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How A Disability Lawyer Can Support You When Dealing With Denied Mental Illness Claims
After receiving a disability claim denial from the insurance company, you might not know where to turn next. You may feel hopeless, but rest assured you are not alone. When you call Share Lawyers, you will speak with someone who knows the insurance industry, knows what you are going through, and can offer you the best possible advice at no cost to you.
Why you should contact a disability lawyer at Share Lawyers:
- Its free to talk to us about disability claims
- We specialize in disability claims for Mental Illness disability claims and can go through your options
- We provide a free consultation with one of our disability lawyers to see how we can help you get your LTD benefits
- We can answer all your questions about the insurance industry
- We have helped many clients with Mental Illness disability claims get their disability benefits
Is It A Medical Problem Or A Workplace Issue
While mental health claims, in general, tend to be more complex, an especially challenging issue arises when someone develops a mental illness because of, say, an abusive boss or bullying at the office.
In these cases, an insurance carrier may take the view that the underlying problem is a workplace issue that should be handled by HR rather than a medical condition, Holden said.
But the line between a workplace and a medical problem is a fine one, said David Share, president of Toronto-based Share Lawyers. If the disorder becomes severe enough, it may follow someone into a new job and different work environment, he said.
Kotak added that, in his experience, a toxic work environment is often simply a trigger of a pre-existing condition.
Even when patients are able to make a successful claim, some doctors worry about sending them back into a toxic work environment.
Most of the cases I treat are directly related to a workplace issue, said Camillo Zacchia, a Montreal-based clinical psychologist. But what can I do as a psychologist about this?
Insurers are increasingly working with employers to facilitate a healthy return to work for employees in these situations, Holden said. But, she added, theres still work to be done.
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What Happens If You Dont Take Your Medications
Another issue with keeping patients on benefits is that individuals with mental illness may stop following their doctors advice or taking their medications.
Disability policies usually require claimants to pursue treatment and make a sustained effort to get better and eventually go back to their job. Thats often a sensible goal from a medical point of view as well, Song said. Most people benefit from the structure and sense of self-esteem that employment provides, he added.
But patients suffering from mental illnesses like depression or bipolar disorder may, at times, refuse to follow their treatment, which is a manifestation of their condition rather than an exercise of their judgment, he said.
But patients who stop their treatment are in breach of their policy contract, which could cause them to lose their benefits, Share said.
Still, Holden said most insurance case managers have a much better understanding of mental illness today compared to a few years ago.
They would understand that its the actual illness displaying itself, she said.
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What Happens After A Denied Claim
The most common mental health Manulife claims are for anxiety, bipolar disorder, depression, grief and substance use disorder. Manulife insurance does have to cover, when sufficient documentation is provided, mental health benefits to anyone suffering from:
- Affective Disorders
- Somatoform Disorders
- Substance Addiction
If you have submitted a Manulife Mental Health disability claim, whether be for STD, LTD or permanent disability, then you are claiming that you are unable to carry out any employment duties due to managing to heal/struggling from a mental health illness or injury. These claims are to be taken as seriously as a physical injury or illness, and should not be subjected to any prejudice or stigma.
It is important that once you receive notice that you claim has been denied, you understand fully why your claim has been denied, and what the offered appeal process is.
If Manulife insurance has failed in providing you with information as to why your mental health claim has been denied, contact your Manulife contact immediately. If Manulife insurance refuses to provide you with this sufficient information, at your request, contact a long term disability attorney as soon as possible.
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Excuses Insurance Companies Use To Deny Disability Claims For Burnout
While the term burnout was coined in the 1970s and the phenomenon has been the subject of studies for decades, it is not a medical diagnosis. You will never receive disability insurance benefits simply because you feel burnt outyou need a documented, disabling medical condition.
However, this does not mean that obtaining short-term disability benefits related to job burnout is an impossible task. It just means that extra care needs to be taken to prove that you are truly suffering from a medical condition that prevents you from performing your job duties.
What you might describe as burnout might really be symptoms of:
- Post-traumatic stress disorder
- Chronic fatigue syndrome
You will need to convince the insurance company that your documented mental health conditions make you eligible for short-term disability benefits.
Benefits For Disabled Adults
SSDI is available to disabled adult workers who have paid Social Security taxes, while SSI is a need-based program only available to applicants that meet strict limitations on income and asset holdings. If you have never worked due to your mental illness, you will not qualify for SSDI. If you have financial support from friends or family, you will not qualify for SSI.
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Mental Health Accommodations Are Available To Anyone Who Has Dealt With An Illness In The Past Yearno Matter How Severe The Symptoms May Be
When we start a new job we’re not embarrassed to ask about the number of sick days or if there’s a gym membership reimbursement. But when it comes to our mental health, we either clam up or don’t know how to ask for the benefits we’re entitled to.
The fact is, forty-one million of us have dealt with some kind of mental illness just in the past yearthats one out of five adults. And every single one is entitled to special protections under the Americans with Disabilities Act . Theres a misconception that these protections are meant for people with severe or chronic conditions, but thats not the case. Consider this list your mental health bill of rights.
Can I Be Fired While On Short Term Disability
Your employment can be terminated but it is discriminatory to fire someone due to a disability. In Ontario, the Human Rights Commission requires employers to provide reasonable accommodations to employees with disabilities. Get legal representation if you think you have not been treated according to the law.
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What If Your Claim Is Denied
Most insurance policies come with some limitations.
For example, some disability policies will not cover pre-existing conditions. If your mental health condition is ongoing, your provider might not cover this condition under disability insurance.
If your short-term disability claim is rejected, you will receive a denial letter in the mail. This letter will tell you why your claim has been denied and explain the specific reasoning behind it. It will also provide you with instructions on how to appeal the decision.
What Other Options Are There Can I Use Short Term Disability For Mental Health
Can short term disability be used for mental health? For income support, anyone with a diagnosis of a mental condition might turn to the following sources. Although none of the following options may guarantee a source of income, they can offer assistance to eligible people with mental health-related disabilities in some situations. The Social Security Administration is typically the most helpful.
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Talk With Your Hr Representative
Before kick-starting the application, you must have a constructive conversation with the HR representative regarding your condition. The earlier this conversation happens, the better.
If the HR department is aware of your condition, the application process is straightforward. At your request, HR will provide you with the short-term disability insurance claim form. A three-in-one structure comprising:
The claimant form. Here, you provide requisite information about yourself, the job, why youre applying for the claim , etc.
The employer form. Here, your employer will provide your job description, salary, employment status, and history with the company. The employer also needs to provide information about other compensation plans.
The attending physician form. Here, your physician certifies your medical condition and how it impacts you.
Suppose HR doesnt have the claim form at your request? In that case, you can contact the insurance company through the contact information on your policy documents .
What To Consider When Buying Disability Insurance
If you’re considering disability insurance, make sure you:
- check with your employer to see if you already have group disability coverage with your employer’s plan
- shop around, especially if you’re considering private disability insurance
Consider group insurance offered through a union, guild, or professional or alumni association. Premiums for this type of coverage usually increase as you get older. You’ll need to renew your insurance every few years.
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Other Disability Options For Mental Illness
Mental health issues are getting more exposure from healthcare professionals, and they are emphasizing the importance of getting help and treatment for these conditions. Especially with the recent pandemic, there has been a surge in mental health issues across America. So, since many disability insurance plans do not cover these conditions, what other options do you have? Here are a few options you can consider.
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 employers group benefit plan.
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Can You Claim Short Term Disability For Mental Health Social Security Disability Insurance
The Social Security Administration makes a lot of information available regarding the standards it uses to evaluate disability claims. Clause 12, a more recent section, covers mental illnesses in its rules. There are nine types of mental disease that are covered by Social Security Disability benefits, according to the material there:
The Social Security Administration explicitly outlines what applicants must demonstrate to receive disability benefits for each of these nine categories.
Streamline Your Application Process
The application process will depend on what kind of Short Term Disability coverage you have and your insurers requirements. If your benefits plan includes services from a third-party disability management service like DMI, ensure you are utilizing their expertise to help you along the way.
If you are applying for short term disability coverage, you want to focus on your treatment and recovery. To get your claims experience started right, our partners at DMI offer their advice to get things going in the right direction:
- Fill out application forms in their entirety. Your application for benefits will be based primarily on the accuracy and comprehensiveness of the information that you provide, so double checking or having a close friend or family member look over your application form for any missing information can save you valuable time and energy.
- Ensure your doctor, treatment team or specialist fills out the appropriate paperwork and provides the clinical records relating to your claims. This is the information your insurer will use to adjudicate your claim for benefits.
- You will need to provide a clear and legible copy of one of the following documents: birth certificate, drivers license, or a government-issued passport.
- Other information you may need to include is your SIN number, banking information for direct deposit, an up-to-date mailing address, as well as your employers address.
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I Return To Work After An Extended Absence Due To Disability
Accommodation is a fundamental and integral part of the right to equal treatment in returning to work. Both employers and unions must co-operate in accommodating employees who are returning to work after a disability-related absence. Occupational Health and Safety committees, which include representatives of both management and labour, can help work out individual accommodations for employees with disabilities who are returning to the workplace.
Section 17 of the Code states that the right to return to work for persons with disabilities only exists if the worker can fulfill the essential job duties after accommodation short of undue hardship. If a person cannot do the essential job duties, despite the employer’s effort to accommodate short of undue hardship, there is no right to return to work. This right under the Code applies regardless of the size of the workplace or the length of time the employee has worked for the company. This is different from the corresponding provisions in the Workplace Safety and Insurance Act. See also Section II-2b) Supremacy of the Code and Appendix B Human rights in the workplace: which laws?
The duty to accommodate does not necessarily guarantee a limitless right to return to work. On the other hand, a return to work program that relies on arbitrarily selected cut-offs or requires an inflexible return date may be challenged as a violation of the Code.
Is Mental Illness A Disability
The ADA considers mental illness to be a disability if it limits one more life of your major life activities. If you have a mental health condition, you are entitled to reasonable accommodations that can help you do your job and are protected from discrimination in the workplace.
The Social Security Administration considers mental illness to be a disability if it is severe and falls under their list of disabling conditions, which includes:
Autism spectrum disorder
Schizophrenia and other psychotic disorders
Somatic symptom and related disorders
Trauma- and stressor-related disorders
Social Security disability insurance is free, but it only offers a limited benefit and can be difficult to qualify for. It is not a replacement for long-term disability insurance.
If you or someone you know is in crisis, you can call the National Suicide Prevention Lifeline at 1-800-273-8255, or text the Crisis Text Line . Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential.
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H Considerations When Contacting An Employee On Leave
Employers are entitled to contact employees on leave if it is reasonably required. For example, contact may be needed to assess accommodation requirements, the length of absence, changes in the prognosis or to find out whether there may be a potential return to work date. If an employee is off work for an undetermined amount of time, the employer can contact the employee after a reasonable length of time to see if the prognosis has changed and whether a return to work date has been identified.
Contacts could be used to show the employee that they are missed and valued by the organization. Such contacts may show the employee that they continue to be a part of the organization and could help with a smooth return to work. On the other hand, repeated contacts requesting information, saying that the workplace needs the employee, or asking for a premature return to work , especially over a short period of time, may constitute harassment.
In determining whether to contact an employee on leave, consider the following factors:
- What is the nature and length of the disability leave?
- What level of contact has the employee asked for?
- How much time had passed since the last contact?
- What is the reason for the contact?
- Is more information really needed or has enough information already been provided?
- How would a reasonable person view a further contact in light of the information above?
Mental Health Conditions And Ada Requirements
The Americans with Disabilities Act covers certain mental health conditions, which means that an employer must provide reasonable accommodations to enable disabled workers to perform the important tasks of their occupation.
Reasonable accommodation can include longer breaks as well as a modified work schedule. Reasonable accommodations can be made for any disability that substantially limits the workers ability to concentrate, eat, sleep, practice self-care, interact with others, or perform any major life activity. The condition does not need to be permanent or even severe to result in a condition that is substantially limiting.
To request a reasonable accommodation for a mental disability, an employee should:
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