Why Did the Insurance Company Reject My Mental Health Claim?

Why Did the Insurance Company Reject My Mental Health Claim?

For Marcia, depression was simply a fact of life. Though she had always struggled with the day-to-day realities, she’d worked tirelessly to find ways to manage it over the years. She finally felt like she had things more or less under control by the time she reached her 30s.

Then she got pregnant – and an event that she hoped would bring her joy upended her life in ways that she never would have expected. Marcia experienced severe prenatal and postpartum depression, and her symptoms persisted a full four years after her child was born.

Managing postpartum depression proved to be far more challenging than Marcia’s prior experiences with mental health. Things reached their breaking point when she was 38. Marcia found that her depression made it nearly impossible to interact with her clients, to the point that she could no longer handle her responsibilities as a personal trainer at Goodlife.

Marcia knew that she needed to step back at work. She filed a long-term disability claim after listening to the advice of a friend. She already knew that her insurance policy covered mental illness claims, and she hoped that the disability benefits would give her time to focus on her struggling health.

It came as an unexpected shock when her claim was rejected due to “a lack of evidence”. Marcia had worked with her therapist for years – she couldn’t understand why her doctor’s signature, along with a clear diagnosis, wasn’t enough to attest to the legitimacy of her claim.

Unfortunately, Marcia’s story is relatively common. What she didn’t know is that mental health-related claims are often denied for a variety of reasons, including lack of evidence. Depression is one of many illnesses categorized as invisible disabilities. Because these conditions cannot be diagnosed with an ‘objective’ measure like an X-ray or an MRI, many insurance providers will seek to dismiss disability claims based on a mental health condition, even if the applicant has a diagnosis and a letter of support from a certified mental health professional. 

Of course, a claim can still be rejected in cases in which the insurance company is willing to accept the supporting evidence. These are some of the other reasons that insurance companies will use to avoid paying a disability claim related to mental health:

1.     Failure to Obtain Appropriate Treatment: These clauses are typically intended for people who refuse to seek treatment or take their prescribed medications. However, they have also been invoked in cases in which the applicant does not have access to the appropriate specialist. For instance, a mental health claim may be rejected if the applicant only has the support of their family doctor and not a psychiatrist. 

2.     Pre-existing Mental Health Issues: If the applicant has a long history of mental health issues, and has managed to deal with those issues in the past, the insurance company may argue that that should still be the case moving forward. As a result, the applicant should still be able to hold a job and perform effectively. 

3.     Disavowal of Workplace Stress: Insurance companies will often claim that harassment and bullying are interoffice issues and that any anxiety or depression related to a toxic work environment does not constitute a true disability.

Thankfully, people with mental health issues don’t need to accept the rationale of their insurance provider. Marcia reached out to Share Lawyers after her claim was denied, and we were able to help her get the benefits that she was entitled to receive. She’s grateful to once again be taking steps to get her depression back under control!

*Please note that all names and identifying details have been changed to protect the confidentiality of all involved. 

Has your long-term disability claim been denied? Contact Share Lawyers and put our experience to work for you. We have recently settled cases against Great-West Life, Desjardins, Manulife, RBC Insurance, Sun Life, and many more. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.