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Submitting a long term disability claim and dealing with your insurance company’s eligibility requirements is a daunting task. It can be particularly challenging when you suffer from a medical condition which is “invisible”. The conditions are often incapable of tangible proof as they are diagnosed by healthcare providers based on an assessment of subjective and fluctuating symptoms.
The treating doctor’s opinion will be based on your medical history and treatment. However, without medical reports showing positive test results and diagnosing a traditional disease or injury, your insurer is likely to deny your claim for disability benefits. These conditions can and should qualify for disability benefits. The key to proving eligibility is to provide clear documentation of impairment and limitations caused by the condition. To be approved, it is then important to explain why you are unable to work.
One of the most common reasons that an insurance company will give when they deny an application for disability benefits is insufficient medical evidence. Insurers determine eligibility on a case by case basis and they do not simply deny all claims which are difficult to prove simply because of the nature of the condition. The first step of the process is to ensure that the application forms provide detailed support of symptoms that interfere with your ability to perform the duties of your employment, with specific examples if possible.
Chronic pain can arise from any number of causes including following surgery, from arthritis or injury or it can be idiopathic (arising from no known cause). Chronic pain impacts millions of Canadians and is experienced differently by everyone. The absence of any test to measure the level of pain a person suffers from can mean that these claims for disability benefits are approached with skepticism and disbelief. Everyday tasks such as getting out of bed or walking up a flight of stairs can be daunting and it is no wonder that such pain can cause disability.
If you suffer from chronic fatigue, you may be eligible for disability benefits. It is important for your medical records to disclose the efforts that your treatment providers have made to determine the cause of your chronic fatigue. If the insurer believes that a person’s fatigue is caused by an untreated mental illness, the insurer may deny the claim based on a lack of appropriate treatment. If the insurer concludes that the insured’s fatigue stems from family circumstances such as caring for small children or an ill spouse, the application for benefits will likely be denied.
Fatigue is difficult to measure and, while your doctor may provide detail and a description of every referral and test you have been subjected to, you should expect that the insurance company may follow up for more medical records. The application process can cause medical professionals to be frustrated that their opinions are not given enough weight and they are being required to provide further medical evidence which may not be available. There are many medical conditions where fatigue is the primary disabling symptom.
Fibromyalgia refers to a chronic, long-term condition which causes fatigue, widespread pain and cognitive issues. People suffering from fibromyalgia often complain of “brain fog” or “fibro fog”. The condition affects millions of people and has debilitating effects. Fibromyalgia is not a degenerative condition but it does not have a cure and can be expected to last undefinitely.
Fibromyalgia is not a mental health condition although it may occur alongside depression and anxiety. In addition stress and emotional trauma can be a trigger for a flare-up of fibromyalgia. Other common triggers include both overexertion and inactivity, lack of sleep, weather changes, infections or even physical injuries.
Treatment for fibromyalgia usually focuses on relieving its symptoms and may include psychological and behavioural therapy, medication, physical exercise and movement such as yoga, pilates or tai chi. It is important to outline the therapy and lifestyle changes that you have attempted or are participating in so that the insurer sees that you are in appropriate treatment. Many fibromyalgia claims are accepted and paid by both the Canada Pension Plan and insurance companies.
Central sensitization syndrome (CSS) refers to a condition where the central nervous system experiences amplification of neural signalling causing pain hypersensitivity. The condition can be seen in various diseases such as Ehlers-Danlos syndrome, fibromyalgia, rheumatoid arthritis and osteoarthritis. Insurance companies will require detailed information of diagnosis and treatment along with any concurrent diagnosis and specialists’ reports. Be prepared for the insurer to make a written request for more detailed information than the answers to questions in the insurer’s forms. It may be necessary to refer to all of your health conditions and provide a detailed description of the cumulative effect of your symptoms and limitations on your ability to work in order to be approved.
Mental illness is a leading cause of disability in Canada and worldwide. Disability insurance policies used to treat mental health claims differently than physical disabilities. For instance, some policies required the disabled individual to be admitted for in-patient treatment to qualify for benefits. Some policies will require treatment or diagnosis by a specialist in order to be approved. The in-patient treatment provision has been eliminated from many disability insurance policies because it is an antiquated and discriminatory practice which holds mental health claims to an unfair standard. It is also unreasonable because the availability of in-patient programs is low and often inappropriate for a particular person’s treatment.
While insurers are less likely to overtly apply a harder test before approving a mental health claim, it is important to provide information about the type of treatment, whether medication has been trialed and whether a referral has been made to a psychiatrist. Given that psychiatrists are unavailable except in the most unstable cases in some regions of the country and the cost of psychological services, your family physician will need to provide information about these issues as part of the application process. .
A traumatic brain injury or TBI occurs when an external force impacts the head and impacts brain function. TBIs can occur as a result of a fall, a motor vehicle accident, an assault or another incident. The symptoms may not appear for days or weeks after the event. Physical symptoms may include dizziness, headache, nausea or vomiting. Sensory symptoms include blurred vision or sensitivity to light or sound. A TBI can also cause memory and concentration problems, sleep disturbance, mood changes and depression or anxiety.
Given the fact that symptoms of a TBI can emerge some time after an incident and because the symptoms are so varied, the insurer may initially deny a claim for disability benefits. Your doctor should provide a detailed medical report supporting cumulative impact of your symptoms in order to qualify for disability income.
Suffering from a disability which depends on the subjective reporting of symptoms can be a challenge in terms of providing medical professionals to treat your specific symptoms and a supportive doctor. When your disability benefit claim is denied , it can feel like another mountain to climb to fight your insurer. While we appreciate that it is difficult to know where to turn, it’s important to get expert advice and help to fight the insurer’s decision. Your benefits are intended to provide you with income when you qualify as disabled under the policy. The tips set out below will help you satisfy the policy criteria and get the financial support you need while you focus on your health.
To prove you are entitled to disability benefits you should gather medical reports to submit along with your application form. Your family doctor is a great resource but it’s important to recognize that they are overworked and they do not receive any income for filling out forms. If you are able to obtain an electronic copy of your file or any reports of specialists, that will be helpful information for you to include along with the application.
Early in the process, it is a good idea to keep a detailed diary of your symptoms. For instance, you will want to note when your symptoms are present and how severe they are. You should record the dates of your observations. If you have had to ask for help for household tasks such as cleaning or yardwork or to look after your children, make a record.
While you are no less disabled than a person with a physical, visible injury, the unfortunate fact is that you should expect to have to provide a lot of support to be approved for benefits. We can help you determine what is missing in your claim so that you can prove you are eligible.
Disability benefits provide crucial replacement income at a time that you are in financial crisis. We can help you by taking over dealing with the insurer so that you can focus on your health and recovery. Our lawyers will provide you with a free consultation to review your file and recommend the next steps in your fight to prove eligibility for benefits.
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