What Types of Disabilities Qualify for Long Term Disability Benefits?

Woman waking up suffering back ache

In an earlier article in this series, I explained that people with mental health conditions could be eligible for disability benefits in their workplace. But what about other conditions? What other types of disabilities are covered by short and/or long-term disability (LTD) benefits?

As I’ve mentioned, the specific policy that you have will dictate the coverage offered. However, there is usually a broad range of disabilities that are covered by most insurance policies. Some include the following:

Fibromyalgia and Chronic Fatigue Syndrome

Fibromyalgia is a common condition which affects 2% of Canadians, primarily women (80 to 90%), as well as men, teenagers and children.

Fibromyalgia affects the central nervous system and manifests through symptoms of pain in one or more parts of one’s body. The severity and location of that pain can vary depending on the day or time – and the person it affects. People suffering with fibromyalgia also often experience other symptoms, such as fatigue, sleep difficulties, lack of concentration and memory, mood swings and gastro-intestinal problems.

Chronic fatigue syndrome (CFS) is a disorder characterized by extreme fatigue or tiredness that doesn’t go away with rest and can’t be explained by an underlying medical condition. Though the causes of CFS are not fully understood, some attribute it to viral infection, psychological stress, or a combination of issues. Anyone can be affected by CFS, but it’s most common among women in their 40s and 50s.

While some people with fibromyalgia and CFS can continue to work, others find that the pain levels and fatigue can make it simply too difficult to continue at their jobs. And that’s when disability benefits can prove extremely valuable, allowing someone to receive a percentage of their income while they recover from disabling medical conditions.

However, getting approved for disability benefits can be a challenge. An insurer typically looks to specific evidence from a CT scan, MRI or X-ray to demonstrate disability. But often you won’t find fibromyalgia or CFS on any of those, as it’s hard to test – or even see – the “invisible” symptoms of either condition. That reality can cause skepticism among insurers – and possible denials.

Alcohol or Drug Addiction

An addiction is generally recognized as an illness in society today. Still, one must look closely at one’s insurance policy to see whether the addiction entitles them to insurance benefits. Generally speaking, a group policy views an addiction to drugs or alcohol as a disabling condition that does indeed fall under its purview. But, only on one condition: that the person demonstrates that they’re compliant with a medical treatment. The type of treatment may vary but often includes actively participating in a drug or alcohol treatment program.

Crohn’s Disease

Crohn’s disease and ulcerative colitis are diseases that inflame the lining of the GI (gastro-intestinal) tract and disrupt your body’s ability to digest food, absorb nutrition, and eliminate waste in a healthy manner.

Signs and symptoms of Crohn’s disease can range from mild to severe and include diarrhea, fatigue, abdominal pain, malnutrition and weight loss. It’s often painful and debilitating, potentially even life-threatening. Understandably, people who suffer from Crohn’s may need to occasionally reduce the amount of hours they work.

But, to be successful with a disability benefits claim, you must prove that your symptoms don’t allow you to function in any workplace. Keep in mind that, due to a lack of understanding, many insurers see Crohn’s disease as a minor condition, which is yet another challenge to overcome. Your responsibility will be to provide detailed medical evidence and documentation to prove that the disease can, in fact, be very debilitating.

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With these and other medical conditions, you must present a strong argument as to why your condition and its symptoms render you unable to work. It’s not always easy to do.

If you’ve been denied short or long-term disability benefits or you would like some advice prior to making a claim, reach out to a lawyer with extensive experience in this area. At Howie, Sacks & Henry, our team of lawyers has handled many disability and critical illness insurance disputes. We can evaluate the appropriateness of the insurance company’s decision and take the necessary action, fighting for the benefits you deserve and fighting for your health and well-being.

For more information, please contact Brad Moscato, Past Chair of the LTD Section, Ontario Trial Lawyers Association, at 416-646-7655 or bmoscato@hshlawyers.com.

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