Winning disability benefits for Obsessive Compulsive Disorder (OCD) is no task. Since it is an invisible illness that can’t be proved with one objective test, benefit providers will be extra skeptical of your claim.
In order to get approved, you will need to submit a bulletproof application. And even after you are approved, you will have to continuously demonstrate that your condition is totally disabling and prevents you from working.
At Resolute Legal, we believe educating yourself is the single most important thing you can do to win the benefits you deserve. So, since you are reading this article, we know you are on the right path. Keep reading to learn the steps you need to take to submit and maintain a successful claim for OCD.
This article is part of our series on medical conditions that qualify for disability benefits.
Is OCD a Disability in Canada?
Yes. All disability benefits providers in Canada recognize OCD as a disability. And it is a condition that can qualify for benefits.
However, a diagnosis on its own won’t win you benefits. Benefit providers approve claims for people who can prove their conditions prevent them from working. When reviewing claims for OCD, providers focus on the seriousness of symptoms, not your diagnosis. They also take into account the treatment you had and future treatment plans. In addition, they consider how your symptoms affect your ability to complete the essential duties of your occupation and how hard you tried to stay in the workforce.
So, in order to win benefits, you must have all these factors documented in your medical records and other paperwork associated with your claim.
What is OCD?
OCD is a mental health disorder that can affect people from all walks of life. The disorder is characterized by uncontrollable, recurring thoughts (obsessions) and/or behaviours (compulsions) that a person feels the need to repeat. OCD can affect various aspects of a person’s life, including their ability to work.
It’s important to note that experiencing repetitive thoughts and engaging in habits or rituals doesn’t necessarily mean you have OCD. Most people feel the need to double-check things or will have reoccurring thoughts during high-stress periods of their lives. However, in order to receive a diagnosis of OCD, this cycle of obsessions and compulsion must be extreme to the point where it consumes more than one hour of the day, causes significant distress and impairs your work or social functioning. Many people have symptoms of OCD. However, in order to receive a diagnosis, you must meet the criteria listed above.
What are Obsessions?
Obsessions are recurring thoughts or urges that cause anxiety. A person with OCD often recognizes that these thoughts are unreasonable or excessive. However, the discomfort and distress caused by these obsessions cannot be subsided by logic. Many people with OCD will try to ease their recurring thoughts by engaging in specific behaviours or compulsions.
Common obsessions include the following:
- Irrational fears of germs or bacteria
- Unwanted forbidden thoughts surrounding sex, religion, or harm
- Aggressive thoughts toward others or self
- Needing things to be symmetrical or in perfect order
What are Compulsions
Compulsions are the behaviours a person feels the urge to do in response to an obsession. These behaviours generally reduce or prevent the distress caused by a recurring thought. However, this relief is only experienced temporarily, meaning the person will need to engage in the behaviour in the future to reduce their anxiety. Compulsions are sometimes related to a person’s obsession. For example, if you have a fear of germs, then you may engage in excessive hand-washing. However, in some cases, the compulsions are completely unrelated to the obsession.
Common compulsions include the following:
- Uncontrollable cleaning and/or handwashing
- Arranging things in a particular way
- Repeatedly checking on things. For example, checking to see if the door is locked over and over again or repeatedly checking to see if the oven is off.
- Compulsive counting
These obsessions and compulsions can be debilitating for those suffering from OCD. They can make it impossible to complete your daily routine, let alone the essential duties of your occupation. If you haven’t already, go talk to your doctor if you think you may be experiencing the symptoms of OCD.
Mental Health prevalence in disability claims
According to a 2019 study by Sunlife, mental health is by far the most common long-term disability claim. The study found that 30% of all long-term disability claims are mental health-related. This is more than the next two common causes combined — with cancer at 15% and accidents at 12%.
Even though mental health claims make up a large proportion of disability claims in Canada, it can be hard to prove that your condition has rendered you unable to work. Unlike other illnesses, such as cancer, insurers can’t see the test results that undeniably prove that you have OCD.
We created this guide to help you show your insurance company and other benefit providers that you require disability benefits just as much as a person suffering from a visible illness or injury does.
Let’s dive in!
Employment and Disability Rights for OCD
It’s common for people to worry about losing their jobs because of OCD. As a general rule, employers have the ability to fire anyone as long as they give proper notice and don’t do it for a discriminatory reason.
With that said, most employers won’t fire workers who need sick leaves. Under Canada’s human rights laws, employers have a duty to help employees with medical conditions that affect their ability to work. Allowing sick leave is a reasonable accommodation that employers should give.
In order to go on sick leave, you will need to provide your employer with a doctor’s note. This note should confirm that your condition is preventing you from working, and as a result, you need to take a leave. Keep in mind you will need to bring these notes to your employer often — every three to six months.
If your application for disability benefits gets denied, you can stay on sick leave while you appeal. Most employers won’t question this so long as you have a doctor’s note. However, if your employer does try to terminate you while you are on sick leave, then you may have the right to severance pay. You also might be able to get your termination overturned if it was due to your condition. However, these situations are very complicated you should always seek legal advice before moving forward.
To learn more, go check out our page on disability and employment rights.
Types of Disability Benefits for OCD in Canada
If OCD has overtaken your life and rendered you unable to work, you have a few options in terms of disability benefits. You could be eligible for disability benefits from the government, your employer, or your insurer.
This list covers the possible options for OCD disability benefits in Canada:
- Employment Insurance (EI) sickness benefits
- Short-term disability insurance
- Long-term disability insurance
- CPP disability
- Workers Compensation
- Veterans Affairs Canada
- Provincial disability benefits
- Disability tax credit
Let’s go over each so you can find out if you qualify.
Employment Insurance (EI) sickness benefits
EI sickness benefits are temporary disability benefits. They are paid through the federal government’s employment insurance (EI) program. EI pays 55% of your salary for 15 weeks.
To qualify, you must have paid into the EI program recently. You pay through deductions from your paycheque. These are automatic. So, if you got an official paycheque, you paid into the EI program.
You apply for EI benefits online through Service Canada. You can apply from home or at any Service Canada office. Your doctor needs to fill out a form to confirm that you can’t work for the 15 weeks that EI covers. And finally, your employer will need to issue a Record of Employment (ROE) to confirm your sick leave.
Please note: If you qualify for short-term disability, then you can’t claim EI benefits at the same time.
You can learn more about EI by visiting our article on the EI sickness benefits program.
Short-term disability (STD) benefits for OCD
Short-term disability (STD) benefits are another temporary disability payment. They pay 50-67% of your regular salary. You can usually get them for 15-17 weeks, but sometimes longer. You’ll typically receive payments every two weeks.
Employers offer these benefits either through the company or a group insurance policy. In both cases, employers hire an outside agency to run the program on their behalf.
You only qualify if you have a plan through your job. Not all employers offer this to their employees. If your employer doesn’t, you might be able to get EI sickness.
As I said before, if you qualify for STD, then you won’t qualify for EI. If you can get STD payments, you have to apply for those instead of EI.
You apply by getting the forms from your employer or the insurance company. The application includes three forms. There is one for you, one for your doctor, and one for your employer. It’s up to you to get all the forms back to the insurer.
If your application gets denied, you can ask for a review. This is called an internal appeal. During the appeal, your claim gets reviewed by someone else in the company. You can have three or four of these appeals. After that, you may have to appeal to an outside judge or file with the courts. Your options will depend on your situation.
Long-term disability benefits for OCD
As you may guess, long-term disability (LTD) benefits pay for a longer period of time. If you win a claim for LTD, the payments can last for many years. A policy will specify that the benefits last a number of years — 2, 5, or 10, for example. Or, they last until you reach a certain age — usually 65.
LTD payments often cover 50-67% of your monthly salary. They are paid once a month rather than every two weeks. Like STD benefits, most LTD benefits come from group plans or private policies.
If your company offers a group medical plan, then check it for LTD benefits. If you’re in a union, your medical plan will likely include LTD.
You can also get them through private insurance policies if you’re self-employed or underinsured. With private policies, the payment is usually a fixed amount, but sometimes it’s a percentage of your earnings.
You apply for LTD by filling out forms and sending them to the insurer. Once again, you’ll probably have three forms. There should be one for you, your employer, and your doctor. And again, it’s your job to submit them. You won’t get a decision until the insurer gets all the forms.
You can appeal a denial, just as with an STD claim. Your LTD plan may allow two to three internal appeals. After, you’d need to do an appeal hearing with an outside judge — or a lawsuit.
CPP disability benefits for OCD
CPP benefits cover permanent disability. If you qualify, then you can get paid until age 65. Currently, payments range from $524.64 to $1,457.45 per month. The amount is based on how much you paid into the program. The more you contribute, the more you’ll get back. Just like with EI, if you had a job with a paycheque, then you paid into CPP.
To qualify for CPP disability, you must have the right amount of credits. You can get credits by credit splitting with a former spouse or paying into another country’s pension plan. Or, you can qualify for credits if you leave work to raise a child.
You can get LTD and CPP at the same time. The LTD insurer usually has the right to offset your payments by the same amount, however. For example, if you get $900 from CPP disability, your insurer can reduce its payment by $900 for the same month.
Even with enough credits, you still need to prove that your disability is “severe and prolonged.” A severe disability prevents you from regularly working a paying job. A prolonged disability has little hope for improvement.
You apply for CPP disability by filling out the forms. Your doctor or nurse practitioner will have to fill out the medical report. Then, you send your application to the designated Service Canada office for your province.
If Service Canada denies your claim, you can appeal on two levels. The first is a reconsideration appeal. You must request this appeal within 90 days of denial. If denied again, then you appeal to the Social Security Tribunal. The deadline is 90 days as well.
At the tribunal, a judge or a three-person panel will decide your claim. You can attend the hearing to give evidence and answer questions.
Workers’ compensation benefits for OCD
Workers’ compensation provides both short- and long-term benefits to people injured on the job. Each province has its own program. To qualify, you must have suffered an injury at work. Also, your employer must be covered — not all jobs are. It’s difficult — but possible — to prove a workplace injury caused or worsened your OCD.
Historically, worker’s compensation programs only considered mental health claims that came from a single workplace incident. They wouldn’t recognize situations of chronic workplace stress caused over time.
This is changing, however. In January 2018, WSIB in Ontario implemented a new policy to allow claims for “chronic mental stress” caused by their work. This policy isn’t adopted by all workers’ compensation programs in Canada. Check with the program in your province to see if benefits are available.
To succeed in this claim, you need a doctor to support your belief that the workplace injury triggered the OCD or made it permanently worse. You’ll need to have a diagnosis of OCD or related mental illness. You will need to prove the specific workplace conditions or events that caused or worsened the OCD. Workplace harassment and bullying are two common reasons. The workers’ compensation program will have to independently verify these events from your employer or coworkers.
Workers’ compensation payments overlap with EI, CPP, and short- and long-term disability. This can get complicated, so you should seek legal advice for any concerns about payments. Depending on your province, you may keep some (or all) of your CPP disability as well as the workers’ comp.
If workers’ compensation denies your claim, you must follow the appeal procedures for your province. These programs also have two levels of appeal: the internal reconsideration and the outside tribunal. In most provinces, this tribunal is called the Workers Compensation Appeals Tribunal (WCAT).
Veterans Affairs Canada
If you’re a member or former member of the Canadian Forces, then you may qualify for short- or long-term disability benefits from Veterans Affairs Canada (VAC).
To qualify, you need to prove that a “service-related injury” caused or worsened your OCD. You’ll also need a doctor to confirm it.
You apply for VAC disability through the VAC either online or with a paper form. The VAC will review your service medical records and request more information if necessary.
The VAC follows a familiar pattern for appealing denials: internal reconsideration, then the Veteran’s Review and Appeal Tribunal.
Provincial income support benefits for OCD
Each province in Canada pays income support benefits to people who can’t work because of disability. If you qualify, you can receive fixed payments for life.
You can qualify for provincial benefits even if you’ve never worked. However, they only apply if your total family income falls below a certain amount. That amount differs from province to province. Family income doesn’t affect the approval process for other types of disability benefits.
You apply for provincial disability benefits by applying through your provincial agency or program. As usual, your doctor will need to provide a report or certificate that confirms you can’t work because of your condition.
If you get denied, you can appeal internally within the agency or program. In some provinces, you can also appeal to an outside tribunal for a final decision. Check with your province for the proper procedures.
Disability tax credit for OCD
The disability tax credit is a type of benefit that lowers your taxable income. To qualify, you must have a severe and prolonged impairment as defined by the program. But, this program has a higher standard than others.
Qualifying for this credit can get some of your previous taxes refunded. It depends on the timeline of your condition. You apply by filling out a T2201 form and sending it to Revenue Canada.
If Revenue Canada denies your claim, you can request an internal appeal. If that appeal fails, then you must go to the Tax Court of Canada to appeal again.
How to Prove an OCD Claim in Canada
Because OCD is largely an invisible illness, doctors can’t verify the seriousness of your symptoms. For that reason, you will have to work extra hard to prove your claim.
No one but you can say how serious your condition is. Disability benefits providers may view your claims with skepticism. After all, you could exaggerate or lie to appear more disabled than you are.
Many people with OCD can manage their symptoms and continue working. So, you need to focus on proving that your case is different. Let’s go over how to do that.
Appropriate medical diagnosis
While an official diagnosis alone is not enough, you still need to have one. It must meet the criteria for OCD under the Diagnosis and Statistical Manual for Mental Disorders (DSM).
Your doctor must show a detailed medical history, as well as the steps that were taken to rule out other possible conditions. Unfortunately, some doctors will give an OCD diagnosis without following the right steps. When this happens, the insurance company will dispute the diagnosis or question the treatment.
When considering your claim, disability benefits providers will look to see if you received appropriate treatment. Not getting the medically accepted treatment for your condition is one of the most common reasons for a denial.
Failing to participate in proper treatment can happen in two ways. One, your doctor didn’t follow accepted standards of treatment. Two, you refused to follow the treatment recommended by your doctor. Regardless of the cause, not getting the appropriate treatment will put your claim in jeopardy. Even if you and your doctor believe that alternative methods may work better, you have to try the standard treatments to qualify for disability benefits. Otherwise, you leave the door open for someone to say that you could work if you tried the appropriate treatment.
Documented treatment plan
In order to get approved for disability benefits for OCD, you must have a well-documented treatment plan. Your doctor may have a plan, but if it isn’t documented and communicated to the insurance company, then it’s the same as no plan. Insurance companies will never approve disability benefits for OCD when there isn’t a documented plan that follows best practices.
Sometimes you can’t get the appropriate treatment because you’re waiting for an appointment with a psychiatrist or psychologist. In these situations, you can still be approved for disability benefits if your doctor has a well-documented treatment plan. The plan should include the fact that you’re waiting for a consultation with other specialists. It must also show that you’re doing all other recommended treatments in the meantime.
It is widely known that some of the most effective treatments for OCD are antidepressants and psychotherapy. So, if you want to win disability benefits, you must try all the recommended medications even if you fear the side effects.
If you’re not taking antidepressants or other medications, then the insurance company will think your symptoms aren’t serious enough to qualify for disability benefits. It’s common for doctors to have you try multiple medications and different dosages to find the right treatment. So, if you have a bad reaction to one medication, you can’t refuse the troubleshooting that follows.
If you have bad reactions to your medications, your medical records must report that in detail. And, if your doctor recommends against a medication, you need to have it documented that the side effects were worse than the condition. Again, you run the risk of getting denied if you stray from standard treatments without a good reason.
Evidence of work-related limitations
With an invisible illness like OCD, disability benefit providers place great emphasis on how hard you try to stay at work. The most common reason for a denial of benefits is “You didn’t try.” Unfortunately, this is a very difficult reason to beat.
So, you must go well beyond saying you can’t do your job. You need to show that you asked for help from your employer to stay at work. Such changes could include fewer hours, easier duties, or changing roles within the company. If your job is medium or heavy work, then you have to try an easier job with light or sedentary duties.
You need to give evidence to show how hard you tried to stay at work. This evidence can include
- Medical records discussing your work attempts
- Employment records that show places you tried to work and all accommodations made
- A written statement from you that details your work efforts
- Signed written statements from your employer or co-workers describing how they observed your struggle to work
If you give strong evidence that shows you tried your best to stay at work, then you have a good chance of winning benefits. On the other hand, if you have little evidence of your efforts or evidence that you made no effort, then you have a slim chance of getting approved.
Medical and employment documents will give you some of the best support for your claim, but the decision-makers need to believe you, too. In legal settings, credibility refers to a person’s trustworthiness or believability.
A decision-maker who finds you trustworthy may rule in your favour — even if you have weak evidence for your claim. And a decision-maker who doesn’t trust you won’t give you the benefit of the doubt in uncertain areas, even with good evidence. Being credible gives you an invisible edge that many people overlook.
- Contradicting medical records or earlier statements
- Making excuses or blaming others for problems
- Criticizing other parties in the claim (even if they deserve it)
- Filing complaints against professionals you see as negative, biased, or unprofessional
- Using aggressive, sarcastic, or confrontational tones in your claim or testimony
- Blocking or stalling reasonable requests for information
- Fighting with doctors over your diagnosis instead of focusing on the disability
- Acting like a medical expert
- Making sure what you say matches the medical records
- Taking responsibility for bad facts or problems with your claim; not blaming others
- Being cooperative and respectful of everyone in the claim
- Accepting expert advice and opinions
- Making good faith efforts to try all reasonable advice, even if you disagree with it
- Obvious efforts to keep working
Common Reasons for Denial of Disability Benefits for OCD
The following are the most common reasons an insurance company will deny disability benefits for OCD.
Insufficient objective evidence of disability
Insurers will often cite “insufficient objective evidence of disability” to deny claims. However, this reason doesn’t work with OCD. Modern medicine has yet to find an objective test to prove OCD.
If the insurer used this reason to deny your claim, you should address it in your appeal. Luckily for you, objective evidence is not a requirement for disability benefit programs in Canada. So, your appeal letter should focus on how your doctor followed the best practices for diagnosis and treatment and make it known that you followed all recommended treatments. You should also emphasize all the things you’ve done to keep working. These documents and testimony can make up for the lack of objective evidence.
This is the most common reason for the denial of disability benefits for OCD. Insurers will look for examples of your doctor not following best practices. They will also look for evidence that you refused treatment.
In cases of OCD, insurers will often deny claims if a person refuses to take medication or attend therapy. It can also happen if your doctor doesn’t recommend these treatments.
If you were denied for this reason, start participating in these therapies as soon as possible and make sure you include this evidence in your appeal letter.
Correct treatment, but no documentation
Insurance companies will often deny claims because of a lack of medical documentation. So, even if your doctor follows best practices and you follow their advice — if it isn’t recorded, it’s like it never happened.
It’s common in cases of OCD for the insurance company to ask for your doctor’s clinical records. They do this to see if the doctor is following best practices — adjusting medication and making appropriate recommendations. If the doctor’s medical file doesn’t document what’s happening, then the insurance company will most likely deny your claim.
Toxic work environment
While many people may believe this would be a rare reason for a denial, it is actually extremely common. The reasoning here is that you can’t work because of your work environment, not your disability. And they will say if the issues at work were resolved, you could return to work. Therefore, this is a human resources problem for your employer — not a situation where you would qualify for disability benefits.
Insurers pay disability benefits to people who can’t do the essential duties of their occupation. This goes for any job — not just your current one. Therefore, if the insurer finds that a toxic work situation is the only reason you can’t work, then they can deny your claim. They will say that you can perform the duties of your occupation in general. In this case, the only barrier to employment is the environment.
A denial on the grounds of a toxic work environment can make an appeal extremely complicated. You should speak to a disability lawyer as soon as possible if you were denied for this reason.
Claim Denied? What Next?
A denial can be devastating — we know that. But now it’s time to dust yourself off and fight for the benefits you are entitled to by law. Our lawyers at Resolute Legal are well-versed in these battles and know exactly what needs to be done. They have accumulated years of experience with mental health claims, including those involving OCD. You don’t have to let your insurance company get away with denying you the support you are entitled to by law. Call us at (888) 732-0470 to book your free claim evaluation today.
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