Disability Claim for Mental Illness: A Case Study

Mental illness can be debilitating, sensitive to talk about, and hard to diagnose. What’s more, when submitting a disability claim for mental illness would you even know what that entails? Here we have outlined a case study of a disability claim for mental illness. Hopefully, you will come away with a better understanding of the disability claims process in Ontario and that we can help.

Disability Claim for Mental Illness: The Facts

The basic facts of the case are as follows. Our client, we’ll call him D.T., was involved in a head-on type motor vehicle accident several years before his psychiatrist obtained a brain spect scan which revealed subtle abnormalities. D.T. had a long-standing issue with depression and poor job performance. The third-party driver was at fault for moving into the plaintiff’s lane of travel and causing a head-on type collision.

And after the accident, his condition slowly and gradually declined even more. His employer provided numerous accommodations to allow him to work in a private setting since he had difficulties associating with co-workers.

Despite receiving medical care for his psychological problems, D.T. was not improving.

Applying for Disability

Approximately 4 years after the car accident, D.T. had applied for Long-Term Disability. He had made several attempts to return to work, each time, going off work again.

His psychological condition was not well understood by his doctors and D.T. was withdrawn and apathetic. He did not socialize with his family or friends. He had difficulties following directions at work. He was unable to complete work assignments.

Long-Term Disability Benefits Declined

D.T. was not working and his LTD benefits were declined.

We immediately applied for Statutory Accident Benefits (“SABS”) from his insurer. Although D.T. had reported the accident to his auto insurer, they never mailed the Application Package to him. He didn’t know his insurer had a statutory obligation to inform him of his right to claim SABS arising out of a motor vehicle accident.

D.T.’s insurer did not assist him in making a claim after the accident. They simply offered to pay him for damaged clothing.

After applying for Dispute Resolution, regarding D.T.’s entitlement to SABS, we were able to settle D.T.’s claim for accident benefits with his insurer.

Seeking Judgement

We also issued a Statement of Claim, or legal action, against the LTD insurer and the at-fault driver

Although the claim against the at-fault driver was beyond the two year limitation period, we used the doctrine of discoverability. D.T. did not discover his injury until he had a brain spect scan. We proceeded through the discovery process and mediation. We obtained a legal opinion regarding D.T.’s serious psychological condition and his inability to work.

CPP Disability Benefits

We assisted D.T. in his application and appeal process for CPP Disability Benefits. Since D.T. was a relatively young man in his 30’s, CPP was hesitant to declare him totally disabled from returning to work on a protracted basis. We continued to provide CPP with updated medical records and reports.

After a lengthy period of time for reconsideration, CPP eventually awarded D.T. CPP Disability Benefits.

With Our Help

We were able to obtain settlements for both D.T.’s claim for LTD and his pain and suffering and loss of income claim against the third party.

Since D.T. was a young man, his settlement was significant in the mid 6- figures to account for his loss of income over decades into the future. D.T. was relieved to have settled his claims. He didn’t realize he could make claims for SABS or sue the other driver.

Although D.T. knew he had a claim for LTD through his employer, he was having difficulty dealing with the insurer himself. They were insisting that he return to work. D.T. was frustrated and after making several attempts to return to work, he couldn’t bring himself to making further attempts.

His LTD had been cut off and he had no income.

In desperation, he reached out for legal help, and fortunately, we were able to provide him with a comfortable settlement and CPP benefits.