Author’s disability claim denied because he didn’t ‘look sick’
Man’s battle with depression and with health insurer sparks debate about social media snooping and other tactics used to deny claims
MONTREAL— Depression forced Giller Prize-nominated novelist Samuel Archibald to take a leave last fall from his job as a professor at Université du Québec à Montréal.
The refusal of the school’s insurance provider to approve his disability claim last November pushed him deeper into his dark hole.
But it was only in early February as Archibald was facing financial ruin that his doctor informed him that the company, Desjardins, had based its decision to deny his claim on Facebook and Instagram posts that showed him exercising, taking care of his children and gen- erally looking like the happy guy he longed to be.
“They said, ‘You’re active, you’re in shape, you don’t look sick,’ ” said Archibald, whose 2011 book, Arvida, was a finalist for the 2015 Giller Prize after being translated into English. “It was the moment that I became angry.”
Archibald went public last week with his ordeal, one in which his emergence from a mental health fog for a few media appearances and an outgoing social media façade were taken as signs of deception.
With the publication of an opinion piece in Montreal’s La Presse, a reckoning has resulted in Quebec.
Archibald said he has been flooded with messages from people who have taken a medical leave from work only to be challenged by their health insurers.
The Collège des médecins du Québec, which represents the province’s doctors, called on the insurance industry to trust the diagnoses of front-line physicians rather than seeking the expertise of their own roster of doctors paid to review and pick apart clients’ cases. The Quebec wing of the Canadian Union of Public Employees called on the province to create an independent review board to assess disability claims.
“We regularly see cases like that of Samuel Archibald,” Yanick Proulx, a union representative, said in a statement. “The evaluation of mental health files is very complex and this complexity serves too often as a pretext for the insurers to avoid paying on claims.”
Archibald himself now has a growing collection of screenshots sent to him by people who have dropped the insurer in outraged solidarity, what he calls a “semi#metoo moment for the insurance industry.”
Desjardins responded to Archibald’s case by noting that nearly half of its insurance claims are for disability cases and that fewer than 5 per cent of mental health claims are declined.
Archibald also said one of the company’s vice-presidents is now personally handling his file.
While his plight has sparked a public debate, none of it surprises those who regularly go to battle with insurers.
David Brannen, a disability lawyer and founder of the firm Resolute Legal, said depression, anxiety and burnout are the most common causes for medical leaves of absence among what the insurance industry sees as “higher-value claims” such as doctors, lawyers, bankers, professors and business people.
Disability claims by members of this group are the most costly. As a result, they are also the most likely to involve physical and online surveillance to verify or contest their claims, Brannen said.
“Insurers will say to the client that if you’re out and around, you’re not curled up in the corner, then you must be well enough to work, but that’s not true. Treatment providers are encouraging people to get out more, to walk the dog, to socialize, to put yourself out there.”
Social media snooping by claims agents is “fairly common,” said Andrew Monkhouse, founder of Toronto employment law firm Monkhouse Law.
“At the lower-level assessment, there is, in my opinion, a lot of judgment being made,” he said. “Like, ‘Oh, this person’s depressed, but here’s a picture of them at a birthday party where they look happy, so they can’t be depressed.’ ”
The Ottawa-based Canadian Life and Health Insurance Association, an industry advocacy group, said in a statement that although social media surveillance does occur “companies would not use it as the only piece of evidence in determining a claim.”
“It would generally only be considered, if relevant, as one piece with all the other evidence provided or obtained,” the statement said.
In 2016, 12 million Canadians received payouts on a disability claim, the advocacy group’s statement noted, adding that it was not possible to say how many of those were for mental health-related issues.
Monkhouse said there is “a perverse incentive” for companies to deny paying on claims.
“Their job is to assess claims and to deny claims that they think might not be legitimate,” he said. “That being said, sometimes they might not do it on grounds that seem particularly fair.”
That description might fit in the case of Archibald, who has spent much of the past week juggling demands for media interviews after stepping into the spotlight with his own personal struggle.
He recalled his psychologist telling him he will know he is on the road to recovery when he rediscovers his fighting spirit.
“When you no longer feel like fighting, it means you are really down. To have won a round and to have received all this feedback, whether it be thanks or people sharing their horror stories, is galvanizing,” he said.
“The paradox is that for the last two or three days I have felt better than I have in a long time.”
“Insurers will say to the client that if you’re out and around, you’re not curled up in the corner, then you must be well enough to work, but that’s not true.” DAVID BRANNEN DISABILITY LAWYER