Medical Conditions that Qualify for Disability Benefits

You may be wondering about the medical conditions that qualify for disability benefits. And whether your diagnosis is on that list. We give a list of medical conditions that qualify for disability below, but as you will learn, any medical condition can potentially qualify for disability benefits. However, the focus is always on the extent of the disability caused by your medical condition. And whether the extent of your disability meets the requirements for various disability benefits plans and programs.

This article lists common disabling conditions and reviews the eligibility criteria for various disability benefits in Canada. So you can see if your medical condition qualifies for benefits.

Contents

What Medical Conditions Qualify for Disability Benefits?

Any medical condition can qualify for disability benefits. Generally speaking, most benefits programs in Canada do not give-out benefits based on a medical diagnosis. Instead, they provide benefits based on the level of disability caused by the medical condition. In other words, the level of disability caused by your medical condition is always the focus, not the diagnosis. To qualify for benefits, you must show that the level of disability from your medical condition meets the eligibility criteria of the disability benefits plan in question.

In the next section, we list the common medical conditions that qualify for disability benefits. For each of these conditions, we discuss the unique challenges you may face.

List of Medical Conditions that Qualify for Disability Benefits

The following is a list of medical conditions that may qualify for disability benefits:

What Medical Conditions Qualify for Short-Term Disability?

Your medical condition must prevent you from doing your regular job duties to qualify for short-term disability (STD). You must show how the symptoms or impairments from your medical condition interfere with your ability to perform your job duties.

To do this, you need to have an official list of your job duties. Then you can get your doctor to review the list of responsibilities and confirm that you cannot perform the majority of them because of your medical condition.

Most STD plans require you to be continuously disabled for seven days or so before you can qualify for benefits. This is called the waiting/elimination period.

The following is an example of typical wording of the disability requirement for a STD plan. Please note this is only an example; the exact wording is different for each plan:

An employee is entitled to payment of a STD benefit if that employee proves that:

the employee became totally disabled while covered
the total disability has continued beyond the elimination period
the employee has been following appropriate treatment for the disabling condition

An employee will be considered totally disabled if the employee is continuously unable, due to an illness, to do the essential duties of the employee’s own occupation in any setting.

Medical Conditions that Qualify for Long-Term Disability

Most medical conditions can qualify for long-term disability (LTD). However, some LTD plans will exclude certain medical conditions.

Assuming you don’t have an excluded condition, you can qualify for LTD benefits if your medical conditions prevent you from doing your regular work. You won’t qualify to apply right away. Most LTD plans require you to be continuously disabled for several weeks before you are eligible to apply.

The most common length of the waiting period is 17 weeks, but this can be different for each plan.

Most LTD plans have a two-tier requirement for disability. For the first two years: you can qualify for benefits if your medical condition prevents you from doing your regular work.

However, after two years, you can only qualify for LTD benefits if your medical conditions prevent you from doing any gainful work (not just your regular work).

Example of a long-term disability requirement from a group LTD plan

This is only an example. Requirements and wording vary from plan to plan.

An employee is entitled to payment of a long-term disability benefit if the employee presents proof of claim acceptable that:

the employee became disabled while covered
total disability has continued beyond the elimination period
the employee has been following appropriate treatment for the disability condition

An employee will be considered totally disabled:

while the employee is continuously unable due to an illness to do the essential duties of the employee’s own occupation, in any setting, during the elimination period and the following 24 months, and
afterwards, while the employee is continuously unable, in any setting due to illness, to do any occupation for which the employee is or may become reasonably qualified for by education, training or experience.
The availability of work for the member does not affect the determination of total disability

What Medical Conditions Qualify for CPP Disability?

Any medical condition can qualify for CPP disability if it prevents you from doing gainful employment. You must also prove that your disability is permanent. If you suffer from a terminal illness, CPP disability will fast-track your application.

The following is the official requirement for CPP disability benefits. Your medical condition must cause a level of disability to meet the following requirement:

Section 42. When a person is deemed disabled — (2) For the purposes of this Act,

(a) a person shall be considered to be disabled only if he is determined in the prescribed manner to have a severe and prolonged mental or physical disability and for the purposes of this paragraph,

(i) a disability is severe only if, by reason thereof, the person in respect of whom the determination is made is incapable of regularly pursuing any substantially gainful employment, and

(ii) a disability is prolonged only if it is determined in the prescribed manner that the disability is likely to be long continued and of indefinite duration or is likely to result in death…

This means you can only qualify for CPP disability if your medical condition causes permanent disability that prevents you from regularly doing any kind of work.

Medical Conditions that Qualify for the Disability Tax Credit

The Disability Tax Credit (DTC) is different from other disability benefits plans. The above plans focus on how your medical condition affects your ability to work. Your ability to work is not the main focus. Instead, it focuses on impairment with your daily activities.

Eligibility

There are several medical conditions that qualify for the DTC. However, You automatically qualify for the DTC if your medical condition causes blindness or you need life-sustaining therapy. You also automatically qualify if you have Type 1 diabetes.

You may be eligible for the DTC if you are:

blind
markedly restricted in at least one basic activity of daily living
significantly restricted in two or more basic activities of daily living
need life-sustaining therapy

To qualify as blind, your visual acuity in both eyes must be 20/200 or less. Or your field of vision in both eyes is 20 degrees or less.

And to qualify for the life-sustaining therapy requirement, you need therapy to support a vital function. And you have to need it at least three times per week for an average of 14 hours per week.

Basic activities of daily living (BALD)

To qualify for the Disability Tax Credit (DTC), you must show that you became markedly restricted in one basic activity of daily living.

The basic activities of daily living (BADL) include the following:

Speaking
Hearing
Walking
Eliminating (bowel or bladder)
Feeding
Dressing
Mental functions necessary for everyday life

Marked restriction

A marked restriction means you cannot do a BADL, or it takes excessive time to do it. It also must be present 90% of the time.

Cumulative effect of significant limitations

Alternatively, you can still qualify for the DTC if you show that your medical condition meets the cumulative effect of significant limitations requirements. This means you must be significantly limited in two or more of the BADLs. A significant limitation is one that doesn’t quite meet the requirement for marked restriction and is present at least 90% of the time.

Life-sustaining therapy

You can also qualify for the DTC if you meet the life-sustaining therapy requirement. Life-sustaining therapy is defined as therapy that:

is essential to sustain a vital function;
is required to be given at least three times each week for a total duration averaging not less than 14 hours a week and
can not reasonably be expected to significantly benefit persons who are not so impaired.

Therapies that may meet this requirement include insulin therapy, kidney dialysis, taking medical foods and formulas, and more.

Overall, the DTC is the most complicated disability benefit. Keep in mind the focus is not on your ability to work. Instead, it focuses on the extent to which your medical condition(s) results in marked impairment in the basic activities of daily living. Or the extent to which your medical condition(s) resulted in the cumulative effect of significant restriction in two or more basic daily living activities.

Medical Conditions that Qualify for Workers’ Compensation

Each Provinces’ workers’ compensation program has its own eligibility criteria, but usually, they all include the following:

Your employer has coverage through Workers’ Compensation; and
You have suffered a work-related injury or illness.

Thus, any medical condition can qualify for workers’ compensation benefits so long as it is work-related and your employer is covered by the program.

It’s important to note that some workers may not be eligible for workers’ compensation, however. For instance, independent contractors and self-employed workers with no employees are common exceptions to this requirement. In most provinces, these individuals have to buy their own personal coverage. However, in some provinces like Alberta, businesses are required to provide insurance to non-employees, like contractors.

Additionally, some provinces don’t require all employers to register for workers’ compensation. For instance, in Nova Scotia and New Brunswick, employers only have to register for coverage if they manage a team of three or more full-time or part-time employees. However, most provinces require that employers register for workers’ compensation coverage after hiring their first employee. For example, in Ontario, employers must register within ten days after employing their first full-time employee or part-time employee.

Overall, keep in mind that any medical condition can qualify for workers’ compensation as long as it was caused by a work-related injury or illness and your employer is covered by the program. Ask your employer if you are ever unsure whether you have workers’ compensation benefits.

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