Mental health claims are now among the most common reasons for long term disability, and among the most frequently denied. The reasons given are predictable, and most of them can be answered with the right evidence.
Why insurers dispute these claims
A psychiatric condition has the same evidentiary problem as chronic pain. There is no scan. The claim turns on the clinical record, on function, and on whether the treatment the insurer thinks you should be having is the treatment you are actually getting.
- “You are not receiving appropriate treatment.” Often this means you are being managed by your family doctor rather than a psychiatrist, which in much of Ontario reflects the waiting list rather than the severity.
- “Your condition is situational.” A condition triggered by a workplace or a bereavement is still a condition.
- Non-compliance with medication. Stopping a drug because of its side effects is a clinical decision, not a lack of effort.
- Gaps in appointments, which for someone who cannot leave the house is a symptom rather than a choice.
What actually helps
- A specialist opinion if you can get one, and documented evidence of the wait if you cannot.
- Treatment notes that describe function, not just mood. What you can concentrate on, for how long, and how reliably.
- A record of what you have tried. Medications, therapy, programmes, and what happened with each.
- Evidence from your employer about performance before you stopped work.
- Honesty about the bad days in your own notes, kept as you go.
A word about being believed
People with a mental health condition often tell me the hardest part is not the condition. It is being treated as though they are exaggerating. That is a reason to document carefully, not a reason to give up. The policy asks whether you can work. It does not ask whether your condition is visible on a scan.
Read more
- Long term disability: the main page
- Your claim was denied: what to do first
- The change to the any occupation test
- Mental health and personal injury law
Speak to a lawyer about a mental health disability claim
Initial consultations are free. Our fee schedule is published in full, by stage of the case, on our Fair Fees page. Call 905-409-2438, send a text, message us on WhatsApp, or use the contact form.
Steven Polak is licensed as a lawyer in Ontario and practises with Lerners LLP at 123 Athol Street, Whitby.