No matter how much we love our job, there can come a time when an individual is undergoing a mental disability, such as tremendous stress, burnout, anxiety, and depression, and medical leave is both necessary and recommended by a physician.
Prior to and in the wake of COVID-19, the mental health crisis has severely increased and Canadian workplaces are riddled with suffering employees. So, what do you do if you are in this position? Can you afford a medical leave? What happens to your income and how will you pay the bills? Do not lose hope – there is a practical solution.
Understanding short-term disability (STD)
To begin, listen to your instincts and physician(s)’ recommendation to take a medical leave, if necessary. Most employers offer an STD plan as part of the employment benefits. STD is a period of “total” disability that qualifies a person to be in receipt of disability benefits (income) while on medical leave from work. The duration of STD benefits, if qualified, will depend on the specific STD plan in place. However, if an employer does not offer an STD plan, there is always the option to apply for employment insurance sick benefits for a limited period.
Total disability is defined in most STD plans as unable to perform the substantial duties of your “own” occupation.
Denial of STD – The Problem Maybe Your Employer
It is important to note that most STD benefits plans are self-funded by the employer; this means that the employer pays out the benefits from its pocket while an insurance company is engaged to simply administer and assess the “validity” of the claim for STD benefits. Though, the unfortunate reality is that such insurance companies typically act as the “agent” for the employer when making determinations of the “validity” and “qualification” of the claim. With that said, it is no surprise that many claims for STD benefits are denied from the outset.
While mental disabilities have become harder to prove because of their subjectivity, in Ontario, they are recognized under the law. Although making an STD application, through your work-related benefits, for mental disabilities can be complicated and/or an intimidating process, it is possible to qualify and be in receipt of STD benefits with little hassle.
The number one reason why an STD claim may be denied
When making an STD claim, if it is stated within your application and/or your medical documents that your mental disability is purely a result of work-related issues, your application will likely be denied. Insurance companies tend not to approve disability claims if the sole reason for the disability is a work-related issue. They form this opinion on the basis that if a work-related issue can be fixed within the workplace, then the disability claim becomes redundant. Nevertheless, the work-related issue can exist to exasperate an underlying health condition; it just cannot be the sole reason for the disability.
What improves the chances of being qualified for STD benefits?
Generally, insurance companies will likely approve a claim for STD benefits if the following criteria are met:
- The insured (person making the claim) must be rendered “totally disabled”;
- There must be a recognized medical diagnosis, such as depression and/or anxiety;
- There must be a treatment plan to mitigate the illness, such as prescribed medication and consulting with a specialist (a psychiatrist and/or a psychologist in the case of a mental disability).
If you are experiencing or have any concerns about the issues stated in this article, we invite you to contact Lecker and Associates as soon as possible so that our firm can guide and assist you in your disability matter.