Also known as the “invisible” disability, it is reported that one in three people in Canada will experience mental illness at some point during their lifetime. Depression, anxiety, bipolar disorder, post-traumatic stress disorder, panic disorder, social phobia, and addiction are some of the ways in which mental illness manifests itself in the nearly 500,000 employed Canadians who are unable to work due to mental health problems. These numbers are only expected to increase.
Unfortunately, insurance companies frequently deny disability claims that arise from the debilitating effects of depression. Read on to find out more about your rights when it comes to filing a disability claim due to depression and the potential next steps to appeal a long-term depression disability denial.
Why are Claims Denied Despite Suffering from Depression?
Insufficient Medical Evidence
Insufficient medical evidence is one of the main reasons insurance companies will deny a mental illness claim. This is related to the invisibility of mental illness. When a physical injury occurs, there is usually a medical record trail. When it comes to a mental illness like depression, there are no imaging or diagnostic tests to prove your illness.
Furthermore, because of the stigma attached to mental illness people often hide their illness from family members, friends, people at the workplace, and sometimes even health care professionals. Regardless of how forthcoming or transparent you may be when it comes to reporting your symptoms to your insurance company, without medical record documentation, your claim will remain invisible.
Without sufficient medical documentation, like clinical notes and records from a professional healthcare provider, insurance companies are unlikely to process your claim. Like an unexcused school absence, your symptoms do not exist without a doctor’s note. That is why it is imperative that your doctors and treatment providers thoroughly document your condition and any treatment received. That way, you can send a letter to your insurance company verifying your symptoms, restrictions, limitations, and any treatment received related to your depression.
Not Receiving Appropriate Treatment
Claimants filing for long-term disability due to depression need to demonstrate appropriate treatment has been received through medical records. If treatment is deemed insufficient, your claim may be denied. The insurance company is looking to make sure no proverbial stone is left unturned before coming to them for your disability claim. Make sure you provide evidence that steps to undergo regular treatment have been taken prior to filing.
Most disability policies have clauses specifying that the insurance company can deny or terminate your claim if you are not receiving appropriate treatment on a regular basis. As a treatable condition, mental illness requires actively seeking adequate medical care. Seeing a physician, usually defined as a medical doctor under your disability policy, is part of this stipulation. Alternative homeo or naturopathic treatment providers or nurse practitioners are generally not included in this definition.
You must follow up with your family doctor or a psychiatrist on a bi-weekly or monthly basis. You will need your physician to maintain documented evidence of your condition and carefully monitor your medications.
Your insurance company may deny your claim if you have not been to a psychiatrist for an initial evaluation or treatment. As professional mental illness specialists, claimants are able to consult with a psychiatrist to confirm they are receiving appropriate treatment and medication for their condition. Speak with your physician to get a referral for a psychiatrist as soon as possible to avoid delays caused by long waiting lists.
Medication and psychological therapy usually constitute most mental illness treatment plans. Some clients may be reluctant to take medication. Insurance companies can deny a claim if it is found that a claimant refuses to try medication prescribed by a doctor. Likewise, the insurance company will likely terminate your benefits if your doctor’s recommendations aren’t followed. If you are concerned about an adverse reaction to a medication based on a previous experience, you will need to discuss alternatives proposed by your doctor.
Understanding depression and its underlying causes can be a complex process. Insurance companies may deny a claim if a claimant hasn’t sought therapeutic services through a psychologist. If your doctor recommends that you see a psychologist, you will need to find a suitable service to receive the benefits listed under your insurance claim.
Other Reasons for Denying your Claim
Insurance companies may look for other underlying causes to deny your disability claim. They may deny your claim on the basis that a uniquely toxic workplace environment or interpersonal conflict with co-workers is the cause of your condition.
Your insurance provider will want evidence that a change in environment is not enough to adequately alleviate the effects of your depression, rendering you capable of performing your job duties. Medical records will need to indicate that your place of work exacerbated your condition to the point of incapacitation. Otherwise, your insurance provider may deny you on the basis that your depression is a pre-existing, ongoing condition and you should be able to continue performing work-related duties.
What Should You Do if Your Claim is Denied?
You have the right to an appeal if your long-term disability claim is denied. Note that a long-term disability appeal has no formal legal standing. During the appeal process, you present evidence to your insurer to support the validity of your claim. Because there is no neutral decision-maker involved, long-term disability claims are very often still turned down.
There is an established timeline that works in favor of insurance companies. Claimants who want to take legal action in response to their long-term disability denial have two years from the date of their initial denial, not the date of their last appeal, to file a claim in court. Appeal processes can be lengthy and convoluted, running the clock in the race against time.
Ensuring a legal course of action by filing a claim in court with the help of a long-term disability denial lawyer is likely to obtain a more favorable outcome than an internal appeal. They can negotiate on your behalf with the insurance company. The evidence presented can strengthen your case to receive a fair settlement or a favourable Judgment.
How Can Derek Wilson Help Maximize Your Chances of a Successful Appeal?
As someone who has over a decade of experience previously working for insurance companies, I have unique insight into why long-term disability claims are denied. For nearly 14 years, I have successfully helped clients obtain long-term disability benefits after denial. I will focus on making the invisible disability(depression), visible to get you the long-term disability insurance benefits you deserve per your specified policy.
My firm focuses only on personal injuries and represents clients with long-term disability claims. We provide fair and honest legal advice with a focus to help clients recover fair compensation with no up-front fees. Call us at 855-769-0418 or get in touch online to schedule a free consultation.