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Short- & Long-Term Disability

Can You Receive Long-term Disability Benefits For Depression?

You can receive long or short-term disability benefits for a variety of psychiatric and psychological conditions as long as they result in a disability that prevents the insured from some or all of their work related duties. Anxiety, bipolar disorder, schizophrenia, or depression can all result, if serious enough, in an inability to perform work duties.  In addition the fatigue associated with dealing with these conditions can itself be enough cause to apply for either short term or long term disability. 

What is Depression?

Major depression has been defined as a mental disorder characterized by the occurrence of one or more major depressive episodes and the absence of any history of manic or hypomanic episodes. Many suffer depression without being disabled from work however if the depression begins to interfere with the insured’s ability to work then the benefits may be available.

What are the Symptoms of Depression?

  • Pervasive feelings of sadness and worthlessness (lasting consistently for longer than two weeks);
  • Fatigue and loss of energy;
  • Inability to concentrate or focus;
  • Slowed speech and physical movements;
  • Unusual sleep patterns (insomnia or excessive sleeping);
  • Loss of interest or enjoyment in all activities;
  • Loss of appetite and/or significant change in body weight; and
  • Suicidal thoughts

How Does a Long-term Disability Claim For Depression Arise?

A claim for long-term or short-term disability arises when the extent of the depression is such that it is interfering in the insured’s person’s ability to work or perform their activities of normal living such that they are “disabled” in accordance with the test for disability set out in the policy of insurance. 

All policies for short or long-term disability define what they mean by total or partial disability and the circumstances under which the benefits will be payable.  Each policy is slightly different as to how disability is defined.  A common form of policy states that a long-term disability benefit is payable for the first two years after the onset of disability, and usually a short waiting period, if the insured is no longer able to perform the essential duties of their own occupation.  These policies then go on to state that after the two-year period is up that the insured can only continue to qualify for the benefit if they are now unable to perform the duties of any occupation. 

In the past, it is not uncommon for these policies to also contain a term that the benefit will be payable if the insured can not perform the essential duties of their own occupation and earn some percentage of their previous income.  Again each policy words the definition of disability slightly different and must be interpreted in each case in accordance with the wording of the policy. 

Most policies also include in the definition of disability a requirement that the insured person is receiving active treatment for the disabling condition and even that treatment be within the country.

How to Make a Long-term Disability Claim?

Disability claims are started by contacting the insurer and completing the long-term disability application form.  Usually, the application process requires both an application to be completed by the insured as well as a form to be completed by the insured’s treating physician.  Often there can be a third form to be completed by the insured’s employer setting out their income, position, and duties of the job role. 

After receipt of the forms, an insurance claims representative will be assigned to the file and will examine the application and medical and employers forms to see if it is obvious that the insured person would meet the insurance policies definition of disability.  This requires an examination of what the disabling condition is, how serious it is, how disabling and what evidence exists to support the disabling nature of the illness.  It also requires an investigation into the person’s job duties and whether it is likely that the disability they have would make it impossible for them to complete most or all of their job duties.  

It is not uncommon for insurers to use their own medical experts, specialists, doctors, nurses, to review these applications and help conclude whether to accept a claim or not.   You may be required by the insurer to be examined by their medical experts as is the insurer’s right under the terms of the policy.

What Happens After a Disability Claim is Accepted? 

If an insured’s claim is accepted and continues to the two year anniversary of disability with the insured still claiming they are disabled a new examination will occur at the two year anniversary to see if the insured meets the new, more difficult test at that stage.  As stated above usually at the two year anniversary of disability an insured will only continue to receive  benefits if they are accepted to be completely disabled from any occupation.  Any occupation however is usually interpreted to mean any occupation the person is reasonably qualified for by education and experience.   

If a person has a vast educational and work background making them very employable in a wide range of similar, replacement occupations, then you have to assess whether the disability disables them from all those areas, not just their former job.  If the person has a very limited education and employment background then it will be easier to establish that disability from their form occupation is completely disabling from all since there is nothing else the person is qualified to do. 

Challenges Faced with a Long-term Disability Claim Based on Depression

There are two primary challenges with a long-term disability claim based on psychological illness in general and depression in particular.  First, the disabling symptoms of such an illness are inherently subjective to the insured suffering from the illness.  How do we know how depressed and sad someone is?  An insurer would argue there is no obvious scientifically objective test, we have to rely on the subjective reporting of the person suffering as to what their feeling and how bad it is.  It is, therefore, more difficult to gather credible evidence of these sorts of disabilities in comparison to something obviously physical like the loss of a limb. 

In addition, it can be difficult even for medical practitioners and certainly insureds to properly articulate why their depression or other psychiatric illness is disabling.  Simply diagnosing someone with depression is not enough.  The evidence must show why the depression is disabling.  Many people suffer psychiatric illnesses but through treatment and perhaps modifications to the job duties they are able to work.  So the evidence must show why in this insured’s case they can not.

Tips For Being Successful in a Long-term Disability Benefit Application Based on Depression

Gather the appropriate evidence of the depression, the treatment received, and why it is disabling from the appropriate medical professional.  A report from your chiropractor setting out your depression is unlikely to be good enough.  A report from a psychologist or psychiatrist is best, a family doctor can also be sufficient. 

Follow your treatment.  If you are not following counseling and medication recommendations from your doctor the insurer will take that as evidence that you likely aren’t suffering as much as you claim

Record your day-to-day feelings and symptoms and how they are affecting your daily life. 

If a claim becomes disputed and must be appealed or litigated.  More corroborating evidence from friends, family, and colleagues may be needed.

Do You Qualify For Long-term Disability?

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