Life is complicated. Individuals face many challenges in their daily lives and must effectively maintain a work-life balance. There are many approaches employers take to help their employees achieve this, the most common is providing employees with health care benefits, including medical, dental and Short/Long Term Disability Coverage.
Employees are typically comfortable using their “normal” benefits, ie. Dental, vision, drug etc., however when individuals start experiencing traumatic symptoms effecting their abilities in the workplace they begin to feel uncomfortable asserting their rights and eligibility to similar benefits.
One of the more common situations employees find themselves in is associated with symptoms of severe stress, anxiety and depression in the workplace. They often seek treatment from their physicians however fail to follow the medical advice due to a perceived stigma associated with mental illness and in fear of reprimand.
The benefit of having this type of coverage (short term and or long term benefits) is it allows an employee to take time off as needed/prescribed. All employers have a duty to accommodate these requests to the point of undue hardship.
The Point of Undue Hardship is an objective standard; the test is whether the proper operation of business is being excessively impeded and cannot continue. Factors that cannot justify undue hardship include: business inconvenience, employee morale, customer preference and contractual obligations. As such, a mere leave of absence by an employee will not reach this standard, and employers have a duty to allow the employee to follow the medical advice of a Doctor, without threat to their employment, and provide a leave of absence as necessary. It should be noted, that there is also an obligation on the employee to provide sufficient medical documentation to the employer, to demonstrate the time off is medically prescribed.
The leave of absence can be Short Term, or Long Term depending on the length of the absence and the medical evaluations. In these cases, employees should also follow appropriate protocols including:
- Requesting accommodation;
- Disclosing necessary information;
- Cooperating with reasonable requests; and,
- Participating in discussions regarding possible solutions (once ready to do so).
Provided that a leave of absence is required, employees should exercise their rights to these benefits in the same way they would use other necessary coverage. Once the request is made, there are 3 likely outcomes:
- Your Employer approves your leave of absence; your disability provider approves your claim;
- Your Employer approves your leave of absence; your disability provider DENIES your claim;
- Your Employer denies your leave of absence; your disability provider denies your claim;
As previously indicated, employers have a duty to accommodate an employee’s medical condition and cannot simply deny a reasonable request for time off with medical documentation. In this instance, an employer could face serious liability, including, but not limited to, human rights damages due to discriminatory conduct.
If the insurance company denies your request, it is recommended you seek legal advice in a timely manner. Insurance companies owe a duty of care to the employees and must act fairly in the assessment, evaluation and processing of a claim. As per 702535 Ontario Inc. v. Non-Marine Underwriters Members of Lloyd’s London, 2000 CanLII 5684 (ON CA):
The duty of good faith also required an insurer to deal with its insured’s claim fairly. The duty to act fairly applies both to the manner in which the insurer investigates and assesses the claim and to the decision whether or not to pay the claim. In making a decision whether to refuse payment of a claim from its insured, an insurer must assess the merits of the claim in a balanced and reasonable manner. It must not deny coverage or delay payment in order to take advantage of the insured’s economic vulnerability or to gain bargaining leverage in negotiating a settlement. A decision by an insurer to refuse payment should be based on a reasonable interpretation of its obligations under the policy.
Disability benefits assist the insured and establish peace of mind. If these benefits are denied or removed without adequate care it leaves individuals who are in a vulnerable position helpless inflicting additional mental suffering and distress. In these instances, insurance companies face serious liability due to the denial of a benefit rightfully theirs.
If an employee finds themselves suffering from mental anguish in the workplace and unable to take the time off as prescribed, it is important to contact an employment lawyer to discuss your rights and entitlements and ensure you are protected.
If you find yourself in a similar position, contact Monkhouse Law today.
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