Why disability claims for mental illness can be difficult to navigate

One in five Canadians will experience a mental illness at some point in their life and many of those people may seek disability payments to help them cope, but experts say the process is often so complicated and mental illness is so misunderstood by employers that workers run into trouble getting the help they need.

According to the Mental Health Commission of Canada, 70 per cent of disability costs in the workplace are attributed to mental illness, and one-third of short and long-term disability claims are related to mental health problems.

But mental illness disability claims can be difficult to navigate.

Sivan Tumarkin, an insurance and injury lawyer, says many people who get cut off long-term disability(LTD) are forced to go back to work against medical advice. But he warns that "people should be very careful not to go back to work if they are not ready" because they can end up in a worse state.

Mental illness can complicate things, he says, because many employers don't recognize mental diseases in the same way as physical illnesses.

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"Unlike a broken bone, mental illness can't be seen unless there is an organic cause — like physical brain trauma," he said.

In his experience, he says he's seen many LTD denials and claims cut-off prematurely because claimants have failed to provide "sufficient medical documentation." This is especially prevalent in cases involving mental illness, he adds.

Difficulty with disability claims

This is a situation all too familiar for Jane, whose identity CBC Toronto is protecting as she fears for her job.

Jane has been working at the same bank for 26 years and recently suffered a mental breakdown due to the pressure and stress of the job. She said her doctor had to jump through hoops and provide her employer with 32 pages of medical records to reinstate her disability pay.

Unlike a broken bone, mental illness can't be seen...- Sivan Tumarkin, partner at Samfiru Tumarkin LLP

"I'm full of anxiety every single day," she said about going through the disability claim process. "Are they going to stop my pay again; are they going to be happy with what my doctor tells them? It's a terrible position to be in."

This experience is something Tumarkin calls "re-victimization" — when a lack of awareness about mental health and disability results in more trauma for the persons battling mental illness.

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Victoria Muir, a City of Toronto employee, says she experienced this when the city sent a letter saying it did not "agree that [she is] unable to return to work."

The letter came after a visit with the city's third-party doctor, who did not see eye-to-eye with the physician who had been treating her for more than two years.

"I hear again that the city doesn't believe me that I suffer from anxiety and panic and depression," she said about the letter. "I hear that they think I'm lying."

Mental illness education is important

According to the auditor general's most recent report, the city of Toronto spent $44 million on LTD in 2015.

Beverly Romeo-Beehler made recommendations to better manage the city's LTD program back in 2015. At the time she said the program needs to be "integrated with best practices in early intervention, claims assessment and monitoring, as well as accommodating employees to return to work."

A spokesperson for the city says the goal of LTD benefits is to "provide adequate income replacement for employees who are totally disabled" and that the city has separate provisions for short-term disabilities and illnesses.

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Tumarkin says education is important when it comes to dealing with LTD claims involving mental illness and disability. The reason for denial is often due to the lack of "sufficient medical documentation" — something he says is frustrating for psychologists and doctors who are treating patients too.

An important step towards understanding mental illness is education for insurers and workplaces, and the acknowledgement and recognition of mental illnesses as bona fide diseases, Tumarkin said.

He says workplaces are getting better at this, but many still don't include mental diseases on their return-to-work forms, which tend to be solely focused on physical ailments. 

Have you had trouble with a disability claim over a mental illness? Share your story with us.