By Matt Lalande in Long-Term Disability on December 22, 2018
Generally speaking, claim liability, whether through an employment group policy or an individual long term disability policy, mandates that a claimant must suffer a “total disability” in order to be entitled to long-term disability benefits. Total disability in the context of disability insurance does not mean that an employee must be completely helpless and incapable of any activity. Rather, total disability has been established by our Courts to mean (within the context of most policies) that an insured is incapable of engaging in all or at least some of the important duties of his or her job.
Most long-term disability insurance policies issued through work provide two definitions of “total disability”. Within the first two years after the onset of disability, total disability is established when an employee is incapable of doing the important duties of his or her job, even though that employee could perform another occupation.
After 24 months of long-term disability, there is typically what is referred to as a “change in definition”. Most, if not all policy definitions change from an employee’s “own occupation” to “any occupation.” The change of definition typically means that an insured person is disabled if he or she is unable to engage in any occupation or perform any type of work for compensation or profit – or – unable to perform the activities of any occupation for which he or she is reasonably suited by reason of education, training and experience. If the employee can only take on minor, trivial or inconsequential work, for which he or she is overqualified, then that employee will more likely than not still be deemed totally disabled.
What are other things considered in assessing total disability?
The salary of the potential alternative occupations are normally to be comparable to the pre-disability salary of the insured. It is certainly a factor to be considered by our Courts. There is also a duty for an insured person to mitigate his or her damages. The claimant must follow medical advice and medical care as mandated in his or her particular policy, and try his or her best to get better, if possible.
Psychiatric illness claims can be very difficult and challenging to navigate for both employers and disability carriers. Examples of psychiatric or psychotic disorders are schizophrenia, schizo-effective (schizoaffective) disorder, schizofreniform disorder or general psychotic disorders. Symptoms and warning signs of psychiatric conditions can be:
Individual perceptions and thoughts become disturbed and the person suffering often has difficulty understanding what is real and what is not. Person suffering schizophrenic conditions can no doubt also experience anxiety, depression, sleeping problems, lack of motivation and decrease in overall functioning.
Psychiatric or psychotic disorders commonly occur before the age of 14, but according to many psychiatric journals, Schizophrenia, for example, which accounts for approximately two thirds of all psychotic conditions, can start between the ages of 16 to 35 – just when people are laying the foundation for or starting their careers.
Schizophrenia is a medicated required mental disorder characterized by delusion, hallucination, formal thought disorder, disorganized or catatonic behavior, negative symptoms (e.g. emotional blunting, decreased initiative, impoverished speech etc.) and cognitive dysfunction.
Objective psychiatric conditions can sometimes manifest themselves during young adulthood when a person is starting their career – and well into adulthood. Another psychiatric condition, chronic bipolar disorder, potential can onset be through all stages of life – even up to and after the age of 50 – however it has been proven that timely intervention might help reduce the onset or persistence of the disorders later in life.
Psychiatric conditions can no doubt result in a person not being able to sustain the reasonable demands of his or her own job – or any employment in the future, for that matter. If you have suffered the onset of a psychiatric condition, you may or may not be able to handle the reasonable duties or requirements of your job or of any occupation that you are reasonably trained to do. There are many studies which show that employment can be central to the concept of recovery in severe mental illness, however, the problem of adhering to any type or regular work schedule or handling stress can be extremely difficult, let alone impossible for some types of persons in certain types of careers.
People with schizophrenia also have a very difficult time adhering to any type of regular schedule because of accompanying cognitive impairment – which is probably the most consistent determinant of deficits in everyday functioning. Schizophrenia often affects such things as:
It’s been reported that up to 98% of people with schizophrenia experience cognitive deficits which impair daily functioning and contributes to chronic disability and unemployment. It is not uncommon for those suffering from schizophrenia later in life to lose functional capability, rendering them unable to continue working.
There is no doubt that throughout the course of a psychiatric illness, positive symptoms will fluctuate depending on the overall pattern of treatment response of the person – however – more often than not, employment will not be sustainable and disability benefits should be payable for life to protect the claimant’s future.
If you or a loved one suffer from a serious psychiatric condition and you have been denied short or long term disability benefits, no matter where you are in Ontario, call us at 905-333-8888 or at 1-833-4-LAWFIRM to start your claim today. We never charge upfront fees, and our consultations are free. Let us help you get your disability benefits back on track today – we are Hamilton disability lawyers who represent claimants all over Ontario. Don’t delay, call us today.