Mental illness is covered under long-term disability benefits. If a claim is denied, an Edmonton disability lawyer can assist with the appeal process. Insurance companies and federal programs are required to provide support to individuals experiencing long-term disability due to conditions such as depression, anxiety, bipolar disorder, or post-traumatic stress disorder (PTSD). These benefits help individuals who are unable to earn sufficient income because of their condition.
What is Considered a Long-Term Disability?
Long-term disability (LTD) is a situation where a person cannot work for an extended period due to a serious illness, injury, or medical condition. The person receives financial support or income replacement while unable to perform regular job duties.
A disability claim is intended to offer financial assistance to individuals who can no longer work due to a medical condition. While coverage depends on the specific policy, it includes a broad range of physical and mental health conditions that limit a person’s ability to carry out their job responsibilities.
Chronic Illnesses | Multiple sclerosis, rheumatoid arthritis, and lupus. |
Mental Health Conditions | Depression, anxiety, bipolar disorder, and schizophrenia |
Neurological Conditions | Parkinson’s disease, epilepsy, and traumatic brain injuries |
Cancer | Intensity of treatment and recovery can prevent individuals from working for extended periods |
Cardiovascular Conditions | Heart disease and stroke |
Musculoskeletal Issues | Severe back pain, herniated discs, and osteoarthritis |
When Is a Disability Considered Long-Term?
During the first 24 months, LTD benefits are provided if the individual is completely unable to carry out the duties of their regular job due to a non-work-related disability. This means being unable to perform tasks that make up at least 60% of their usual work responsibilities.
After the initial 24 months, benefits will only continue if the disability prevents the individual from working in any job for which they are reasonably qualified based on their education, training, or experience. This includes occupations that could provide at least 50% of their previous earnings.
Remember that each Edmonton long-term disability policy can differ.
Don’t let a denied claim stop you. Speak with our disability lawyers to appeal and pursue the compensation you deserve.
Mental Illness As Part of Disability Claims
When a mental health condition, such as depression, interferes with daily activities and normal functioning, it may be considered a long-term disability that requires medical support. Individuals in Canada may be eligible to file a long-term disability claim for mental illness, depending on their insurance coverage or participation in a government program.
Long-term disability benefits generally come from two main sources:
- Insurance coverage: through an employer-sponsored group benefits plan or a private insurance provider
- Government programs: including the Canada Pension Plan (CPP disability benefits), Alberta Workers’ Compensation Boards (WCB), and other regional assistance programs (Assured Income for the Severely Handicapped (AISH))
How to Prove a Mental Illness for Disability Insurance
Unlike physical injuries, many mental health conditions, like chronic pain, are not visible or supported by objective tests.
A strong starting point is consulting a family doctor and discussing any mental health concerns. While general practitioners may provide initial support, more complex conditions are referred to specialists such as psychologists, psychiatrists, or counsellors who have the expertise to provide proper treatment and assessment.
Being honest and transparent about symptoms not only supports recovery but also helps build solid medical evidence. These records reflect the progression of the condition and support the validity of the claim. Minimizing symptoms or withholding information can weaken the case.
Here are some records to strengthen your long-term disability payments:
- Medical records from a doctor confirming a diagnosis
- Documentation outlining the treatment plan recommended by a healthcare provider
- Evidence of ongoing care, such as regular appointments and follow-up visits
- Prescriptions for antidepressants or other related medications
- Statements from a doctor, employer, family members, or friends showing how depression affects the ability to work
Can an Insurance Claim for Mental Illness be Denied?
There are situations where the insurance company’s decision may result in a denial of a long-term disability claim. Benefits may also be prematurely stopped if policy terms or specific conditions are not met. While the exact grounds will be outlined in your insurance policy, common reasons for denial include:
- Failing to seek medical attention when symptoms appear
- Lack of sufficient medical evidence showing the individual is affected
- Not following the prescribed medical treatment after LTD benefits are approved
- Inconsistencies in records or statements
- Fraudulent use of mental illness to obtain LTD benefits
If a claim is denied, it’s important to challenge the decision, so you receive the benefit properly and have the opportunity to recover money you may be entitled to.
In case it still gets rejected even after following the required documents, it is time to consult a disability lawyer in Edmonton.
What Can An Experienced Edmonton Disability Lawyer Do?
When a long-term disability claim is denied, the appeals process can be overwhelming. An experienced Edmonton disability lawyer specializing in disability law can help you understand the reasons behind the denial and identify the steps needed to challenge it effectively.
A lawyer can review your case, gather the necessary documentation, and make sure all procedural requirements are met to strengthen your appeal. They can also communicate directly with the insurance company on your behalf.
Many disability lawyers offer a free consultation, so you can discuss your situation, understand your options, and determine the best strategy to pursue your claim without any initial cost.
Even for mental health claims after a car or motorcycle accident, our legal team can help you with your claim, even when insurers argue.
Need a Long-term Disability Lawyer in Edmonton? Call +1 (780) 666-0134
Struggling with a long-term mental health condition that prevents consistent work or daily activities? Sidhu Personal Injury Lawyers Edmonton can help you pursue a claim and secure the benefits you deserve.
If your claim has been denied, even after completing the application process, our injury lawyers can review your case and communicate directly with the insurance company or government agency on your behalf.
Support is available for LTD disputes, from initial applications to appeals. Call or book online to receive a free initial consultation. No upfront fees. Payment is only required if your claim is successful.
Frequently Asked Questions
What is the difference between a long-term and short-term disability?
Short-term disability provides income support for a limited period, usually a few weeks to a few months, after an illness or injury. Long-term disability begins after that period and covers extended absences, lasting several years or until retirement. Short-term disability has a shorter waiting period, while long-term disability requires a longer approval process and more documentation. The main difference is the duration of coverage and the level of medical proof required.
Is there a maximum duration for long-term disability benefits in Alberta?
The length of time you can receive long-term disability benefits in Alberta depends on the terms of your policy. Benefits may end when you reach age 65, no longer meet the definition of disability, or fail to comply with insurer requirements such as medical exams or documentation. They can also stop if the insurer determines that you are capable of working in another occupation or if your policy has a set maximum benefit period.
Do you have to pay taxes on LTD benefits?
LTD benefits may or may not be taxable, depending on who paid the premiums. If the full premium is paid personally, the benefits are generally tax-free. However, if an employer covered all or part of the premium, the benefits are considered taxable income.Â