Does your back pain prevent you from working? Do you struggle to perform everyday tasks and need to win disability benefits for back problems?
Insurance companies have a vast number of requirements to qualify for disability benefits for back problems. And, the long list of back problems can make diagnosis cloudy.
Back Pain Disability Benefits: The Ultimate Guide is full of insights and answers for people who need to win disability benefits for back pain and related problems. I cover the types of disability benefits available for back pain, the challenges you will face, and how you can overcome them.
- Does back pain qualify as a disability in Canada?
- Employment and disability rights for back pain
- Types of disability benefits for back pain
- How to win disability benefits for back problems
- Common reasons for denial of back pain disability claims
- What if your claim is denied?
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Does back pain qualify as a disability in Canada?
Here’s the good news: All Canadian insurers see back pain as a cause of disability. While most people with back pain recover quickly, it can also be chronic. Often, it interferes with work and daily life.
Following is a list of back problems that can qualify for disability:
- Degenerative disc disease refers to pain that originates from a degenerated disc in the spine. Pain from this type of disorder decreases over time.
- A bulging disc, or a slipped disc, is when an intervertebral disc expands beyond its normal bounds. Pain happens when the disc presses on a nearby nerve root.
- Lumbar radiculopathy is nerve irritation caused by damage to vertebrae discs. Pain increases with hip movements, coughing, and sneezing.
- Sacroiliac joint disease is the inflammation of the firm joint between the spine and the pelvis.
- Sciatica is when the sciatic nerve gets pinched. This disorder can cause back pain, numbness, weakness, and tingling that radiates down the body.
- Fractures of the spine happen when vertebrae break or collapse. If left untreated, this can lead to more severe problems.
- Osteoarthritis of the lower spine is when the cartilage in the joints and discs of the back break down.
- Ankylosing spondylitis is a type of arthritis that affects the spine.
- Spinal stenosis is when the bone channel the spinal nerve goes through gets narrower.
It’s not enough to just have a diagnosis. To win disability benefits for back problems, you have to prove that you can't work because of the pain. Insurers focus on how serious your symptoms are, how they affect your work, what kind of treatment you’ve had, and how hard you tried to stay at work. You must document all of this.
Employment and disability rights for back pain
Many people worry about losing their jobs when they take sick leave. As a general rule, employers can fire anyone as long as they give proper notice. But, they can't let you go for a discriminatory reason.
Most employers won’t fire workers on sick leave. Under Canada’s human rights laws, employers must help employees if their medical condition affects their work. Allowing sick leave is a reasonable accommodation that employers should give.
To take sick leave, you’ll need to give your employer a doctor’s note. The note should confirm that you can't work and need time off. If you need to stay off for a longer time, you’ll need to regularly provide these notes. Usually, you can submit them every three to six months to show that you're still unable to work.
If you apply for disability benefits and get denied, you can stay on sick leave while you appeal. Most employers won’t question this as long as you continue to provide doctor's notes.
If your employer tries to fire you while on sick leave, you may have legal rights to severance pay. You can even have the termination overturned if it was because of your condition. These situations are complicated, however. You should always get legal advice.
Types of disability benefits for back pain
You may qualify for disability benefits for back problems if you become unable to work. You can get benefits from the government, your employer, or an insurance company.
This list covers the options for disability benefits in Canada:
- Employment Insurance (EI) sickness benefits
- Short-term disability insurance
- Long-term disability insurance
- CPP disability
- Workers' compensation
- Veterans Affairs Canada
- Provincial disability benefits
- Disability tax credit
Let’s go over each, so you know whether you qualify, how to apply, and how to appeal if they deny your claim.
Employment Insurance (EI) sickness benefits
EI sickness benefits are a temporary disability benefit paid through the federal government’s employment insurance (EI) program. It pays 55% of your salary for 15 weeks.
To qualify, you must have paid into the EI program recently. You pay through deductions from your paycheque. The deductions are automatic. So, if you got an official paycheque, then you paid into the EI program.
You apply for EI benefits online through Service Canada, from home or at any Service Canada office. You also need to have your doctor fill out a form that confirms your inability to work for 15 weeks. Finally, your employer will need to issue a Record of Employment (ROE) to verify your sick leave.
Note: If you collect short-term disability, you can’t claim EI benefits simultaneously.
Short-term disability (STD) benefits
Short-term disability (STD) benefits are another temporary disability payment. They pay 50-67% of your regular salary. You can usually get them for 15-17 weeks, but sometimes longer. You’ll typically receive payments weekly.
Employers offer these benefits through the company or a group insurance policy. In both cases, employers hire an outside agency to run the program for them.
You only qualify if your employer has one of these plans. Not all jobs offer this option. If your job doesn’t, then you may be eligible for EI sickness benefits.
As mentioned in the last section, if you qualify here, you won’t be eligible for EI. Additionally, if you can get STD payments, you have to apply for those instead of EI.
You apply by getting the forms from your employer or the right insurance company. The application will include three forms. There is one for you, one for your doctor, and one for your employer. It’s your job to get all the forms filled and back to the insurer.
If your application gets denied, you can ask for an appeal. First, someone else in the company reviews your claim. This is called an internal appeal. You may have multiple of these appeals — up to three or four. After, you may have to appeal outside of the company. Your options will depend on your situation. You may have to go to an arbitrator or judge.
Long-term disability benefits
Long-term disability (LTD) benefits pay for longer. So, if you win a claim for LTD, the payments can last for many years. A policy will specify the number of years (2, 5, or 10 years) or a certain age when they stop (usually 65).
LTD payments often cover 50-67% of your monthly salary and pay once a month rather than every two weeks. Similar to STD benefits, most LTD benefits come from group or private plans.
If your company offers a group medical plan, check if it has LTD benefits. If you’re in a union, then your medical plan will likely include LTD.
You can also get long-term disability through private insurance policies if you’re self-employed or underinsured through your company. With private policies, the payment is usually a fixed amount. However, it might also be a percentage of your earnings.
You apply for LTD by filling out forms and sending them to the insurer. Once again, you’ll probably have three forms. There will be one for you, your employer (if applicable), and your doctor. Again, it’s on you to get those forms back in. You won’t get a decision until the insurer gets all the forms.
Just as you can with the STD claim, you can appeal a denial. Your LTD plan may allow two to three internal appeals. If those fail, then you'll have an appeal hearing with an outside arbitrator or a lawsuit.
CPP disability benefits
CPP benefits cover permanent disability. If you qualify, then you can get paid until age 65. Currently, payments range from $600 to $1,300 per month. The amount is based on how much you paid into the program. The more you contributed, the more you’ll get back.
To qualify, you must have the right amount of CPP credits. If you had a job with a paycheque, then you paid into CPP. You can also get credits by credit splitting with a former spouse or paying into another country’s pension plan. Or, you can qualify for credits if you left work to raise a child.
You can get LTD and CPP at the same time, but the LTD insurer usually has the right to offset your payments by the same amount. For example, if you get $900 from CPP disability, your insurer can reduce its payment by $900 for the same month.
Even with enough credits, you still need to prove that your disability is “severe and prolonged.” A severe disability prevents you from regularly working a paying job. A prolonged disability has little hope for improvement.
You apply for CPP disability by filling out the forms. Your doctor or nurse practitioner will have to fill out the medical report. Then, you send your application to the designated Service Canada office for your province.
If Service Canada denies your claim, you can appeal on two levels. The first is a reconsideration appeal. You must request a reconsideration appeal within 90 days of denial. If denied again, then you must appeal to the Social Security Tribunal within 90 days as well.
Once you appeal to the tribunal, a judge or a three-person panel will decide your claim. You can attend the hearing to give evidence and answer questions.
Workers' compensation benefits
Workers' compensation pays short- and long-term benefits to people injured on the job.
Each province has a compensation program. To qualify, you must have been injured at work. Additionally, your job has to be covered. That’s right — not all jobs have access to workers' compensation.
It’s difficult — but possible — to prove that a workplace injury caused or worsened your back pain. Workers' compensation agencies will try to blame back pain on injuries you had outside of work.
To succeed in this claim, you’ll need a doctor to support you. They will need to confirm that the workplace injury caused the back pain or made it worse.
Workers' compensation payments can overlap with EI, CPP, short- and long-term disability. You should seek legal advice for any concerns about payments. Depending on your province, you may keep some (or all) of your CPP disability and the workers' compensation.
If workers' compensation denies your claim, then you follow the appeal procedures for your province. These programs also have two levels of appeal: the internal reconsideration and the outside tribunal. In most provinces, this tribunal is called the Workers' Compensation Appeals Tribunal (WCAT).
Veterans Affairs Canada
If you’re a member or former member of the Canadian Forces, you may qualify for short- or long-term disability benefits from Veterans Affairs Canada (VAC).
To qualify, you need to prove that a “service-related injury” caused or worsened your back pain. You’ll also need a doctor to confirm it.
You apply for VAC disability through the VAC, either online or with a paper form. The VAC will review your service medical records and request more information if necessary.
The VAC follows a familiar pattern for appealing denials. First, there’s an internal reconsideration, then the Veteran’s Review and Appeal Tribunal.
Provincial income support benefits
Each province in Canada pays income support benefits to people who can’t work because of disability. If you qualify, you can receive fixed payments for life.
You can qualify for provincial benefits even if you’ve never worked; however, they only apply if your total family income falls below a certain amount. This amount differs from province to province. Family income doesn’t affect the approval process for other types of disability benefits.
You apply for provincial disability benefits by applying with your local agency or program. As usual, your doctor will need to provide a report or certificate confirming you are unable to work because of your medical condition.
For denials, you can appeal internally within the agency or program. In some provinces, you can also appeal to an outside tribunal for a final decision. Check with your province for the proper procedures.
Disability tax credit
The disability tax credit is a type of benefit that lowers your taxable income. To qualify, you must have a severe and prolonged impairment as defined by the program. However, this program has a higher standard than the others.
Qualifying for this credit can get some of your previous taxes refunded, depending on your condition’s timeline. You apply by filling out a T2201 form and sending it to Revenue Canada.
If Revenue Canada denies your claim, you can request an internal appeal. If that appeal fails, then you must go to the Tax Court of Canada to appeal again.
How to win disability benefits for back problems
1. Diagnostic imaging helps, but credibility is key
The most common reason that long-term disability claims for back problems get denied is “lack of objective evidence of disability.” However, you can seek out diagnostic imaging to prove the disorder. This evidence alone isn’t enough to win disability benefits, but it is valuable for your case. It can help show your pain is legitimate.
Make sure to tell the doctor about your problems and pain in detail. Then, they will choose an imaging technique that fits and analyze the results for a diagnosis.
The most common imaging techniques are X-rays, CT scans, and MRI scans. X-rays can check for instability in the structure of the bones to find issues such as spinal fractures. CT scans are more detailed than x-rays. They can image specific conditions such as spinal stenosis or a bulging disc.
MRI scans are used to assess details of the disc and nerve root. They allow doctors to identify disorders like degenerative disc disease, bulging discs, and spinal stenosis. An important note about MRI results is that there is no accepted link between back pain and what can be seen on an MRI. This is where credibility becomes very important.
One of the best ways to build credibility is to try a variety of treatments for your back pain. You will have a much better chance of getting disability benefits for back problems if you work with professionals who can back up your claims.
A decision-maker who finds you trustworthy may rule in your favour, even if you have weak documentation for your claim. On the other hand, if they don’t trust you, then they won’t give you the benefit of the doubt — even with good evidence. Credibility gives you an edge that many people overlook.
- Contradicting medical records or earlier statements
- Making excuses or blaming others for problems
- Criticizing other parties in the claim (even if they deserve it)
- Filing complaints against professionals you see as negative, biased, or unprofessional
- Using aggressive, sarcastic, or confrontational tones in your claim or testimony
- Blocking or stalling reasonable requests for information
- Fighting with doctors over your diagnosis instead of focusing on the disability
- Acting as a medical expert
- Making sure what you say matches the medical records
- Taking responsibility for bad facts or problems with your claim
- Being cooperative and respectful of everyone in the claim
- Accepting expert advice and opinion
- Not blaming other individuals or groups
- Making good faith efforts to try all reasonable advice, even if you disagree with it
- Obvious efforts to keep working
2. Show that you’ve done all you can to get better
When you apply for disability benefits for back problems, you have to prove that you have done absolutely everything you can to help yourself. There are lots of treatments for chronic back pain. For example, you might try drug treatment, various therapies, surgery, psychological counselling, and physical rehabilitation.
Initially, many people with back pain turn to drug treatment to lessen their discomfort. But, issues can arise from drug use. For example, you might experience major side-effects or be prone to addiction. Or, you might not be able to afford the medication.
There are also a variety of therapies that you can get. Exercise, electrotherapy, and superficial heating and cooling of the skin are just a few. Many of these therapies don't work for patients. But, they're all worth trying before you can get disability benefits for back problems.
If your particular disorder can be fixed with surgery, that's another option. However, surgery can come at a high cost. Lots of people can't afford it. Additionally, there is always a chance for complications. Other health conditions can prevent a safe procedure, as well.
Psychology also plays a role in your back pain. It is crucial to seek out psychological counseling to make sure there isn’t a way you can cope with your problem. Disability benefits are often denied if applicants fail to do this, so attempting this form of therapy is crucial.
Lastly, attempting physical therapy is a must. Physical therapy is known to be very difficult and painful before you get results. So, you must give it your full effort before you apply for disability benefits. If your physical therapist says you didn’t put yourself in a position to succeed, you will likely get denied.
3. Document pain from sustained sitting or standing
Back pain can limit you from sitting or standing for long periods. This is some of the best evidence of disability from work. Many jobs require you to sit behind a desk for an extended time. If your back pain seriously prevents you from doing this type of work, you have a strong argument to be approved for disability benefits.
You must document movements throughout the day to present as evidence. You have to prove that you cannot sit or stand for a long time without experiencing severe pain. The pain must prevent you from performing your job duties. If you're able to sit for more than two hours, your back problem might not be as severe as it seems. However, if you're unable to do that, you have a strong case to get disability benefits for your back problems.
Common reasons for denial of back pain disability claims
1. Insufficient objective evidence of disability
Although insurers often cite “insufficient objective evidence of disability” to deny claims, this reason doesn’t work with back pain. This is because modern medicine has yet to find objective evidence of disability caused by pain.
If you receive this as a reason, address it in your appeal letter. Fortunately, objective evidence is not a requirement under most disability insurance policies and programs.
Your appeal letter should focus on how your doctor followed best practices for diagnosis and treatment. It should mention that you stuck to the recommended treatment. You should also emphasize all the things you’ve tried to stay at work.
2. Incorrect treatment
If you got the right treatment, then you wouldn’t be disabled, right? This reason for denial shifts the blame to you or your doctor. It suggests that your doctor offered the wrong treatment, or you refused the right treatment.
The insurer may argue that your symptoms come from misdiagnosed and untreated depression rather than pain, so your treatment can’t work for you.
Some insurers may say that you haven’t received treatment for multidisciplinary pain and therefore your disability is not permanent. Make sure you have ways to shut down this argument.
3. Insufficient work effort
You can’t do your job, but you could do an easier job, couldn’t you? This reason often arises if your job duties were medium to heavy, and you didn’t try a job with light or sedentary duties.
The best way to fight this is to try easier jobs. Until you do, the disability benefits providers will always doubt you. You might show that while your job had medium duties on paper, your employer made accommodation to qualify your duties as light.
What if your claim is denied?
You have done all the paperwork and have gathered all the evidence you can. But when you receive the decision a few weeks later, you are denied your disability benefits for back pain. This puts you in a very difficult situation.
Getting denied is a tough pill to swallow, and I know that — I have seen it many times before with clients. Suppose you don’t get the right type of evidence for your disability claim. In that case, the insurance companies will deny your disability claim for these technical reasons, even if they know you are disabled.
Are you 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 1-888-732-0470 for a free consultation or click here to book online. All consultations are by phone.