Most US workers are impacted by workplace stress. A 2023 article by Zippia Research reported that 83% of US workers suffer from work-related stress. That same article also revealed that 25% of workers say their job is the number one stressor in their lives. Constant stress is a characteristic of a toxic work environment, which may cause employees to experience mental and physical health issues.
Long term disability (LTD) insurance is meant to replace part of your income if you become disabled. It is essential to understand that LTD insurance does not cover job discontent or uncomfortable work environments. Instead, it is explicitly meant to help those who are physically or mentally unable to perform their work tasks due to disability.
A question commonly asked is, “Can you make a long term disability claim to get out of a toxic work environment?” Employees may receive long term disability benefits if a toxic workplace affects their ability to perform their occupation. However, the relationship between these two circumstances is complicated. You should know that it is common for insurers to deny these claims.
Your insurance company will argue that you do not qualify because you suffer from “workplace issues” or a “situational disability.” Understanding how these claims are evaluated and the difference between general and situational disabilities can help you make informed decisions.
How Does a Toxic Work Environment Affect My Long Term Disability Claim?
Harassment, bullying, unreasonable job demands, constant stress, and other negative behaviors and conditions characterize toxic work environments. These environments are decidedly damaging and can lead to mental illness and physical health issues. However, the relationship between a toxic work environment and a disability insurance claim is complex.
If the toxicity at work triggers a health condition that prevents you from working, a disability claim may be successful. Medical conditions like severe depression, anxiety disorders, or other disabling mental health problems may qualify. However, you need clear medical documentation that your condition is severe enough to inhibit your ability to perform your occupation.
Most insurance policies do not cover a toxic work environment or situational disabilities. This is why the insurance company focuses on your employment and work environment. They want to deny your claim, so they claim your condition results from “workplace issues” or a “situational disability.” They suggest that you are not disabled; you have a challenging work environment.
Disability insurers often have rigorous verification processes to ensure that only valid claims are approved. This usually includes medical examinations, regular follow-ups, and documentation from treating physicians. The evidence must indicate that you cannot work due to specific health reasons not limited to particular situations.
Situational vs. General Conditions
A situational condition only occurs in certain situations. A person or place, such as your supervisor or workplace, can trigger it. The condition goes away once you are no longer in that situation.
A generalized condition exists regardless of the situation. A toxic work environment could trigger the condition, but it does not disappear when you leave it. The condition is always present and impacts both your ability to work and your activities of daily living.
Your Regular Occupation vs. Your Job
Occupation is a critical term in long term disability claims. Your job is what you do for your employer, but your occupation is a general description of what you do. Here is the definition of “regular occupation” as defined by a Unum disability insurance policy:
Regular Occupation means the occupation you are routinely performing when your disability begins. Unum will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.
While evaluating your claim, the insurer evaluates whether you can return to your occupation, not your specific job place. If your problems do not prevent you from performing your occupation for another employer, you will not be found disabled.
However, if your problems prevent you from performing your occupation for another employer, you may be found disabled. It does not matter if your workplace is toxic or even if your workplace triggered your disability. You have to prove that you have a medical condition that prevents you from performing your regular occupation.
Does a Bad Work Environment Disqualify Me from Receiving Benefits?
A standard LTD policy will not pay benefits if you do not have a mental or physical health issue. However, having a toxic work environment does not automatically disqualify you from receiving disability benefits.
Insurance carriers are looking for any reason to deny claims. If there is any evidence that your work environment may have contributed to your disability, they will deny your claim. If the long term disability insurer does deny your claim, you should strongly consider seeking legal advice.
The insurer may tell you that you do not qualify for benefits, but that does not mean they are correct. You may have grounds for legal action if your insurance company fails to approve a legitimate claim.
Get Help with Your Denied Claim
In conclusion, long term disability is meant for people who cannot work due to a disability. It is not meant for employees to use as a means of escaping a toxic work environment. If you have a generalized disability and your claim was denied, we can help you obtain the benefits you deserve.
At Ortiz Law Firm, we specialize in wrongfully denied or terminated long term disability claims. Call us at (888) 321-8131 to schedule a free case evaluation with an experienced long term disability lawyer.