Eating Disorders and Long-Term Disability Benefits in Canada

Eating disorders are complex mental health conditions that can have serious physical and psychological consequences. They affect a person’s relationship with food, body image, and overall well-being. According to the Canadian Mental Health Association, roughly 1-4% of women in Canada are affected by anorexia nervosa, and a similar percentage of women are affected by bulimia nervosa. Another 2% of individuals are affected by binge-eating disorder. Individuals struggling with eating disorders may face significant challenges in their daily lives, including maintaining employment.

For those unable to work due to the disabling effects of eating disorders, long-term disability (LTD) benefits can provide crucial financial support. However, obtaining these benefits is not always straightforward, and many individuals encounter denials or obstacles in the LTD claims process.

Understanding Eating Disorders

Eating disorders encompass a range of conditions characterized by abnormal eating habits, extreme concerns about body weight or shape, and distorted self-perception. Common types of eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorders (OSFED). These disorders can lead to severe physical complications such as malnutrition, electrolyte imbalances, organ damage, and mental health issues like depression, anxiety, and obsessive-compulsive behaviors.

Anorexia Nervosa:

Anorexia nervosa is characterized by an intense fear of gaining weight and a distorted body image, leading to restrictive eating behaviors and significant weight loss. The health consequences of Anorexia include malnutrition, dehydration, cardiac complications, gastrointestinal problems, osteoporosis, impaired cognitive function, depression, and anxiety.

Bulimia Nervosa:

Bulimia nervosa involves episodes of binge eating followed by compensatory behaviors to prevent weight gain, such as self-induced vomiting, excessive exercise, or misuse of laxatives or diuretics. Health Consequences of Bulimia include electrolyte imbalances, dehydration from purging behaviors, dental erosion, esophageal or gastrointestinal complications, cardiac irregularities, menstrual irregularities, and further mental health issues.

Binge-Eating Disorder (BED):

Binge-eating disorder involves recurrent episodes of binge eating without compensatory behaviors, leading to feelings of distress, guilt, or shame. The health consequences of BED include obesity or weight fluctuations leading to health risks such as diabetes, hypertension, cardiovascular disease, psychological distress, depression, anxiety, low self-esteem, gastrointestinal issues, joint problems, and sleep disorders.

Eating Disorders Impact on Employment

The effects of eating disorders on employment can be profound. Symptoms such as obsessive thoughts about food, body image disturbances, compulsive behaviors related to eating or exercise, and physical health complications can interfere with job performance, productivity, and attendance. Individuals may struggle with fatigue, cognitive impairments, mood fluctuations, and social isolation, making it challenging to meet job demands and sustain employment.

Common Reasons for LTD Benefit Denials

Despite the debilitating nature of eating disorders, LTD benefit denials are not uncommon. Common reasons for denials include:

Lack of Objective Medical Evidence:

Insufficient documentation of the severity of eating disorder symptoms, functional impairments, treatment history, and their impact on work capacity can lead to benefit denials.

Discrepancies in Medical Records:

Inconsistencies or gaps in medical records, treatment compliance issues, or lack of specialized evaluations (such as assessments by mental health professionals) can raise concerns for insurers.

Change in Definitions:

Differences between “own occupation” and “any occupation” definitions in LTD policies can lead to benefit terminations if insurers argue that individuals can work in alternative occupations, despite limitations from eating disorders.

Independent Medical Examinations (IMEs):

Insurance companies may request IMEs by their chosen healthcare professionals to assess disability claims. IME reports that contradict treating professionals’ opinions can be used to deny benefits.

What To Do If Your LTD Benefits Have Been Denied

If your LTD benefits for an eating disorder have been denied, taking proactive steps can help protect your rights:

Review Your Policy:

Understand your LTD policy terms, coverage details, appeal procedures, and timelines for appeals.

Gather Strong Documentation:

Compile comprehensive medical records, mental health assessments, treatment history, medication records, functional assessments, and supportive statements from healthcare providers detailing the impact of the eating disorder on your ability to work.

Appeal with Strong Support:

Submit a thorough appeal with robust medical and vocational evidence supporting your disability claim. Address any concerns raised in the denial letter and provide additional context or explanations as needed.

Seek Legal Assistance:

Consider consulting with an LTD disability lawyer experienced in handling eating disorder and mental health-related claims. A lawyer can review your case, provide legal guidance, advocate during the appeals process, and escalate the case if necessary.

Eating disorders can have profound effects on an individual’s physical health, mental well-being, and ability to work. Securing LTD benefits is crucial for financial stability during periods of disability related to eating disorders. Understanding the reasons for benefit denials, gathering strong medical documentation, navigating policy nuances, and seeking legal support when needed are essential steps to address denials effectively and access the benefits individuals deserve in Canada.

Why You Should Contact an LTD Disability Lawyer

Navigating LTD claims for eating disorders can be complex, especially when facing denials or challenges from insurance companies. Disability lawyers at Preszler Injury Lawyers understand the legal complexities, protect individuals’ rights, ensure fair treatment, and can help secure the disability benefits needed for financial stability during challenging times of CRPS-related disability.