Depression

Does depression qualify as a disability in Canada?

In Canada, all disability benefits providers recognize clinical depression as a disability and a condition that qualifies for benefits.

However, long term disability claims are only approved because the person suffering cannot maintain full or part-time employment. To receive these benefits, you must prove that your condition is entirely disabling and preventing you from working. This involves plenty of medical evidence establishing the severity of your clinical depression and presenting undeniable proof to your insurance provider.

‍

When your claim for long term disability benefits is reviewed, the insurance company will focus on the severity of your symptoms, along with your current and future medical treatments. Therefore documentation and credibility are key when submitting your claim to receive long term disability benefits.

‍

Employment and disability rights for depression

Those suffering from depression have a hard enough time just finding the energy to complete basic self-care tasks at home. Adding on full-time employment can be too overwhelming for those suffering from clinical depression.

‍

Canada’s human rights laws dictate that your employer must assist you with health conditions that affect your work. They cannot fire you for a discriminatory medical reason regarding your depression. This means that requesting sick leave is well within your rights and should be accommodated if you provide a doctor’s note. This note should state that you need time off and the required length. A note will need to be re-submitted every three to six months for more prolonged bouts of absence.

If you apply for long term disability benefits and your claim is denied, you can remain on sick leave while you appeal. Most employers will not object to this if you’re still providing doctor’s notes regularly.

‍

You have legal rights if your employer tries to fire you while on sick leave or while you’re applying for long term benefits due to your clinical depression. If you are terminated due to your depression, you have the right to severance pay and may be able to have your employment reinstated. This situation can become complicated, so hiring a lawyer with experience in long term disability benefits claims will be an immense relief.  

‍

Types of disability rights for depression

Not all disability insurance plans are the same. Here are the typical benefits included in Canadian disability insurance plans:

‍

Paid Sick Leave

Some workers will have a bank of sick time to use in the first days of disability. The intent of this benefit is to allow the worker to have a few days to get back to work. Some workers may have many weeks or even months of accrued time to use.

‍

If you do not believe that you will be able to return to work before your paid sick leave is exhausted, be sure to complete an application for disability insurance benefits right away. You do not need to wait until you have used all your paid sick leave before submitting your application. Also, it is always easier to work on a disability application while you are being paid so don’t wait until your benefits have run out.

‍

Another major reason not to wait to apply for STD Benefits is because of deadlines that may apply. You may miss the deadline to apply for benefits because you are being paid sick leave benefits.

‍

Employment Insurance Sickness Benefits

Your alternative to paid sick leave is government provided employment insurance (EI) benefits. Most workers have fewer than 15 weeks of paid sick leave so EI benefits will make up the difference between the expiry of paid sick leave and a STD Benefit. EI Benefits must be applied for through the government. In order to apply, you must obtain a medical report from your doctor and a Record of Employment (ROE) from your employer.

‍

Go to www.servicecanada.gc.ca for information on the EI sickness benefit and to download the application forms. Service Canada will not process your application until both the medical form and the ROE has been submitted, so be sure to book a doctor’s appointment and request your ROE right away.

‍

Short-Term Disability Benefits

The first of two main benefits in most disability benefit plans are STD Benefits. The purpose of STD Benefits is to provide you with income while you are unable to work due to illness or disability. The Benefit is designed to cover short absences and not intended to be a long-term solution.

‍

STD Benefits provide a weekly or bi-weekly payment for a number of months. The short pay periods are designed to provide you with uninterrupted income while you are absent from the workplace. Most often, you will be required to use accrued paid sick time before accessing your STD Benefits. While cashing in sick time may be frustrating for some, it is wise to accept this condition because the sick time should provide you with more income than the STD Benefit.

‍

The STD payment typically provides for a percentage of your regular weekly earnings or a specific amount of money. The benefit payment calculation details are specific to the policy and set out in the insurance policy document.

‍

Payment examples include:

• The worker will be paid 60% of his or her pre- disability weekly earnings, or

• The worker will be paid $500 per week, or

• The worker will be paid their pre-disability weekly earning, up to a maximum of $500 per week.

‍

Most STD Benefits last between three and six months. If the group plan does not have a LTD Benefit, the worker will have no further benefits under the group policy.

‍

Long-Term Disability Benefits

LTD Benefits are the second major element of most group disability plans. There are some plans, however, that only include LTD Benefits. If your plan has both STD and LTD Benefits, a disabled worker will ‘roll over’ to the LTD Benefit at the expiry of the STD period if they are eligible to do so.

Eligibility for LTD Benefits is not always a given. Workers often earn their eligibility to the Benefits through working continuously for the employer for a number of months.

‍

Eligible workers will be able to make a claim for LTD Benefits if they have been out of work continuously for a specific period of time. This period of time is typically the length of the STD Benefit. This period of time set out in the policy wording is referred to as a “waiting period” or “elimination period”. LTD Benefits will not be paid prior to the elimination period; however, benefits will be paid for the total period of continuous disability if the claim is approved.

‍

Benefit payments under a LTD Benefit are assessed based on a percentage of your pre-disability income. Typically, the benefit will be between 55% and 75% of your regular earnings, or a set amount of money per month. Other polices will have a net formula.

‍

Payment examples include:

• The worker will be paid 66.7% of their monthly pre-disability earnings, or

• The worker will be paid $3,000 per month, or

• The worker will be paid 66.7% of his or her monthly pre-disability earning up to a maximum of $3,000 per month.

‍

The exact payment formula will be set out in the policy document. Be sure to refer to your policy to confirm what the applicable payment formula is for your claim.

The LTD Benefit will make payments on a monthly basis for a set number of years (e.g. 5, 10, 20), or until you reach a certain age (e.g. 60, 65, 67). Some plans may have a benefit termination formula where a mixture of the years a claimant received benefits and the claimant’s age is used to calculate an end date. Generally speaking, the latest date where a claimant will be eligible for Benefit payments is called the Maximum Benefit date.

‍

How to win disability benefits for depression

‍Proving an invisible illness to receive long term disability benefits can be a challenge. Unlike physical diseases, there is no one test to prove how serious your clinical depression is. It won’t be easy to be approved for benefits without plenty of medical evidence. 

‍

The first thing you will need is an official medical diagnosis. Language is important here; doctors may describe your condition as ‘burnt out’ or ‘overwhelmed’ when that’s not the full scope. It is also essential that your doctor takes the proper steps towards your diagnosis, including ruling out other conditions like thyroid disease, fibromyalgia, or any other conditions with depression as a side effect. If your diagnosis is incomplete, insurance companies will question this and deny your benefits claim. 

After being diagnosed, the insurance company will check if you followed an appropriate treatment plan to manage your depression. Documentation of medications, treatments, and therapies is critical in having your claim approved. If you’re waiting to see a specialist, note all other methods of treatment you’re seeking in the meantime. If you are not actively taking medication or seeking treatment, insurance companies will see that as a red flag. 

‍

Since the medications for depression can come with serious side effects, you must document all troubleshooting you have done with your doctor to find the right prescription. Any change in medication type or dosage is worth noting and presenting in your file. 

‍

The best way to win long term disability benefits is by presenting firm medical evidence that demonstrates your effort to stay at work and that you seek benefits as a last resort. Present your insurance provider with undeniable proof that you did everything in your power to remain employed. 

‍

How to hurt your long term disability claim for depression

• Skipping or missing doctor or therapy appointments
• Leaving prescriptions unfilled or not taking medication
• Hiding your condition from your employer and not asking for accommodation
• Having a poor attitude towards those working on your claim
• Contradicting statements in your claim

How to improve your long term disability claim for depression

• Presenting a full medical file with an official diagnosis
• Taking advantage of any therapy or supports offered through your workplace
• Actively attending therapy 
• Being honest about your condition
• Co-operating with doctors and your insurance provider

Common reasons for denial of clinical depression claims

The most common reason a claim for long term disability benefits is denied is lack of evidence. Since depression is an invisible illness, it can be harder to prove without a doubt that it is debilitating enough to keep you from working. Without all the evidence supporting your claim, insurance providers will find a reason to deny it.

‍

The lack of a proper diagnosis is a significant issue for these claims. This is why your medical file is so essential to your case. Making sure you’ve seen a doctor and explored every avenue to receive your diagnosis is crucial. Even with a proper diagnosis, claims can be denied if the employee doesn’t follow through with their medications, follow-up appointments, therapies, or anything medically relevant.  

‍

Lastly, insurance companies love to use plausible deniability. If you don’t have solid proof of your effort to stay at work, they will use the excuse that you didn’t try. To win your disability benefits claim, you must show that you sought help from your employer to stay at work. This can include requests for fewer hours, lighter duties, or even a change in positions at work.

‍

What if your claim is denied?

Know that you are part of a large group of Canadians who have had their benefits denied by the insurer at some point during the course of a claim. Those who have been issued a denial letter are those who had their application rejected by the insurer. They were deemed eligible to apply for benefits, but not totally disabled and therefore were not approved for benefits. Those who have been issued a termination letter are those who were approved for benefits but were then found not totally disabled. The insurance company generally chooses to terminate benefits at or before the two-year mark from the date of disability.

‍

For those who have been denied, some will be legit mate because the applicant is not in fact disabled. Other applicants are truly disabled but were simply denied by the adjuster because their application was not strong enough to warrant approval. Of course, the insurer would prefer that denied applicants forgo the appeal process and not sue for benefits.

‍

For those who were approved and then cut off sometime afterwards, the insurer is attempting to ensure that the denial is accepted by the insured during the “own occupation” period. This is ideal for the insurer as it may prevent appeals or legal claims. Thus, it allows the adjuster to close the file well before the Change of Definition date occurs.

‍

You cannot change the fact that the insurance company denied your claim. However, you do have complete control over what you do in response to the denial or termination of benefits.

‍

The options available to the applicant will depend on what is permitted by their policy or plan. In most cases, the applicant can advance their claim to an internal appeal mechanism or commence a lawsuit. If a plan is through a non-profit disability benefit trust fund, it is likely that only an internal appeal mechanism will be available to them. For these workers, they have been denied the right to have a neutral court decide whether or not they are entitled to benefits.

‍

WHAT IS THE DIFFERENCE BETWEEN A DENIAL LETTER AND A TERMINATION LETTER?

It is a bad day for any disabled worker when they receive a denial letter or termination letter. The letter is essentially a rejection of financial support in a time of need and it leaves most people very worried about their financial future. After receiving a letter, some disabled people experience severe declines in their mental or physical health because it feels like their expected safety net has been ripped out from beneath their feet.

‍

What the disabled person does after receiving a denial letter or termination letter is critical. First, be sure that you keep a copy of the letter. Photocopy and safely store a copy of the letter before making any marks on the letter. Any competent disability lawyer will want to see a clean copy of the letter to review at an initial meeting.

‍

The denial letter is also important as it offers a window into the insurance company’s decision-making process on your file. The letter should (but does not always) spell out what information was reviewed and what findings were made with respect to the information in your file. The insurer should explain why your application was denied, or why you are no longer entitled to benefits. For new claims, the denial will typically mention that while your injuries cause you to suffer some restriction, you do not meet the test for total disability. For cases where a benefit termination letter is sent, the insurer will often mention that activities (often from surveillance evidence or information from phone calls) are inconsistent with reported restrictions and limitations. The explanation provided in other circumstances will parrot select wording from the medical expert chosen by the disability insurer. Once you have sorted out why you were denied, you can then determine what you can do to attempt to overturn the unfavourable decision.

‍

Warning! There is a lot of misinformation about insurance policies and the rights that come with them. Do not rely on the word of a union representative, co-worker, or supervisor to explain your rights and ideal strategy when facing an insurance benefits claim. This is especially so where there is no right to sue. While they may have the best intentions, they may not have the best advice. Contact an experienced disability lawyer to avoid a major claims mistake.

‍