Has Manulife, Sun Life Financial, Great-West Life, Desjardins Insurance, Empire Life, Canada Life, Industrial Alliance, RBC Insurance, La Capitale, SSQ Insurance, or Beneva has denied your long-term disability benefits for depression? If so, we urge you to read on.
Depression is a very complex mood disorder that can cause persistent feelings of sadness, and loss of interest in day-to-day life, and can impair a person’s performance at work, at school or within their social relationships. Major depression and clinical depression are the same. For some, this mental state is so debilitating they have difficulty carrying out day-to-day activities. At the depths of a depressive episode, some who suffer from this condition may feel that life is not worth living.
There’s no doubt that depression can have a brutal impact on a person’s work performance and overall employability. Serious depression can contribute to absenteeism, on-the-job functional limitations, overall impaired work performance, fatigue, isolation, poor personal hygiene, feelings of being unmotivated, persistent mood issues, focus and concentration issues.
Depression can be crippling, debilitating, and overwhelming. Unfortunately, disability insurance carriers don’t always see or believe that claimants suffer from depression that is serious enough to warrant them off work, or satisfying the definition of disability within their insurance policies. Depression is an invisible illness and is diagnosed based on symptoms and behavioral patterns and it’s easy for insurance companies to not believe your suffering and shades of darkness.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, or the DSM-5 (which is which is the principal authority for psychiatric diagnose in North America) outlines that a diagnosis for depression must involve 5 or more of the following symptoms below during the same 2-week period with at least one of the symptoms being either (1) depressed mood or (2) loss of interest or pleasure:
For a person to receive a diagnosis of depression, these symptoms must cause a claimant significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of alcohol/drug abuse or caused by another medical reason.
The DSM-5, (The American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders) classifies depressive disorders into:
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, which was released in 2013, added two specifiers to further classify a diagnoses of depression:
With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.
With Anxious Distress – The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.
No one knows the precise reasons or pathophysiology of depression. We do know that depression is a potentially life-threatening disorder that potentially affects millions of people all over Canada. Studies show that depression affects nearly 1 in 5 Canadians – and even more in Medical studies have shown that it could have a variety of causes such as:
Biological Issues – the brain of a severely depressed person appears to have physical changes. The significance of these changes is, as yet, not understood;
Chemical Imbalance – neurotransmitters, or brain chemicals are linked to mood and may have a direct role in depression;
Genetic influences and genetic contribution – medical studies have shown that hereditability could be as high as 75%;
Adverse life events – The impact of adverse life events such as the influence of chronic stress and seriously hostile life events such as death or loss of a loved one, deep financial problems can be the beginning of depression, abuse or death; and
Hormone imbalance – may play a role in triggering depression. The thyroid gland is often at the center of an imbalance.
Depression wears many hats, but a few of these symptoms are easy to recognize such as:
Some or even all of these are the hallmarks of a depressed person. The above symptoms are, at times, so overwhelming they completely incapacitate the person. Since depression varies from person to person, the expression of the above symptoms will be different for each person.
Untreated depression can cause emotional, behavioral, and health problems for the individual (and their families). Complications can include such things as alcohol abuse, substance abuse, anxiety, work or school problems, family conflicts, relationship difficulties, social isolation, suicide, self-mutilation (cutting), and premature death (from other medical conditions).
Clinical depression and it’s effects on a person’s ability to work can negatively impact their overall employability. Persons who suffer from serious depression can no doubt be highly susceptible to poor attendance, problems with sustained concentration, difficulty managing emotions, difficulty managing conflict, fatigue, and forgetfulness – all of which can impair a person’s employability.
In addition, a person can suffer from elevated cognitive and physical responses, as well as distractibility, confusion, vegetative symptoms, loss of energy and appetite – all of which can have a very serious effect on employability or cause a depressed employee to be vulnerable to adverse work outcomes.
Countless studies have been published since the early 1980s which tell us that depressed employees exhibit more job loss, premature retirement, functional limitations within the context of employment and critically reduced work performance.
It depends if your depression causes such an impairment in your work function that you are unable to sustain the substantial duties of your own employment. Remember, most long-term disability policies in Canada state that a person can qualify for long-term disability if the claimant suffers a “total disability” and he or she cannot complete the duties and requirements of his or her own job, within the first 24 months of the onset of disability. Again, claimants that suffer from serious depression will may all sorts of ailments that may affect their work productivity such as concentration issues, fatigue, stress, distractibility, mood issues, lack of cooperation, tardiness, social withdrawal, or alcohol and drug abuse.
The 24 month mark is an important juncture in disability cases. After 24 months, the test for total disability, and most Canadian policies, changes considerably. The claimant must at this point, be unable to complete the substantial duties of any occupation for which he or she is reasonably trained by virtue of their education and experience. This is not always an easy threshold to surpass and it is the time when most disability insurance companies wrongfully deny or cut off a claimant’s long-term disability benefits.
Proper medical support – make sure you have the proper medical support. If your are suffering from a chronic illness, injury, or any other type of disability, you must have the support of your family doctor, not only for the required Attending Physician Statement but for the overall support and care for your condition.
Participate in a treatment plan – most policies mandate that a claimant may be ineligible for long-term disability benefits if he or she is not participating in a treatment plan. Stick to all prescribed treatment. The onus is on the disability claimant to prove his or her disability and if you do not participate in a recommended treatment plan, this could definitely negatively affect your disability claim.
Supply all of your medical documentation – when you apply for disability benefits, your disability insurance company will normally only ask you to release medical records from your family doctor. You should provide your disability insurance company with all clinical notes and records from any primary and secondary healthcare providers, as well as any specialists or hospitals that you have attended. Insurance companies will never spend the money to request a claimant’s entire medical history. Go the distance and supply more than they ask for.
Go back, go back, go back – with disability claims, you must show your disability insurance adjuster everything that may impede your ability to sustain regular gainful employment. When your adjuster asks for a release of records, speak with your family doctor and ask him or her to provide everything in their possession as far back as it goes. Many times, current clinical conditions are influenced by the past and it’s important that your disability carrier recognizes this
Do not ignore your insurance adjuster – you may feel that your adjuster ignores you, does not return calls or ignores what you say – but regardless, it’s important that when your disability adjuster asks for something, you provide it immediately without delay. Don’t be like them. We understand that it may be difficult for you to do this due to your disability, or the cost of obtaining certain clinical records however, it’s important that you try your best to provide exactly what your insurance company needs without delay.
Get off of Facebook and Instagram – insurance companies are notorious for investigating claimants and Facebook and other social media outlets can irreparably harm a person’s disability case. Most times surveillance is of no issue because disability claimants never claim to be disabled 24 hours a day. For example, a person who suffers from clinical depression may have good days and bad. However, insurance company adjusters never seem to understand this. We tell our claimants the best thing to do is to simply get off of all social media and keep their lives private.
Don’t wait – if you suffer from a disability that prevents you from working, apply for long-term disability benefits as soon as you can. There are often limitations in the policy as to when you can apply for disability benefits, and when you may be too late.
Be honest -always be honest with your disability adjuster. When you file your disability claim, it’s important to be truthful, straightforward, candid, and forthright with your disability claim.
If you suffer from depression and have been denied long-term disability, it’s important to know that you have rights. It is not the end of the road if you receive a denial letter from your group disability insurer.
You have a right by law to retain the services of a disability lawyer to file suit against your insurance company for the wrongful denial of your long-term disability benefits if both you and your medical professionals are of the opinion that you satisfy your policy’s definition of total disability.
Don’t face this battle alone; contact us locally in Southern Ontario at 905-333-8888 or Nationwide at 1-844-LALANDE for your free consultation. Alternatively, you can send us a confidential message through our website. We are here to help guide you through your legal journey to justice and recovery.
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Yes, depression can qualify as a disability for long-term disability benefits if it significantly impairs your ability to work. Medical documentation and a detailed account of how your depression affects your daily functions are crucial for your claim.
You should provide comprehensive medical records, including psychiatric evaluations, treatment history, and statements from your healthcare providers. Additionally, personal accounts of how your depression impacts your daily life and work can be valuable.
A disability attorney can help by ensuring your claim is thoroughly documented, accurately represents your condition, and meets all necessary legal criteria. They can also navigate the appeals process if your claim is initially denied and represent you in hearings.
Common reasons include lack of sufficient medical evidence, failure to follow prescribed treatment, and the insurance company’s assessment that the condition is not severe enough to prevent work. An attorney can help address these issues and strengthen your claim.
Manulife, Sun Life Financial, Great-West Life, Desjardins Insurance, Empire Life, Canada Life, Industrial Alliance, RBC Insurance, La Capitale, SSQ Insurance, or Beneva can all vary in their times to answer your claim for long-term disability benefits. The time frame can vary significantly depending on the specifics of your case, the completeness of your application, and the insurance company’s processes. Generally, it can take several weeks.