Long term disability (LTD) occurs when you are unable to work due to an injury or an illness. Those who suffer from injury or illness and have previously purchased disability insurance are able to submit an LTD claim through their disability insurer, which gives them a degree of financial security during this difficult time.
There are two main categories of long term disability: physical disability and psychological disability.
Physical Disability Claims
Physical disability occurs when your body is disabled through an injury or illness. You are unable to work because of a physical inability to do so.
Examples of physical disability include partially or totally disabling:
- Spinal cord injuries
- Limb injuries
- Cardiovascular disorders/diseases
- Oncological disorders/diseases
- And many others…
When you are physically disabled, your medical practitioners are usually able to provide diagnostic evidence of the extent of your injury or illness, such as through the use of x-rays, ultrasounds, and blood tests. The insurance company, then, is able to obtain objective proof of what and where your injury is. This information enables them to assess how difficult it is for you to continue with the essential duties of your own employment.
An insurance company will have guidelines for how specific physical injuries should be treated, how long they should take to heal, and which types of jobs they prevent the injured person from doing.
However, the insurance companies’ standards for what constitutes a physical injury are becoming narrower. Unfortunately, psychological disabilities face even larger obstacles.
Psychological Disability Claims
Psychological and psychiatric disability occurs when you struggle with a mental disorder, and you are unable to carry out the essential tasks of your employment and/or any employment.
Examples of psychological disability include:
- Major depression
- Post-traumatic stress disorder (PTSD)
- Mood/anxiety disorder
- And many others…
Unfortunately, psychological disabilities are often “hidden” – which means they are not always immediately apparent. They are also not easily measureable by an objective diagnostic tool, as physical disabilities can be. Due to this, insurance companies are more skeptical about psychological LTD claims.
Unlike physical disabilities, the insurance company cannot apply objective standards to psychological disabilities. Each person will respond differently to a mental illness and take a different amount of time for recovery. It is also much harder to create guidelines for which jobs and tasks a person with a mental illness should or should not be expected to perform.
Another difficulty with psychological disabilities is that they take control away from the insurance companies. With many physical disabilities, the insurance company will hire a third party to provide vocational rehabilitation services. In reality, these healthcare providers are paid by the insurance company to get people back to work. However, a psychologist is not a third party provider chosen by the insurance company. The insurance company, then, has absolutely no control over what that psychologist says about the patient’s condition. This independence gives psychologists an opportunity to give their full professional opinion on what treatment the patient does or does not require in order to be successful on their path to full recovery.
These factors lead to insurance companies being less willing to fund for psychological counselling or support for mental disabilities.
Making matters worse, OHIP provides no coverage for psychological therapy which focuses on emotional, personality, and behavioural issues. Only psychiatrists, who more focus on the medical treatment aspect, are covered by OHIP. If collateral insurance is provided through your workplace, usually there is a maximum of $500 to $1000 of coverage per year. The average psychologist charges $160 to $180 per hour, which means someone suffering from a mental illness can only afford 3 to 4 sessions per year. If your mental illness is debilitating and you cannot work because of it, it is unlikely that you will fully recover after so few sessions of therapy.
Problems with How Insurance Companies Measure Psychological Disability: Global Assessment of Functioning
Insurance companies try to get a less subjective measure of psychological disabilities through a diagnostic tool called the “Global Assessment of Functioning” (GAF).
The GAF scores a person based on an impression of their mental functioning at a particular point in time. It is scored between 0 and 100. The higher your score, the better your mental state is perceived to be. For example, a GAF of 70 is not considered to represent an extremely disabled individual. However, a GAF score under 60 is problematic, and could indicate that the individual is unable to perform the essential tasks of their employment.
In my experience, the GAF has two major problems:
- The GAF only takes a measurement of a person at a one specific point in time. It is nothing more than a snapshot of someone at one moment. Everyone, not just those with psychological disabilities, experiences fluctuations in their mental state from day to day or week to week. Therefore, the GAF cannot accurately describe a person’s real mental state based on only one session.
For example, people who are depressed have good days and bad days. If the GAF is performed on a good day, they will score much higher than they should, despite legitimately being in need of aid and therapy.
- Many people instinctively put their best self forward when meeting new people or being evaluated. In doing so, a person who is psychologically disabled can receive a high score on the GAF and be denied LTD funding, despite their extreme disability being readily apparent to their family and doctor – people who they see regularly and are more comfortable around, so they show their true self.
In this scenario, the individual may even return home mentally exhausted after the stress of the GAF and suffer from an exacerbation of their symptoms. However, the GAF is never able to measure this aftermath because, as I mentioned above, it can only capture a single moment.
Due to these issues, the GAF is a controversial method of measuring the subjective reality of mental disability. In only reviewing medical documents or only in a onetime psychological examination, it is difficult for insurance companies to gather the evidence they need in order to decide whether someone with a psychological disorder qualifies for a disability claim or not.
If you or a loved one are suffering from a severe mental disability that prevents a return to work, it is important to find a lawyer experienced in psychological and psychiatric disabilities claims.
Roger R. Foisy is a Personal Injury Lawyer in Ontario with the knowledge and experience necessary to represent psychological long term disability claims. Contact us now for immediate support and a free consultation.
More on Long Term Disability from Roger R. Foisy