Winning Disability Benefits for Lupus

By David Brannen
Are you not able to get back to work because of lupus? Is chronic lupus preventing you from living a normal and comfortable lifestyle?

If you have been considering applying for disability benefits for lupus, you are well aware of the obstacles that you will face along the way.

There are specific requirements that insurance companies have for qualifying for these benefits. In addition, you must demonstrate that the severity of your lupus is seriously preventing you from working. The whole application process for qualifying is quite tedious and can be difficult.

Figuring out how to navigate through the various roadblocks and obstacles to get approved only makes life tougher for you. The goal of this article is to offer a summary of the cumbersome process of applying for disability benefits for lupus in Canada. If you follow the guidelines we outline, you will be well on your way to being granted the benefits you need. This article is part of our series looking at medical conditions and disability benefits

Knowing your Lupus symptoms and their severity

Before embarking on the quest for winning disability benefits for lupus, you must know if your symptoms and their severity meet the requirements for qualification. The most important symptoms are pain and fatigue. To qualify for benefits, you must have disabling pain that is preventing you from working.

Likewise, chronic fatigue also presents a strong case for qualifying for benefits. Ultimately, you have to ask yourself if the problems you are facing are disabling you from performing your duties at work. Once you come to this conclusion, you should look at the options for disability benefits available to Canadian residents. Identifying the best option for you will give you a clearer path to winning your benefits.

Which disability benefits for lupus do I qualify for?

When it comes to claiming long-term disability benefits, you might be eligible for one of two types of disability benefits if you are a worker. These are the Canada Pension Plan (CPP) disability benefits and the long-term disability insurance benefits.

The Canada Pension Plan Disability Benefits for Lupus

The CPP, designed to support you after retirement, also covers disability benefits that start once you become disabled and last until you are 65. After that, these disability benefits are converted into regular pensions. In order to be eligible for the CPP disability benefits, you have to have worked for four out of the past six years and paid payroll taxes. The CPP requires you to prove that your disability is both prolonged and severe, leaving you unable to work.

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Long-term disability benefits for Lupus

Group disability insurance policies are the most common type of disability insurances in Canada. If your employer has insured you as part of a group, you are receiving your disability insurance through your job. These group disability insurance policies provide both long-term and short-term disability benefits. If you are suffering from a chronic form of lupus, you can apply for the long-term disability benefits if eligible. If successful, these will provide you with monthly income payments during long absences from work to take the financial pressure off you.

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Steps you need to take to win disability benefits for lupus

1. Obtaining a specific diagnosis from a qualified physician

The most important part of putting yourself in a position to win disability benefits for lupus is getting a specific diagnosis for it. If you cannot get a doctor to give you a legitimate diagnosis, you will have no case to provide to insurance companies.

The disease is often difficult to diagnose because there isn’t a standalone test that can determine whether you have it or not. To have the best chance of getting properly diagnosed, you should see a Rheumatologist.

These doctors specialize in autoimmune disorders like lupus. They use a list of eleven criteria for lupus to assist them in making the diagnosis. In general, if you have four or more of the criteria, you can be diagnosed with systemic lupus. The different criteria go as follows:

  • Butterfly (malar) rash on the nose and cheeks.
  • Raised red patches on the skin called discoid rashes.
  • Skin rashes that come from sunlight.
  • Ulcers in the mouth or nose.
  • Nonerosive arthritis in multiple different joints.
  • Inflammation of the lining around the lungs or heart called cardiopulmonary involvement.
  • A neurotic disorder, such as seizures.
  • Renal disorder, which is excessive protein in urine.
  • Low white blood cell or platelet count, known as Hematologic disorder.
  • Immunologic disorder which affects antibodies.
  • Antinuclear antibodies.

The criteria are quite specific, but each can be tested for, unlike lupus. After going through the many tests required for each of these symptoms, you can find out if you do have lupus. This will allow you to move forward in the process of winning disability benefits.

2. Show that you have gone through every treatment option available

In order to receive disability benefits for lupus, you must have documented prove that you have done all the possible treatments to alleviate your lupus symptoms. Lupus is a tough illness to treat because the symptoms vary from person to person. Usually, a health professional will create a plan specific to your needs. The general categories of treatment for lupus are prescription drugs, living a healthy lifestyle, and having regular appointments with your doctor to make sure all of your symptoms are being treated correctly.

Prescription drugs have been developed that treat the most symptoms of lupus. There are anti-inflammatory drugs that are used to stop swelling and treat different forms of pain associated with lupus. Antimalarial drugs are another type of drug used to treat a variety of lupus problems.

Since there are no lupus-specific drugs available, you have to rely on your doctor’s ability to identify where your problems are stemming from. Often, lupus patients may not see their symptoms completely subside with drug use. If this is the case, you strengthen your chances of receiving benefits.

While living a healthy lifestyle seems like a weak treatment plan, it is still important if you want to win disability benefits for lupus. If you have a history of substance abuse or obesity problems, you can be rejected benefits. You must show you are keeping your body in the best condition possible to handle the disease.

You must make an effort to keep track of your healthy habits to give to insurance companies. You should maintain a healthy diet with documents on what kinds of food you eat throughout a normal week or have regular meetings with a dietitian. You should also keep a journal of your sleep patterns to show you are keeping a consistent and regular sleep schedule.

Try to keep documentation on everything so you can convince insurance companies you are living a healthy lifestyle. Being able to prove you are a healthy individual is crucial to winning your case.

Lastly, you have to make sure you can show you have been seeing your doctor consistently. This proves that you are serious about fixing your problem. If you have been working with your doctor to attempt every possible treatment option to alleviate your problems with lupus, you will be in a good position to receive disability benefits for lupus. Doctors will also be able to more accurately tell you if you have gone through every possible option you could have to treat your symptoms, which will help with deciding if you should apply for benefits. Doctors are a reliable and trustworthy source for insurance companies. Having plenty of documentation from your doctor gives insurance companies convincing information that can really help your case.

3. Keep track of limitation in your daily life associated with lupus

While actively trying to find treatments and being diagnosed are important steps in this process, it is crucial that you are able to prove your daily life is being heavily affected by the disease. The best indication of an inability to do work related tasks is any difficulties doing activities at home.

You must document the physical limitation you are having at home in great detail. You must also be able to discuss why these difficulties at home directly translate to problems in the workplace. In particular, an inability to maintain concentration, pace, or persistence in activities will help build a stronger case. Be consistent with your documentation and use a ton of detail in the description of how lupus is affecting your activity to give insurance companies the information they need to grant you disability benefits for lupus.

You have done it all, but then your disability claim gets denied. Now, what?

You have gone through the entire rigorous process; you have gathered every piece of relevant evidence that you can, and you’ve completed each and every piece of paperwork you had to, but you still get rejected disability benefits for lupus. After the countless hours you spent filling in every detail you thought you could, you still stand in the same place that you started.

I understand that this experience can be completely demoralizing. It is alway tough for me to see my clients, who seemed to have done everything right, get denied any benefits.

Even the smallest detail that is missing allows the insurance companies to deny you benefits, even if you do have lupus. They need to have clear proof - anything less will result in a denial.

Still Feeling Unsure About Your Disability Claim? Sometimes a quick call with us can answer your concerns and help you move forward with confidence. Call us now at 888-732-0470 for a free consultation or click here to request a free consultation.

Tags: Disabling Medical Conditions

David Brannen
Founder & Managing Lawyer, Resolute Legal
As Resolute Legal's managing lawyer, David spends his days representing people with disability claims and overseeing other disability lawyers within the firm. David is a former occupational therapist and is one of the few lawyers in Canada who focus exclusively on disability-related claims. David is the author of A Beginner's Guide to Disability Insurance Claims in Canada and The Beginner's Guide to CPP Disability.

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