Is your back pain preventing you from working? Are you struggling to perform everyday tasks and need to win disability benefits for back problems? Insurance companies have a huge number of requirements to qualify for disability benefits for back problems. And, the long list of different back disorders tends to 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 or related problems.
I wrote this Guide to give you an overview of how to win disability benefits for back pain. I cover the types of disability benefits available for back pain, the challenges you will face, and how you can overcome those challenges.
- 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?
Yes, all disability benefits providers recognize back pain as a cause of disability in Canada. While most people who experience back pain will recover in a few months, some people develop chronic pain and problems that interfere with work and daily activities.
Following is a list of back disorders that can qualify for disability:
- Degenerative disc disease refers to the symptoms of pain originating from a degenerated disc in the spine. This type of disorder actually has a decreasing amount of pain over time.
- A bulging disc, commonly known as a slipped disc, is when an intervertebral disc expands beyond its normal bounds. Pain from this disorder comes when the affected disc compresses a nearby nerve root.
- Lumbar radiculopathy is nerve irritation caused by damage to vertebrae discs. Pain from this disorder increases with hip movements, coughing and sneezing.
- Sacroiliac joint disease is the inflammation of the sacroiliac joint, the firm joint between the spine and the pelvis. Sciatica is the pinching of the sciatic nerve, the largest nerve in the body. This disorder is characterized by back pain, numbness, weakness, and tingling feelings that radiate down the body.
- Fractures of the spine are when the bones of the vertebrate break or collapse. If left untreated, this problem can lead to severe problems that can affect day-to-day life.
- 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 the narrowing of the bone channel the spinal nerve goes through.
Keep in mind that having one of the above conditions does not automatically qualify you for disability benefits.
Disability benefits providers pay benefits to claimants who can prove their conditions keep them from working. When reviewing claims for back conditions, providers focus on the seriousness of your symptoms, how they affect your work, what kind of medical treatment you’ve had, and how hard you tried to keep working. You have to have all of this documented in medical records or other paperwork with your claim.
Employment and disability rights for back pain
Many people worry about losing their jobs because of back pain. As a general rule, employers can fire anyone as long as they give proper notice and don’t do it for a discriminatory reason.
However, most employers won’t fire employees who need sick leaves. Under Canada’s human rights laws, employers have a duty to help employees with medical conditions that affect their work. Allowing sick leave is a reasonable accommodation that employers should give.
To take a sick leave, you’ll need to give your employer a doctor’s note confirming that you cannot work and need the leave. You’ll need to provide these notes regularly, usually every three to six months, to confirm your continued inability to work.
If you apply for disability and have your claim denied, you can stay on sick leave while you fight the appeal. Most employers won’t question this as long as you continue to provide notes from your doctor.
If your employer attempts to fire you while you’re on sick leave, then you may have legal rights to severance pay or even having the termination overturned, if it was done solely because of your condition. However, these situations are complicated, so you should always get legal advice.
Types of disability benefits for back pain
If you become unable to work because of back pain, you may qualify for disability benefits from the government, your employer, or an insurance company
This list covers the possible options for back pain 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 through deductions from your paycheque. The deductions are automatic, so if you got an official paycheque, you paid into the EI Program.
You apply for EI benefits by filing an online claim with Service Canada, either from home or at any Service Canada office. You also need to have your doctor fill out a form confirming your inability to work for the 15 weeks covered by EI. And finally, your employer will need to issue a Record of Employment (ROE) to confirm your sick leave.
Note: If you qualify for short-term disability, then you can’t claim EI benefits at the same time.
Short-term disability (STD) benefits
Short-term disability (STD) benefits are another temporary disability payment. They pay 50-67% of your regular salary, usually for 15-17 weeks but sometimes longer. You’ll typically receive payments every two weeks.
Employers offer these benefits either through the company or a group insurance policy. In both cases, employers hire an outside agency to run the program on their behalf.
You only qualify if your employer has such a plan. Not all employers offer this option to their employees. If your employer doesn’t, then you may qualify for EI sickness benefits.
As mentioned in the last section, if you qualify here, then you won’t qualify for EI. 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 insurer that runs the program. The application will include three forms, one for you, one for your doctor, and one for your employer. It is your responsibility to get all the forms back to the insurer.
If the company denies your claim, you can ask for a second review from someone else in the company, called an internal appeal. You may even be able to ask for a third or fourth internal appeal. After that, you may have to appeal to an outside arbitrator or file with the courts. Your options will depend on your situation.
Long-term disability benefits
Long-term disability (LTD) benefits, as the name implies, pay out for a longer period of time. If you win a claim for LTD, the payments can last for many years. A policy will specify either a number of years (e.g., 2, 5, or 10 years) or a certain age (usually 65).
LTD payments often cover 50-67% of your monthly salary and pay out once a month, rather than every two weeks. Like STD benefits, most LTD benefits come from group plans or private policies.
If your company offers a group medical plan, then check it for LTD benefits. If you’re in a union, your medical plan will likely include LTD.
You can also get them through private insurance policies, if you’re self-employed or underinsured through your company. With private policies, the payment is usually a fixed amount, but sometimes it’s 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 for you, your employer (if applicable), and your doctor. And 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 and then an appeal hearing with an outside arbitrator or a lawsuit.
For more information check out our Ultimate Guide to Long-Term Disability Benefits.
CPP disability benefits
Like LTD, CPP benefits cover permanent disability. If you qualify, the payments can go to age 65. They currently range from $600 to $1,300 per month, and you can get extra payments if you have children. The size of your payment is based on your contributions to the program. The more you contributed, the more you’ll get back.
To qualify, you must have the right amount of CPP pension credits paid into the program. Like with the EI, if you had a job with a paycheque, then you paid into the CPP program. You can also get CPP pension credits by credit splitting with a former spouse or paying into the pension plan of another country. You may also qualify for credits if you left the workforce to raise a child.
You can get LTD and CPP at the same time, but the LTD insurer usually has the right to offset by the amount of your CPP payment. That means that a CPP disability payment of $900 per month could give the LTD insurer the right to reduce its payment to you by $900 per month.
Even with enough pension credits, you still need to prove you have a “serious and prolonged” disability, as defined by CPP rules. 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 official form. You also have to get your doctor or nurse practitioner to fill out the medical report form. You then send your application to the designated CPP office for your province.
If Service Canada denies your claim, you can appeal on two levels. You must request the first, a reconsideration appeal, within 90 days of learning of the 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 from the judge or panel.
Workers' compensation benefits
Workers' compensation pays short- and long-term benefits to people injured on the job.
Each province has its own compensation program. To qualify, you must have suffered a workplace injury and worked for a covered employer. That’s right, not all employers are covered.
It’s difficult but possible to prove a workplace injury caused or worsened your back pain. Workers' compensation agencies will try to back pain on injuries you had outside of work.
To succeed in this claim, you need a medical doctor to support your belief that the workplace injury triggered the back pain or made it permanently worse.
Workers' compensation payments overlap with EI, CPP, and short- and long-term disability. This can get complicated, so you should seek legal advice for any concerns about payments. Depending on your province, you may keep some (or all) of your CPP disability as well as 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, then 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: 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.
However, although you can qualify for provincial benefits even if you’ve never worked, they only apply if your total family income falls below a certain amount, and this amount differs from province to province. Family income doesn’t affect the approval process for the other types of disability benefits.
You apply for provincial disability benefits by filing an application with your provincial 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, but this program has a higher standard than the others.
Qualifying for this credit can get some of your previous taxes refunded, depending on the timeline of your condition. You apply by filling out a T2201form 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
Diagnostic imaging helps, but maintaining your credibility is the key
The “lack of objective evidence of disability” is the most common reason insurance companies give for denying your claim for long-term disability benefits for back problems. One piece of evidence you need to prove your pain is legitimate is diagnostic imaging that proves the disorder.
While this alone isn’t enough to win disability benefits, it does provide valuable evidence to strengthen your case. 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 x-rays that 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, allowing a doctor to identify disorders such as degenerative disc disease, a bulging disc, and spinal stenosis. Make sure to let the doctor know of your problems and pain in detail to allow them to best choose an imaging technique and analyze the resulting image for diagnosis.
An important note to make regarding MRI results is the fact that there is no accepted correlation between what can be seen on an MRI to back pain. This is where credibility becomes very important.
One of the best ways to build this credibility is going through a variety of different types of treatment for your back pain. By working with professionals who can back up your claims, you will have a much better chance of receiving disability benefits for back problems.
A decision-maker who finds you trustworthy may rule in your favour, even if you have weak documentation for your claim. And a decision-maker who doesn’t trust you won’t give you the benefit of the doubt in uncertain areas, even with good evidence. Credibility gives you an invisible edge that many people overlook.
Credibility killers include:
- 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 like a medical expert
Credibility boosters include:
- 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
Show that you’ve done all you can to get better
When trying to be accepted for disability benefits for back problems, you have to prove that you have done absolutely everything you can to eliminate your problem. There are a variety of treatments for chronic back pain including drug treatment, various therapies, surgery, psychological counselling and physical rehabilitation.
Initially, many sufferers of back pain turn to drug treatment to alleviate their discomfort. Issues that arise from drug use that can limit effectiveness are experiencing major side-effects, having a susceptibility to addiction, and having the means to afford the drug.
There are also a variety of therapies such as exercise, electrotherapy, and superficial heating and cooling of the skin. Many of these therapies prove to be ineffective for many patients, but they are all worth trying before receiving disability benefits for back problems.
If available for your particular disorder, surgery is another option that can treat back disorders. The high price of surgery is usually the main problem with this form of treatment.There is always a chance complications to occur and other health conditions can prevent a safe procedure.
Psychology also plays a role in your back pain. It is important to seek out psychological counseling to make sure there isn’t a way you can cope with your pain. 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 to qualify for benefits. Physical therapy is known to be a very difficult and painful process before results are realized, which is why you must give it your full effort before applying for disability benefits. If your physical therapist says you didn’t put yourself in a position to succeed, you will not be able to receive benefits.
Accurately document instances of pain from sustained sitting or standing
The best evidence of disability from work are limitations in sitting and standing for long periods of time. Many types of jobs require extended periods of time being sedentary behind a desk. If your back pain seriously prevents you from performing this type of labor, you have a strong argument to be granted disability benefits.
You must document instances of movements throughout the day to present as evidence. You have to be able to prove you are unable to sit or stand for a long period of time without experiencing severe pain that prevents you from performing at work. If you are able to sit for more than two hours, you should reevaluate the severity of your back problem, but if you are unable to do this, you have a strong case for receiving benefits.
Common reasons for denial of back pain disability claims
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 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 letter should then focus on how your doctor followed best practices for diagnosis and treatment as well as how you adhered to the recommended treatment faithfully. You should also emphasize all the things you’ve done to keep working.
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 – either 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.
Insufficient work effort
You can’t do your job, but you could do an easier job, couldn’t you? This reason often arises when the job you did had medium to heavy duties, and you didn’t try a job with light or sedentary duties.
The best way to fight this reason is to try easier jobs. Until you do, the disability benefits providers will always doubt you. You might also show that while your job had medium duties on paper, you got enough disability accommodations from your employer to qualify your work as light duties.
What if your claim is denied?
You have done all the paperwork and have gathered all the evidence you could, but when you receive the decision a few weeks later, you are denied your rights to disability benefits and placed in a very difficult situation.
This is a tough pill to swallow, and I know that — I have seen it many times before with clients of mine. If you don’t get the right type of evidence for your disability claim, the insurance companies will deny your disability claim for these technical reasons, even if they know you are actually disabled.
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 book online. All consultations are by phone.