Even people who are truthful and legitimately disabled are not guaranteed the payment of benefits as there are countless reasons that can be given for denying claims. However, those who find themselves unable to work due to heart disease should still look at their qualifications and consider getting disability benefits despite the challenges.
This article is part of our series on medical conditions and disability benefits and provides general information on how to increase your chances of winning disability benefits for heart disease.
Claiming for Heart Disease is difficult because of the uniqueness of the disability. Unlike other disabilities, the condition is difficult to prove as legitimate. It truly is a silent killer, so workers suffering from it usually look relatively healthy and do not show any physical signs of being “disabled” or unfit to work.
What is Heart Disease?
Heart disease, also known as coronary artery disease (CAD) or ischemic heart disease, is a category of cardiovascular disease that is caused by a build-up of fatty deposits, calcium deposits, inflammatory cells or plaque in the coronary arteries. This creates a block that limits the supply of blood to the heart, which leads to ischemia or cell starvation due to a lack of oxygen. The patient's heart could slow down or stop completely. Symptoms include pain in the chest, shoulder, back, jaw or neck, shortness of breath, nausea and vomiting, fatigue, sweating, and an irregular heartbeat.
In order to claim disability benefits for heart disease, the worker must be able to prove that his or her symptoms are due to myocardial ischemia—a blockage of the coronary artery. Diseases that fall under this category include myocardial infarction, stable angina, unstable angina and silent ischemia.
Myocardial infarction is commonly known as a heart attack. This happens when blood stops flowing to a part of the heart resulting in damage to the heart muscle. The pain feels like a heartburn that lasts for a few minutes.
Stable angina, which is sometimes called <i>effort angina, is triggered by physical activity like running or walking. Emotional stress has also been identified as a precipitant. This manifests as chest discomfort that dissipates when the trigger is removed or ceases.
Unstable angina is also known as crescendo angina. Unlike stable angina, it can happen even when the patient is at rest. It usually occurs following a crescendo pattern with each new incident being more severe than the previous one. This is often an indicator of an impending heart attack.
It is also possible for a patient to suffer from CAD but not exhibit any obvious signs or symptoms. This is aptly called silent ischemia. It can be detected in the same way as the other types of heart disease.
Testing for Heart Disease
Those who are claiming disability benefits for heart disease must subject themselves to an abnormal stress test or abnormal electrocardiographic testing (EET). Physicians rely on this test to find evidence of blockages in the coronary arteries. The test is conducted by increasing the heart rate, whether through drugs or exercise, and the increase in blood flow to the heart is measured. If the blood flow is not sufficient to meet the demand, then parts of the heart muscle start to starve. The next course of action would be an invasive procedure to open the artery such as bypass surgery.
EET should not be mistaken for exercise tolerance tests or ETTs. Claims are often denied due to the results of ETTs, which are not very reliable in conclusively diagnosing CAD. False positives or false negatives can occur due to several factors including medication. Moreover, the results of ETTs can be misleading. Exercises like walking or bicycling done under controlled conditions do not accurately capture the activities done by an employee in a work setting. Cold temperatures, hunger, and stress experienced in the workplace while performing duties would exacerbate the symptoms of heart disease. Thus, a normal ETT does not always indicate a healthy heart.
Claiming Disability Benefits for Heart Disease
There are two sources of disability benefits for Canadian workers suffering from heart disease: the Canada Pension Plan and Long-term Disability Insurance Benefits.
Canada Pension Plan Disability Benefits for Heart Disease
The Canadian government mandates that employers are required to deduct Canada Pension Plan (CPP) contributions from the salary of their employees. The CPP is a retirement pension, but unknown to many employees, there are also other benefits payable under the plan including survivor benefits, post-retirement benefits, and disability benefits. The last type begins when an individual becomes disabled before the retirement age of 60 or 65 years old. Anyone who has "a severe and prolonged disability" and is considered a recent contributor to the CPP can qualify for benefits. The CPP administration defines “recent contributor” as someone who has contributed to the CPP in:
- four of the last six years, or
- three of the last six years if he or she has contributed for at least 25 years.
There are two types of disability benefits under the CPP. One is paid to the disabled worker while the other is paid to that worker’s children. Those who are approved for CPP disability benefits would receive a taxable monthly payment.
There are two approaches to getting approval of a CPP disability benefits claim. About 95% of all people applying for CPP disability uses the <i>bare minimum approach</i> when claiming. It is a highly ineffective method because doing the “bare minimum” almost always results in delays and denials. The ideal approach is to use the <i>Blueprint Strategy</i>. It is best for people who are very serious about their claim and who want to maximize their chances of success.
Long-term Disability Insurance Benefits for Heart Disease
Another common type of disability benefits plan in Canada is insurance-based disability plans. Insurance protects individuals from the risk of accidentally losing the ability to earn income. As such, many workers have group disability insurance policies as part of their employee benefits packages. This means that member employees were insured as part of a group that shares a common sponsor, which is usually an employer, professional organization, union or bank. The sponsor buys the policy from an insurance company for the benefit of the group’s members. The coverage can be short-term or long-term depending on the benefits.
There are also individual disability policies sold to professionals or self-employed business people. These are bought directly from an insurance broker and the coverage continues as long as the monthly premiums are paid.
For long-term disability benefits, the employee can become eligible for monthly income payments during long absences from work. These payments are computed as a percentage of the worker’s salary, a specific monthly amount, or a combination of the two. These amounts are specified in the insurance policy along with the maximum period of time that the benefits will be received.
Anyone who has disability insurance and suffers from heart disease can apply for payment of disability benefits. Just like in claiming CPP disability benefits, there are two approaches. The bare minimum claim, though technically a complete application, has a high chance of getting denied. On the other hand, the <i>winning claim </i>stands out from other claims and is difficult for an insurance company to deny.
Challenges of Applying for Disability Benefits for Heart Disease
1. The abnormal stress test has its limitations in detecting myocardial ischemia.
The abnormal stress test is the universal screening test for plaque in the coronary arteries. However, the blockage must be significant enough in order to be detected by most types of EETs. As such, they are usually unable to detect the early onset of CAD; EETs are most effective during the latter stages of the development of heart disease. The most accurate type of stress test, the nuclear stress test, has a high sensitivity but also exposes the patient to a high level of radiation making it not a recommended option.
2. The impact of heart problems on work performance will be examined.
The approval of a claim is usually not based on the type of heart disease and its level of seriousness. For instance, a worker who has suffered from heart attacks does not necessarily have a better chance of getting approved than someone who has stable angina. What is more important is the negative impact of the disease and its symptoms on the employee's performance of his or her work tasks. The CPP administration and insurance companies look at how heart problems make it impossible for a worker to be optimally productive.
3. The effect of work stress on the severity of symptoms need to be documented.
A disability benefits claim for CAD can be further strengthened by tracing the root cause of the disease to the workplace. Aside from the worker's own testimony, evidence about this link could also be gathered from his or her examining physician's medical documents as well as reports from the immediate supervisor and co-workers. Having a supportive workplace would certainly be advantageous. Also, it is crucial to be able to prove that the best treatment is to avoid any work that might have triggered the symptoms of CAD in the first place.
Moving Forward With a Disability Claim for Heart Disease
Heart disease is a fairly common condition that affects many Canadian workers. Those who suffer from it will find their work adversely affected to the point that claiming disability benefits becomes a necessity. However, the CPP administration and insurance companies do make honest workers jump through hoops before they can even get a chance at getting their application considered.
Doing the bare minimum is not enough—almost everyone does it to no avail. Recognizing the unique nature of heart disease will allow afflicted employees to choose the right approach for their claims. This includes finding a suitable doctor who will properly diagnose one's illness and, when necessary, a lawyer who is well-informed about CAD.
Insurance companies commit a lot of time, money and effort to disprove a claim.
Winning CPP disability benefits does not guarantee approval from insurance companies. Just because an employee was successful with a CPP claim, it does not already prove that he or she is disabled. The CPP administration and the insurance company are two different entities. The latter would dedicate more resources towards finding negative information and evidence against a claim. This could happen even when the same facts and requirements were presented to both institutions. Thus, it is important to create a solid case for disability benefits. The guides linked above provide specific details on how to strengthen a claim, especially for long-term insurance.
Your disability benefits can be terminated without prior notice.
Keep in mind that applying and getting a claim approved is only half the battle. Insurance companies will proceed to find reasons to terminate payments as soon as they get the opportunity. This could take years or just a few weeks. Be wary of any conditions that are stipulated in approvals and be diligent in fulfilling continuing disability reviews. There are insurance companies that become even more ruthless after approving a claim. They might require monthly medical reports or regularly call for updates. Those who have more resources might do undercover surveillance like secretly videotaping the employee or monitoring his or her online activities. Rehabilitation programs and counselling are also sometimes required. Though these are ultimately for the benefit of the insurance companies, employees might as well take advantage of them so they can make the transition for going back to work.
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