Personal Injury

Long-term disability insurance part 3: mental health conditions

By AdvocateDaily.com Staff

In part three of a four-part series on long-term disability insurance, Toronto personal injury and disability lawyer Nainesh Kotak discusses the obstacles faced by claimants with mental health disabilities.

Long-term disability (LTD) applicants with mental health conditions are confronted by unique challenges navigating the process, Toronto personal injury and disability lawyer Nainesh Kotak tells AdvocateDaily.com.

Kotak, principal of Kotak Personal Injury Law, says the increasing prevalence of mental illness in society at large is reflected in the LTD field, where conditions such as depression, anxiety issues, or post-traumatic stress disorder factor into many applications for benefits.

For example, the Canadian Mental Health Association reports that about 20 per cent of the population will be personally affected by mental illness during their lifetime. In addition, about eight per cent will suffer a major depression.

Despite those developments, “There is still a stigma attached to psychological conditions,” says Kotak. “They’re more invisible than a physical disability.”

As a result, he says employees with mental health issues are less likely to report problems to their doctor and may require extra support when challenging denials or terminations by insurers.

“People with mental illnesses are particularly vulnerable, and also appear to be more inclined to walk away from a long-term disability claim because they feel overwhelmed or intimidated,” Kotak says.

As a condition of continuing benefits, he explains that LTD policies generally contain clauses requiring policyholders to seek appropriate treatment and follow their physician's instructions in order to mitigate their issues.

“When you’re representing someone with anxiety or depression, you need to emphasize the importance of following those instructions,” Kotak says. “If they’re asked to see a psychiatrist or are prescribed certain medications, they need to follow through, or it could lead to denial of their LTD claim.”

According to Kotak, many people are unaware that a psychological illness can ground a valid LTD claim on its own, without the presence of any physical condition.

“A mental condition can affect your energy level, cognitive function, memory and many other things that impact on your ability to work,” he says. “We have many claims that are exclusively related to mental health.”

Although scientific studies are few and far between, Kotak says his personal experience suggests the rate of denial for mental health-related LTD claims is high.

“We've had many clams that had to go to litigation where people with mental illness were denied,” he says. “If you look at the websites of major insurance companies, you will see they talk a lot about programs available in the workplace to help with anxiety or depression. It’s good to see something like that on paper, but I think the reality is a bit different.”

Stay tuned for part four, where Kotak will discuss LTD for terminated employees.

Click here to read part one — which covers the basics.

Click here to read part two — handling denial of claims.

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