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If you’re on long term disability (LTD) for depression or anxiety, you may be worried about what your insurer can require of you. Can they make you take medication? Can they dictate your treatment plan? These are common questions—and the answers matter because your benefits depend on compliance with policy terms. The short answer is no. You cannot be forced to take medication; however, the insurer could terminate your benefits if you refuse to take medication that has been recommended. Therefore, you need to understand how to dispute their decision and support your right to refuse their preferred course of medical treatment.
In Canada, both private insurance companies and government programs play a role in providing disability benefits, with life and health insurance companies and government programs each having their own requirements and processes for evaluating claims.
Disability benefits can be provided through employer-sponsored group long term disability insurance, private insurance policies, or government programs, and your rights and obligations will differ depending on the applicable program.
Long term disability (LTD) benefits are intended to provide income replacement to individuals who are unable to work due to a serious medical condition, including mental health conditions such as depression and anxiety. To qualify for long term disability benefits, you must demonstrate that your medical condition significantly limits your ability to work or carry out daily activities. Applying for LTD benefits can be a challenging process, involving detailed medical documentation proving strict eligibility criteria.
Consulting a long term disability lawyer can be invaluable, as they can help you understand your rights, gather the necessary evidence, and ensure your claim is as strong as possible. Whether you are just starting the process or facing challenges with your disability claim, having legal advice can make a significant difference in getting your claim approved.
Depression and anxiety are among the most common mental health claims that can disrupt a person’s ability to maintain steady employment. Some of the symptoms involve persistent sadness, impaired social interactions, panic attacks, extreme fatigue, lack of attention to personal hygiene and trouble focusing, all of which can make it difficult to fulfill job duties or manage daily responsibilities. Daily tasks such as grocery shopping and completing other household chores essential to ongoing daily life can become impaired.
In most cases, individuals experiencing these symptoms will need to take time away from work to focus on medical treatment. Treatment may include taking prescribed medication but will often usually involve time-consuming ongoing care including cognitive behavioural therapy, counselling or other interventions recommended by a mental health specialist.
A formal diagnosis and a well-documented treatment plan will provide you with a strong claim, as insurance companies require ongoing medical evidence to support long term disability claims. This includes detailed records from your healthcare providers outlining your functional limitations and the impact of your mental health symptoms on your ability to work.
Working with a long term disability lawyer can help ensure that your application for LTD benefits is thorough and that you have the support needed to navigate the process. By providing strong medical evidence and following your treatment plan, you can improve your chances of receiving the benefits necessary to manage your mental health and focus on recovery.
While insurers cannot force you to adhere to any specific treatment plan, including psychiatric medications, they can require you to meet certain conditions to keep your benefits active. These requirements are outlined in your LTD policy, and will include adherence to a prescribed rehabilitation plan and ongoing treatment for your condition. Failure to follow appropriate treatment or participate in a rehabilitation plan approved by your treatment provider can result in your claim being denied or terminated.
Insurers expect you to be under the care of a qualified healthcare professional and to follow a treatment plan designed to improve your condition. This often includes:
The goal is to demonstrate that you are making reasonable efforts to recover and to comply with your physician’s guidance and advice. Insurers often deny mental health claims by concluding that the claimant is not in ‘active treatment.’ For example, if your family physician has recommended that you obtain counselling and you make no effort to find a counsellor, your disability insurance company will conclude that you are refusing to participate in active treatment.
If your doctor has recommended that you participate in counselling and you have no coverage for that treatment, your insurer may offer to pay for this therapy as part of a rehabilitation program. Participation in this therapy is not optional and is your obligation under the policy. It is reasonable to make sure that your own treatment provider is informed of the proposed therapy and agrees that it is appropriate.
If your doctor recommends medication as part of your treatment, the insurer will expect you to follow that advice. Refusing medication without a specific medical reason can look like noncompliance. Insurers may argue that you are not doing everything reasonable to improve your health, which could jeopardize your benefits. They may also take the position that if you took medication, you would recover, which may not be accurate or reasonable.
Insurers will require ongoing documentation in the form of regular updated from your family physician or mental health specialist. Submitting complete medical information and details of treatment is crucial to support your claim. This includes progress reports, treatment notes, and confirmation that you are actively participating in care.
Your insurer can require you to attend an IME with a specialist they choose. These assessments help insurers verify your diagnosis, functional limitations, and treatment compliance.
Mental illness, including anxiety and depression, is recognized as a valid disability under Canadian law, and the Canadian Human Rights Act protects employees from discrimination based on mental health conditions.
You have the right to refuse medication. However, you need to protect your benefits by ensuring your decision is medically supported. Here’s how:
LTD benefits are designed to support recovery while you cannot work. Insurers view active treatment as evidence that you are working toward improvement. If you refuse treatment without justification, they may argue that you are not meeting your contractual obligations.
While Service Canada evaluates claims for CPP disability benefits in a similar way to insurance companies, they have less ongoing involvement after they approve a claim. Therefore, the most likely time for CPP-D to take a position about treatment is at the initial application stage. CPP disability claims are sometimes denied on the basis that not all treatment options have been exhausted. The decision summary will indicate that the condition may not be “prolonged” because there are options for further treatment.
Navigating the disability benefits system can be overwhelming, so understanding your legal obligations and rights is essential.
Your LTD insurer cannot make you take medication for depression or anxiety. They can, however, insist that you follow a reasonable treatment plan and provide proof of ongoing care. If medication is part of that plan and you choose not to take it, you’ll need persuasive medical documentation and alternative strategies to maintain your benefits.
If your claim is denied, get legal guidance from a lawyer who is knowledgeable about long term disability claims to help strengthen your claim and improve your chances of success. Your long term disability benefits are too important to simply accept a denial.
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