Jenny* has been feeling down since her husband was diagnosed with cancer a year ago. She has not fully responded to the antidepressants her doctor gave her. She has no time for counselling. Jenny thinks of herself as a dedicated employee who kept working in spite of her distress. However, she just had a poor performance review and heard stern criticism from her boss. Jenny broke down, left work and is now sitting in her doctor’s office crying.
Jenny tells her doctor how betrayed and unappreciated she feels at work. She has worked for this company for over ten years and was trying hard. Her reward was to be told off by her boss. Her doctor listens and puts her on a leave.
Jenny’s boss has watched her performance steadily get worse over the past year. He feels angry and dissatisfied. He is unhappy with her high number of sick days and the quality of her work. Although she seemed to be a good employee, he is now having doubts. He is disappointed that she is going on stress leave.
The disability carrier received information from the workplace stating Jenny was well until her performance review. The carrier was told that she left work because she was going to be performance managed. The employer thinks she wants to stay home to care for her husband. He questions whether there is anything wrong with her. The doctor wrote a brief note saying Ms. Jones is medically ill and cannot work. The disability carrier wonders which story to believe.
In the case above, a well-intentioned employee went to work in spite of personal problems and paid a price. If you attend work when you are medically or emotionally unwell, your performance is still judged against the performance of others doing similar work. You may hear suggestions that your work is not up to par. Listen to the comments rather than getting angry with the one who makes them.
Talk to your doctor or mental health professional about how you are performing. Keep your appointments with your health care professional.
Depending on the situation, you might tell your boss or supervisor that you are addressing some health problems. Ask them to tell you if your performance slips. Over the years, I have seen employees share the details on their mental health with others at work. I advise against this. While you should not be ashamed of your psychiatric condition, others may not understand. My advice is not to share your medical details. General statements pointing out the obvious will do.
Stress claims can make both disability costs and lost workdays rise. Companies can be overwhelmed as a result.
In Jenny’s case, her boss did not say anything early. When he first noticed problems, he might have gently asked if there were workplace problems. He could have pointed out that if problems outside of work were affecting her, they should be addressed. Continuing problems could affect her performance. However, he should not ask about her medical health or personal life. Doing so is outside of work boundaries. He may not be able to deal with the answers. However, he can mention support programs offered by the company’s human resource or occupational health programs.
The disability carrier is left to decide whether Jenny has a valid medical condition. Avoiding workplace problems or claiming disability to have time to care for her husband are lifestyle choices rather than a disabling illness.
Even if the workplace is the source of distress, the question is whether a medical disability exists. If it does, is it severe enough to cause problems? What are the symptoms? Is there an active treatment plan?
Being off work resting is not considered active treatment for a psychiatric disorder. Receiving counselling or medication is considered appropriate.
As a psychiatrist, for me the term ‘stress’ has little meaning. The physical equivalent to stress could be chest pain. Chest pain can come from many sources – a pulled muscle, anxiety, pneumonia or a heart attack. Stress can also have many triggers.
An accepted psychiatric diagnosis written on a medical form goes a long way towards having a claim accepted. A medical leave for psychological reasons is still a medical leave, and should be referred to as a medical leave request.
To my patients such as Jenny I would say if you are medically unable to work, your employer is entitled to know. However, the information you provide depends on who does the asking. Your boss does not need details. The medical arm of the company, such as an occupational health division, does. This can help with assessing the disability claim or assisting in claim management.
When providing medical information to an insurer, be careful that your forms do not go to your boss. Keep your medical information with the medical people or insurers. If you are unclear about any aspect of the forms, do not be afraid to ask questions of either the medical people or insurers. Hiding medical information when completing a disability claim may make it invalid.
Over the years I have provided advice to patients, employees, employers and disability carriers about disability claims. Making assumptions and miscommunication are the most common reasons for disagreements on claims. The employee, employer and disability carrier may all think their goodwill is being abused. By understanding the concerns and roles of everyone involved, you are more likely to successfully make a claim.