You have not been able to work for months. You cannot concentrate, you are not sleeping, and the thought of your inbox brings on panic. Your doctor agrees you should not be working. The insurer’s letter says there is “insufficient objective medical evidence” of a disability. Mental health long-term disability claims are some of the most frequently denied, and the reasons are usually about evidence and policy wording, not whether you are genuinely unwell.
Why these claims are harder
There is no blood test or scan for depression or anxiety. Insurers often lean on this, treating a lack of “objective” findings as a reason to deny. But a psychiatric diagnosis based on a clinical assessment is objective medical evidence. The question is whether your records show how the condition affects your ability to do your job, and whether the treatment you are receiving is consistent with the severity you describe.
The policy terms that matter
The definition of disability. Most group policies pay if you cannot do the essential duties of your own job for an initial period, often two years. After that, the definition changes to whether you can do any job you are reasonably suited for by education, training and experience. Many claims are cut off at that change.
Mental health limitations. Some policies limit benefits for mental and nervous conditions to a set period, often two years, unless you are hospitalized or meet other conditions. Read your policy for this clause. It is not in every policy, and where there are also physical conditions, it may not apply.
Treatment requirements. Most policies require you to be under appropriate treatment. Insurers often argue that a claimant who is not seeing a psychiatrist or psychologist is not as ill as claimed.
Offsets. Benefits are usually reduced by CPP disability benefits and some other income. Insurers commonly require you to apply for CPP disability.
Evidence that supports a claim
- Regular appointments with your family doctor, with notes that describe your symptoms and how they affect daily functioning, not just the diagnosis
- A referral to and assessment by a psychiatrist or psychologist
- Consistent treatment, including medication and therapy, and a record of adjustments when things did not improve
- A clear description of your job’s demands (concentration, deadlines, client contact, safety) and why your symptoms prevent them
- Statements from family or colleagues about changes they have seen
- Records of any failed return to work
Insurers sometimes use surveillance or social media. A photo at a family event does not prove you can work, but inconsistencies between what you report and what you post will be used against you.
If you are denied or cut off
Most insurers offer an internal appeal. You do not have to use it, and it can delay things. The limitation period to sue is generally two years, and when it starts can be disputed, so do not let an internal appeal run the clock down without advice. Our post on LTD denials covers the options, including suing the insurer.
Insurers owe a duty of good faith in handling disability claims. An unreasonable delay or denial can support a claim for additional damages.
How we can help
At Kabir & Alam, we represent people whose LTD benefits have been denied or terminated, including claims based on depression, anxiety, PTSD and other mental health conditions, and we handle these claims with discretion. Read more about our disability benefits practice or book a consultation with us.
This post is general information about Ontario personal injury law and is not legal advice. Every case turns on its own facts. Speak with a lawyer about your situation before making decisions.