Unfortunately, disability insurance is not as straight forward as is sometimes thought and is intended only for fairly specific reasons and times away from work.
Since people pay into disability insurance policies for many years, it is often felt that the pay out of that coverage is an entitled right. In reality, insurance does not imply that everyone who contributes will receive a benefit: if that were the case, the cost of insurance coverage would be much higher. Disability insurance is provided to cover absences from work due to unavoidable medical illness or injury.
When a person is unhappy in a job because it is boring or there is a conflict with the employer or other colleagues, it can be depressing and stressful. These are real problems that cause distress and interfere with the enjoyment of life, but in the eyes of the insurance companies, these problems are not cause for disability coverage.
In the case of personal conflicts, the first step should be conflict resolution counselling, although in my experience this seldom happens. If the problem is dissatisfaction with the work itself, the best solution is often to look for another job that will better suit the individual’s personality, skills and interests.
If a person in this situation was to stay home from work for these reasons, he or she would be away from work forever. As long as the work remained the same or the same people were there to have conflicts with, the individual would likely feel the same way about returning to work.
Often, people refuse to leave an unsatisfactory job because they know they can’t find one that will pay as well or they may be only a few years from pension-able retirement. These factors can make the decision a tough one but do not justify a disability pension.
In reality, most people today will change their jobs several times over the course of their life. In our changing economic times, it is important to remain flexible and not become too dependent on a single employer or pension plan. While pensions and job security are great and sometimes very important, it is also important to be satisfied with your occupation. Consider that you spend most of your time at your job.
In other instances, people seek help for treatable conditions but then refuse the recognized best treatment. This is the right of the individual, but does not mean that the insurance company must cover absences from work if available treatment is not accepted.
On the other hand, there are legitimate instances of mental illness that may require absence from work and that can be covered by a disability insurance policy. It is important to understand the coverage you have and to read the policy carefully before purchasing it.
Below are a few tips to help unravel the complicated language of disability insurance.
First of all, it is important to understand what the company’s definition of ‘disability’ really is. Different policies have different ideas on this. There are three common definitions: some refer to a disability as being unable to perform one’s ‘own occupation’ or one’s ‘regular occupation’; others refer to disability as being unable to perform ‘any occupation’; and still other companies refer to ‘total disability’.
With the first type of coverage, if you are unable to do your specific occupation you will get coverage. For example, if you are a surgeon and develop a tremor you will get disability insurance even though you could still perform another occupation. However, if you have an office job and you lose your foot you won’t be covered because you can still do your job.
In the second category, the policy considers you to be disabled only if you are unable to work at any job for which you are qualified by education, training or experience.
Finally, the narrowest definition of all is the ‘total disability’ coverage, which only considers you disabled if you are unable to work at any job whatsoever. Obviously, the quality of coverage varies significantly among the different definitions of disability. It is important that you understand what kind of coverage you are getting.
Being aware of the kind of coverage you have will be useful if you ever need to use your benefits.
In instances of prolonged absence from work, the insurance company will often require an independent medical assessment. The claimant is asked to see a doctor who is hired by the company and has no therapeutic relationship with the patient. This is designed to provide an objective perspective on the injury or illness and the doctor files a report to the company.
In all cases, it is up to the insurance company to decide whether or not to cover a particular disability. Your doctor simply gives a diagnosis, a severity rating and opinions about the cause and prognosis of the problem, but has no say in whether you receive payment or not.
Unfortunately, this issue often comes between patient and doctor when the patient feels entitled to coverage and sees the doctor as the barrier to payment. Remember that your insurance coverage is really not up to your doctor.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.