SVP at Sun Life Health explains how comorbidities and mental health are reshaping disability benefits
Managing chronic conditions and long-term disability (LTD) claims are becoming a challenge for plan sponsors, according to a recent Sun Life report.
Sun Life’s Designed for Health paper found that while mental disorders, circulatory disorders and cancer are the top three reasons for LTD, employees on disability leave are increasingly struggling with multiple, overlapping health disorders, making their LTD claim more complex.
Marie-Chantal Côté highlighted how nearly half of cancer-related disability claimants also submitted drug claims for cardiovascular disease, and 49 per cent of those with musculoskeletal conditions also filed claims related to mental health.
The numbers reveal what she described as “an extra degree of difficulty” in supporting employees because “there are a lot of things that coexist at the same time,” she said.
Côté stressed that while employers and insurers naturally focus on the primary diagnosis, like cancer, they must also account for underlying chronic conditions when designing benefit plans and offering support.
“Everybody will support you [for cancer],” she said, “but then if you're also suffering from a cardiovascular chronic condition, we need to keep that in mind.”
Comorbidities exist when individuals have multiple chronic conditions and they’re becoming increasingly common among Canadians, especially those on long-term disability (LTD). Sun Life analyzed drug claims from over 1.5 million LTD claimants and found they are twice as likely to submit claims for medications related to a secondary chronic illness, and three times more likely to be treating two or more conditions simultaneously.
Diabetes notably emerged as a frequent underlying issue: LTD claimants are nearly three times more likely to have a diabetes-related drug claim, and overall diabetes claims have risen 30 per cent from 2019 to 2023.
Mental health as a LTD
Côté also flagged the rise in mental health–related claims, particularly adjustment disorders, which saw the most significant growth between 2019 and 2024. She connected this to the aftermath of the pandemic and broader societal stressors but warned that the implications are practical and immediate and emphasized that support strategies must evolve.
“How we support people, both as an insurer and as an employer, will be different based on the reason,” she noted.
In general conversation, terms like depression or anxiety are often used interchangeably to describe low mood or mental strain. But when it comes to LTD, Côté noted the determining factor isn’t the diagnosis itself but rather the employee’s ability to function. She explained that within Sun Life’s framework, major depressive disorder is classified based on clinical criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), which helps define claims more precisely.
“We don’t really distinguish from diagnostic A to B to C,” she said. “It’s more about being unable to be able to perform their duties.”
That means two people with the same condition - like cancer - can have vastly different outcomes when it comes to work. One may remain on the job, while the other may be fully unable to function.
Côté acknowledged that while depressive disorders have long appeared in disability data, the recent surge in adjustment disorder claims stood out. This condition, she explained, relates to difficulty processing or responding to significant life changes or stressors.
“The adjustment disorder specifically is around when there’s a lot of things going on and a lot of changes around you or in your world, is the difficulty to be able to process that and react to that,” she said.
When it comes to mental health, Côté believes the bigger question is why people aren’t getting help sooner.
“There’s still this expectation that when we talk about mental health, it should be manageable. We should be strong,” she said, emphasizing that mindset, combined with the complexity of benefit plans and discomfort around seeking help, often deters people from accessing support early on.
Access to care is another critical factor. Even when services are available, she noted they may not be equitably distributed or well-known. Some communities, especially in rural or remote areas, face additional challenges.
But the most layered obstacle is intersectionality as Côté highlighted it’s already difficult for many employees to navigate mental health care. That difficulty is magnified for those from underrepresented or marginalized groups.
In her view, employers and insurers need to recognize that each employee’s path is shaped not just by health status, but by social, cultural, and economic factors that can either ease or block access to meaningful care.
“We have to remember as well that everyone's journey is not the same. If you overlap intersectionality, like a person who is an LGBTQ+ member, a person who lives in a reserve, a person who is part of an underrepresented group, it’s challenging for everyone to have access.”
A ‘welcome back’ transition
Côté underscored how difficult and vulnerable the return-to-work process can be for employees, especially after a mental health-related leave. The experience often comes with uncertainty, self-stigma, and evolving workplace dynamics.
She believes managers play a crucial role in shaping the return-to-work experience. Equipping them with proper training, tools, and the right language makes a difference, as does fostering a workplace culture that focuses on inclusion over resentment.
“Create a culture of welcoming the person back,” she said. “Not so much of, ‘You left us with all the work,’ but ‘Welcome back. We’re thrilled to have you back.’ The solutions that they provide can have an impact. How they prepare to return to work can have an impact. How they support the employees while they’re at work will also have an impact.”
For Côté, the way an employee is supported during that transition can significantly influence their recovery and reintegration. An effective return-to-work program should offer personalized accommodations tailored to the employee’s specific needs, including flexible support and phased reintegration plans.
Continued access to benefits and mental health resources is also essential, she said, particularly given the risk of recurrence as well as making digital tools widely available to provide low-barrier access to care and make mental health support more accessible.
