario trial lawyers’ association.