Stress can be a common cause of illness, and it is linked with high levels of sickness absence. But in terms of Group Income Protection (GIP) policies, insurers often reject work-related stress claims as work-related stress is not a classified clinical mental health problem.
For a GIP claim to be successful, the underlying conditions need to meet policy requirements, but employers should also explore alternative options.
Stress-related illnesses
There can be a very thin line – and sometimes an overlap – between work-related stress and more structural anxiety or depression. While the former can often be resolved by changes in the workplace, the latter requires medical treatment. Yet the two are often interlinked – pinpointing the direct cause of stress and/or anxiety can prove challenging, as stress can come from external sources and be exacerbated at work. As a result, it may be argued that high levels of stress can lead to the inability to perform a job, potentially justifying an incapacity claim on the GIP policy.
However, insurers typically don’t accept work-related stress claims as stress itself is not classified as an illness and GIP claims require a diagnosed underlying mental health condition. Successful GIP claims will be supported by extensive medical evidence as the policy is rooted in medically supported causes of absence. Most GIP policies are set up with an ‘insured occupation’ definition of incapacity, while some are set up with a narrower ‘gainful occupation’ definition. However, the principle for both is the same – it must be an illness or injury that is preventing the individual from working. Specifically, something that can be demonstrated by the provision of objective medical evidence.
Recommendations
Firstly, when looking to submit a claim, it’s important to review the policy wording to understand what is covered. Most policies do not explicitly state that work-related stress or work-related issues are not covered. In fact, no exclusions are listed. However, a work-related claim is unlikely to be accepted when the primary cause of absence is not an illness or injury, but an issue related to the workplace, such as a problematic line manager or heavy workloads, for example.
To have a claim accepted on a GIP policy, the member must be unable to work because of illness or injury, specifically meeting the insurer’s definition of incapacity. This typically means they are:
Unable, by reason of illness or injury, to perform the material and substantial duties of the insured occupation
Not performing any other occupation
To assess a claim the insurer will require both employer and employee to complete a claim form as well as general practitioner (GP) details and consent to request medical evidence from doctors. If appropriate, the employee may be required to attend a third-party medical assessment.
However, most work-related stress GIP claims can be resolved in the workplace. For example, some neurodivergent individuals may be more susceptible to stress and therefore might not be able to cope with a highly stressful environment. An insurer is likely to argue that in the legal sector, for example, stress is part of the job requirement given the demanding workloads and long hours. Therefore, it is not a medical condition preventing the employee from performing their job; it is down to the employer to find a solution for the employee and resolve any workplace issues. For example, they could be moved to a more suitable position, such as a non-client facing role or, if there is no other option, potentially end the working relationship.
Beyond this, employers should also seek to create a culture of transparency and care in their businesses. By encouraging employees to speak out, employers may prevent employee health issues from spiralling and help where necessary. From an employee benefits perspective, support might be in the form of an employee assistance programme (EAP), a virtual GP or readily accessible mental health support services.
We recommend flagging any stress, anxiety, or mental health absences with the GIP insurer as early as possible – potentially after only 2 weeks absence. If the insurer’s rehabilitation team can intervene early, they can often identify the root cause of the absence and determine the best course of action, for example a medical treatment or some workplace adjustments.
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