Get answers from our community members. Moderated by disability lawyer David Brannen.
While disability benefits programs focus mostly on impairment and disability, your medical condition and diagnosis are still important. If you plan to apply for disability benefits, the optimal strategy for success includes consideration of your specific disabling medical condition. This is because the type of medical condition will inform the type of evidence, testing, reports, and medical documents you need to present to have your claim approved. Some medical conditions can be controversial or politically charged. Therefore, each case is unique and you must develop a custom game plan to maximize your chances success. Below we cover the key issues related to medical conditions and disability benefits.
Approval of disability benefits is based on impairment and disability, not diagnosis
Establishing you have a certain medical condition or diagnosis is not enough to win approval for short- or long-term disability benefits. Disability benefits claims are approved based on impairment with work capacity. In other words, proving you have a medical diagnosis is not enough, you must prove that the symptoms or limitations associated with that medical condition are sufficient to prevent you from performing the duties of your job. It is possible to win approval of disability benefits if you can prove impairment, but not have a definitive medical diagnosis or cause of the impairment.
Diagnosis dictates treatment in claims for disability benefits
While having a diagnosis or medical condition will not – in and of itself – result in an approval of disability benefits it is still an important consideration in any claim for disability benefits. Insurance companies will only approve and pay disability benefits if they believe you are getting proper treatment for your medical condition. Therefore, have a medical diagnosis is important because it dictates your treatment plan. You must be receiving reasonable treatment based on your medical condition and diagnosis or the insurance company will deny your claim or stop payment of benefits.
While technically not required for approval of disability benefits, the lack of a diagnosis will cause problems because the insurance company may question your treatment plan as being insufficient. A lack of medical diagnosis also opens the door for the insurance company to imply that you are malingering or exaggerating symptoms because you are lazy, don’t want to work or have taken on a disability role to gain attention from others.
Medical conditions and their implications for your disability benefits claim or appeals
Click on the links below to learn more about disability claims involving specific medical conditions:
Case study & how to Avoid the 5 Most Common Mistakes
Resolute Legal is a national law firm focused exclusively on helping Canadian workers win disability-related payments and compensation from their employers, insurance companies, the CPP Disability Program and Workers' Compensation Programs.