COVID-related delays the latest weapon for LTD insurers denying mental health claims

COVID-related delays the latest weapon for LTD insurers denying mental health claims

By Nainesh Kotak

Pandemic-related delays in mental health care are the latest weapon in the arsenal of insurance companies fighting long-term disability (LTD) claims.

Our healthcare system has never been perfect, and waiting lists are a fact of life for many Canadians, regardless of your medical ailment. Mental health services have traditionally suffered from a lack of investment, and it can be difficult to get speedy psychological support unless you’re in an emergency situation.

Significant gap in mental health services

Unfortunately, you can’t expect your LTD insurer to take the realities of the health care system into account when it comes to your claim — in fact, they’re more likely to use delays to their advantage, so that they can terminate your coverage.

I have often seen insurers deny benefits on the basis that the individual has provided “insufficient medical evidence” to support their claim or that they have failed to obtain necessary treatment, despite the fact they’re on the waiting list to see the specialist that can help them.

Many clients are caught in a catch-22 situation: They can’t pay out of pocket for non-OHIP treatments that would keep their LTD benefits going, but the wait times to see a specialist covered by OHIP are six months or longer.

As CBC News recently reported, the COVID-19 pandemic has only exacerbated existing issues in this province’s healthcare system. In the story, the Ontario Medical Association highlighted mental health services as a key gap, calling for additional funding to meet the “tsunami of patients” currently seeking psychological care.

“I think everyone in society who has been gripped by the pandemic understands the value and the importance of a robust healthcare system,” OMA President Adam Kassam told the news outlet. “We can’t have an economic recovery without a healthcare recovery.”

Keep your case manager updated

Meanwhile, a study by the Canadian Institute for Health Information covering the year before the pandemic found that half of Canadians seeking mental health counselling had to wait a month for services, while one in 10 waited at least four months for care. There’s a good chance both figures are considerably longer now, almost two years after COVID-19 announced itself to the world.

Claimants who are on waiting lists and can not afford to seek alternative counselling from a social worker or another non-OHIP covered professional can boost their case against their insurer by updating their case manager on their status and documenting efforts to obtain appropriate care in emails.

If there is a denial in the future, those messages will become part of the evidence and could be to justify a higher award or even in support of a punitive damages claim if the insurer acted in bad faith.

Pandemic delays are just the latest in a series of obstacles faced by people with mental-health related LTD claims.

Ripe for legal challenge

An increasing number of LTD cases involve a psychological element to them, and although society has come a long way in its treatment and understanding of those with mental illnesses, significant stigma remains.

The insurance industry, in particular, seems to lag some way behind when it comes to appreciating the debilitating impact of conditions such as anxiety, depression, post-traumatic stress disorder, and obsessive-compulsive disorder.

As a result, claimants with mental health are more susceptible to denials and terminations, particularly after 24 months of benefits, when the test for continued coverage becomes stricter.

However, many of these adverse decisions by insurers are ripe for legal challenges, and we are proud to advocate strongly on behalf of people suffering from psychological disabilities.


We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies including Manulife, Sunlife, Desjardins, Cigna, Great-West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.

Call your trusted long-term disability lawyers at 1-888-GOKOTAK (Toll Free for all of Canada), or (416) 816-1500 (Local Number for Ontario Residents), (403) 319-0071, (587) 414-1010 (Local Numbers for Alberta Residents). Our consultation is free, and we don’t get paid until you do. We represent disabled people throughout Ontario and Alberta, including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St.Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Keswick, Kingston, Ottawa, Banff, Brooks, Calgary, Edmonton, Fort McMurray, Grande Prairie, Jasper, Lake Louise, Lethbridge, Medicine Hat, Red Deer, Saint Albert and other locations.