Statistics show that nearly one-third of people who suffer a severe disability continue to work. If you’re one of those people, you may be thinking, ‘I need help. But does my medical condition qualify for disability benefits in Ontario?'
This is both a common and complicated question. It’s common because 22 per cent of Canadians 15 years and older report having at least one disability (many of which are related to mental health). And it’s complicated because the eligibility qualifications are not clear.
So, what conditions qualify for disability benefits?
Many medical conditions can potentially qualify for disability benefits. However, it comes down to degree of disability and whether the disability meets the requirements of your benefits plan and program. The determining factor is the level of impairment, rather than the name of your diagnosis.
What are the challenges?
Each medical condition comes with its own challenges.
Mental illness, for example, is an invisible ailment that can’t be seen in a diagnostic test. But one in three workplace disability claims in Canada related are related to mental illness! In many cases, an insurance company will reject a physician’s assessment as not being persuasive enough. “Insurance companies do not tell you that they look for any and every way to not pay benefits,” said Samantha Share, Assistant Managing Director at Share Lawyers. “They often will refer to the fact they have had their medical consultant review the claim and base their decision to deny benefits on the document review opinion of that unnamed medical consultant.”
Other common tactics used by the insurance company are denying claims based on a lack of or unclear diagnosis, a lack of treatment for the condition, or the assumption that the symptoms of the condition are not severe enough to stop the claimant from working in their own or any other job.
Just because you have been denied your benefits does not mean that you have go back to work and struggle through your symptoms. Don’t trust the insurance company’s initial reaction.
You can fight back for what you deserve.
Disability insurance policies are not all the same
To qualify for long-term disability benefits, you must establish that your medical condition prevents you from being able to do your job or any job for which you are qualified. However, different insurance companies, such as RBC Life Insurance, Manulife and Sun Life (to name a few) use different (but similar) language in defining what constitutes total disability under their respective long term disability policies, and it is important to review and understand the specific definition of total disability that would apply to your claim. Use this free online tool to determine how an experienced lawyer can help you navigate your claim.
What medical conditions qualify for long-term disability?
Assuming you don’t have an excluded condition, you can qualify for long-term disability benefits if your medical condition prevents you from doing your regular job. Some common injuries and medical conditions are:
- Back injuries
- Brain injuries
- Bipolar Disorder
- Chronic Fatigue Syndrome
- Chronic Pain
- Crohn’s Disease
- Eating Disorders
- Gender Dysphoria
- Head Trauma
- Heart Conditions
- Herniated Disc
- Hip Replacement
- Inflammatory Bowel Disease
- Mental Health Issues
- Multiple Chemical Sensitivity
- Multiple Sclerosis
- Nerve Damage
- Neurological Disorders
- Parkinson’s Disease
- Pelvic Injuries
- Psychiatric Disorders
- Post-Traumatic Stress Disorder (PTSD)
- Severe Migraines
- Sleeping Disorders
- Spinal Cord and Nerve Damage Injuries
- Ulcerative Colitis
- Vertigo and Vision Impairments
- COVID 19 and Long COVID
While some conditions may not appear to be disabilities, they can still adversely affect a person’s life. They may need care, support, and expert legal assistance to ensure their claim is approved.
Have your disability benefits been denied in Orillia? What is your next step?
Claimants with denied disability benefits should use one of the free online tools available to find out if they have a valid disability case and should not wait to call a disability lawyer. The longer they wait, the longer they will be without income. Samantha Share said, “A disability lawyer can get the appeal or lawsuit process started right away. They also can make suggestions as to alternate forms of income that may be available to the claimant during the waiting period.”