Mental Health and Insurance: How to Protect Your Income

Let’s talk about mental health and how it affects your income. I’ve struggled with anxiety and depression almost my entire life and it has affected my personal relationships, marriage, motherhood, my career and, you guessed it, my money too. There are obvious ways money and mental health go hand-in-hand, but there are less obvious consequences to this health-and-wealth tango that lurk outside the purview of the public eye. 

Has a mental health episode affected your ability to work? Have you ever had to file a mental health claim with your insurance provider? Even if you have avoided dealing with a mental-health situation because you didn’t know what to do, you are not alone. 

According to the Center for Addiction and Mental Health (CAMH), Canada’s largest teaching hospital, half of all Canadians will experience a mental health episode by their 40th birthday. Right now, “450 million people currently struggle with mental illness, making it the leading cause of disability worldwide.” I am one of the 6.7 million Canadians that are affected. Let’s talk about mental health in Canada, insurance providers, and how to advocate for yourself when you need help.  

Insurance coverage for mental health resources 

Are you struggling with your mental health right now? Are you worried about your income and financial stability? In Canada, mental illness is a recognized disability.  If your mental health renders you unable to work, you could qualify for benefits through your workplace group health insurance program. Many employers provide a group benefits plan to their employees which often includes short-term disability coverage (STD), long-term disability coverage (LTD), and various paramedical services to help treat mental health issues. Let’s take a look at each:

Short term disability 

Short-term (STD) disability is a type of insurance that pays a percentage of your salary while you are out on leave. Short-term disability coverage may be available to you if you are unable to work because of a mental health issue. Many employers offer this type of insurance coverage in the employee benefits package, but you can also purchase your own disability insurance coverage independent from your group plan. 

The amount of coverage varies among providers and can also depend on the particular package you are enrolled in. Some employers offer a few different types of benefits packages which provide different levels of coverage at different price points. Generally, short term disability will replace 50-80% of your salary for 3-6 months or longer, depending on your package and provider. 

Long-term disability 

Should your mental health prevent you from returning to work by the time your short-term disability claim expires, you could qualify for long-term disability (LTD) coverage. This type of insurance will replace a portion of your income while you are on leave, usually 50% to 70%. However, it does not last indefinitely. 

Long-term disability coverage will eventually expire, leaving you without coverage.  Depending on your plan and provider, your long-term disability benefits could last anywhere from 2 to 10 years, or expire when you turn a certain age outlined in the policy. 

Employment Insurance sickness benefits 

Sometimes, employees are not able to access disability coverage through their employer for a variety of reasons. If that is the case for you, there is another option available through the Government of Canada. Disability benefits are available through the government’s Employment Insurance (EI) program. If your claim is approved, you will receive a monthly benefit payment that covers 55% of your income for up to 15 weeks. This type of insurance benefit is tied to your employment and how much money you make.

In order to qualify for EI sick leave, you must have been employed recently and paid into the program. Most working people automatically pay into the EI program because it is included in the tax deductions that come off each paycheque. You must apply online or through a Service Canada location and provide a form from your doctor that confirms you are unable to work for a medical issue. Then, your employer must submit a Record of Employment (ROE) to confirm you are on sick leave. 

Paramedical services 

Paramedical services are non-physician health care providers. That means they’re not doctors and they typically work outside the public healthcare system. Their services aren’t covered, you’ll have to pay for them out of pocket. If you’re enrolled in a group benefits program at work, you likely have access to health care professionals and services which could include, but are not limited to: 

• Psychological testing
• Psychologist
• Social worker
• Behavioural therapies
• Naturopath 
• Acupuncturist
• Prescription medication 

How insurance companies handle mental health claims 

The number of mental health claims has been increasing over the years and it is predicted to grow even more in the future. In fact, the insurance industry is preparing for the “second pandemic” referring to the increase in short and long term disability claims coming down the pike, thanks to the mental strain of a global health crisis. What should insurance companies do when a mental health claim comes their way? More importantly, what should you expect from your provider after you submit a mental health related claim? 

The first step that an insurance company will take is to determine whether or not your claim is valid and if it’s covered by their policy. If it is, they should provide support for both you and your family members as well as offer advice on how to cope with mental illness. However, fraudulent claims, of any nature, happen. They must perform due diligence, so expect your claim to be treated with an expected degree of suspicion or skepticism. After all, you cannot argue with an x-ray of a broken bone. But mental health cannot be quantified on scans or lab tests. It is incredibly nuanced and presents differently in each individual person. 

Unfortunately, even though the insurance industry as a whole has come a long way in its understanding of mental health and provision of services, not every claims worker is mental health literate. Be prepared to experience some pushback, and even standoffishness. It is not an indictment on your character or credibility. 

Finding the right ally

Your first line of defense is to make sure your doctor is a mental health ally who understands how the insurance industry works. Other than yourself, the very best advocate you can have is your own doctor. In some provinces, they are the access point to psychiatry and other services as well. You can also turn to people in your personal support network and community outreach programs. 

Navigating your mental health claim 

You must prove your mental health condition renders you unable to work. But that’s hard to do since mental health is dynamic, nuanced, and unique to each person.  In order for your provider to take your claim seriously, your doctor needs to submit documentation with a diagnosis that is as specific as possible. If your doctor simply labels your mental health issue as stress or burnout, you can have a much harder time getting your claim approved. Here’s what needs to be covered in your claim documents: 

• The cause of your mental health illness or issue. Is it workplace related, or caused by something else, like a traumatic event, a chronic pain condition, a comorbidity, etc?  
• When the symptoms first started to disrupt your life and when you first sought treatment from your doctor or health care professional.
• Other factors that are contributing to your inability to work such as family dynamic, financial stress, another medical problem, workplace conflict, etc. 
• Are there signs of a pre-existing mental health issue? Document your symptoms, when they started, the severity, etc. 
• An appropriate diagnosis based on the DSM-5 framework, along with a description of specific symptoms to support the diagnosis. 
• What is your capacity to work? Your doctor should clearly state why your symptoms render you unable to work. 
• Your treatment plan. Your insurer needs to see that you are motivated to return to work. Your claim should include a treatment plan such as medications, therapy, recurring regular appointments, etc. 
• Proposed return to work date. Your insurer may want to know when your doctor believes you will be fit to return to work, based on the current treatment plan. This is not set in stone. You and your health care provider will decide together when you are able to return to work based on your unique situation and progress. 

How to advocate for yourself 

Mental health claims are notoriously hard to navigate. The pushback that claimants might receive can be hard to accept. In my own experience, I was treated horrendously by my claim worker, which almost derailed my progress. Luckily, my doctor was a great ally. She is passionate about mental health and wellness, and was the best advocate I could have asked for. 

It is important to remember that your mental health matters and that you are more than just a claim number. If you happen to have a less than stellar agent assigned to your claim, here some ways to protect your mental health from further deterioration: 

• Always remain calm and respectful, no matter what. If you become hostile, rude, or evade communication, it could hurt the credibility of your claim. 
• Ask for communication to be strictly in writing, such as by email. It will allow you time to cool down, respond calmly, and have a written record of communication with your agent, should you need it. 
• Discuss with your doctor if your claim agent should be required to stop communicating with you directly, and instead, communicate only with your doctor. This would be an extreme case but could be an option available to you. 
• Fill out and promptly submit any documentation your insurance provider asks of you. Even if it feels repetitive or redundant. 
• Show up to all your appointments and follow through on your treatment plan. 
• Be honest and forthcoming about your symptoms and medical history. Do not try to hide any mental health issues from your past, no matter how long ago. This could be grounds for your provider to deny your claim.
• If you feel you are unable to advocate for yourself, ask someone close to you to be your advocate. This could be a spouse, family member, or a close friend. Consider bringing this person with you to appointments and helping you with paperwork and your claim documentation. You do not have to go through this process alone. 

Mental health and the economy

The effects of mental health on the greater economy cannot be understated. Decades of research show that when one person suffers, we all suffer. Mental illness is the leading cause of workplace disability claims. Right now, almost half a million people are unable to work each week because of their mental health struggles. The combined healthcare-related expenses and lost productivity cost our economy about $51 billion each year. And while the Canadian economy weakens when our collective mental health does, our mental health crisis is not unique to the Great White North. 

Mental health has been a silent pandemic reverberating around the globe for quite some time already. But it wasn’t until the Covid19 Pandemic took centre stage that the curtain was finally pulled back. Suddenly, billions of people around the world now know what it feels like to live with stress, anxiety, depression, and hopelessness on a daily basis. Mind over matter is easier said than done. In the mental health community, such a vapid trope does more harm than good. Mental illness is real. It’s painful. It’s debilitating. The pandemic has inelegantly demonstrated how our mental health permeates through every aspect of our lives. 

Covid19 has certainly made it harder to access critical mental health resources. But those of us living with persistent mental health issues know all too well the barriers that exist between those who need care and those who deliver it; barriers that existed long before a global existential crisis. The pandemic has certainly taken its toll on each of us. But it has also brought mental health to the forefront of our collective consciousness. Public health restrictions, shutdowns, job losses, school closures, work-from-home mandates, it’s a lot to carry. Half of all Canadians are buckling under the pressure of it all, with 41% of us reporting a significant decline in our mental health since March 2020. Can you relate? I know I can. 

Canada and mental health resources

In Canada, we are blessed with many things. My favourite? A publicly funded healthcare system. But with all the good things I have to say about Canadian healthcare, I have my fair share of grievances too. Canada is great at providing essential healthcare services like hospital stays and doctor’s visits. But it’s not so great at providing the kind of care that prevents a mental health struggle from turning into a full-blown crisis. If you’ve ever had to navigate the system with a new or chronic mental health issue, you know. 

If you suffer a critical mental health emergency that requires a hospital stay, in/out patient program, or medically necessary psychiatric care, Canada’s got your back. They’ll bankroll most, if not all of it. But if you seek care for a problem when the “check engine” light comes on, before the engine seizes, accessing the care you need gets a lot harder, and usually more expensive. I’ve lived out this scenario myself, along with too many others I know. 

Psychiatry is a publicly funded medical service. But if you’re not in crisis mode, the wait to see a psychiatrist in Canada can be up to a year and a half. That’s too long to wait when your mental health is deteriorating. In the meantime, there are incredible resources such as psychologists, counsellors, and social workers to fill the void. But they’re not free, and they’re not covered by public health care. 

Luckily, there are mental health programs, resources, groups, and organizations available to Canadians across the country. Some are free, other’s work with your budget. For more information, visit the Canadian Centre for Mental Health and Support website.

Should you get disability insurance? 

However, do not rely on the government to pay your bills. For that, you need to do some planning: emergency funds are a must but there are other ways to protect yourself. If you were unable to work, how would you pay your expenses? Would it cause you financial hardship? If the answer is yes, you should consider disability insurance. Luckily, most workplace benefits packages include some sort of short and long term disability coverage. However, it may not be enough coverage for your needs. To find out if you are covered, and for how much, speak with your HR department or benefits provider. Personally, I am a huge advocate for disability insurance. I have used it, and it protected my family during a time I was not fit to work and generate income. 

Some people will need to get their own private health insurance, like those who work for small businesses or start-ups, and those who are self employed. You can get disability insurance through most life insurance providers. Often, a disability or critical illness insurance policy can be added as a rider to your life insurance policy; essentially bundling them together in one product with a single premium payment. 

So how can you take care of yourself without breaking the bank or losing your job? When it comes to mental health, the best defense is a good offence. It starts with understanding your rights and knowing what options are available to you before the worst-case scenario plays out. The Government of Canada provides publicly funded benefit programs. But they are limited and may not offer enough support. Still,  many options are available, no matter your situation.  

If you or someone you know is struggling with their mental health and don’t know where to turn, please visit the Canadian Centre for Mental Health and Support website for help and resources.