Medical Conditions That Qualify for Disability Benefits

You may be wondering what are the medical conditions that qualify for disability? And is my diagnosis on that list? We give a list of medical conditions below, but as you will learn, any medical condition can potentially qualify for disability benefits. 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. I then review the eligibility criteria for the most common disability benefits. So, you can know if your medical condition can qualify for benefits.

1. What medical conditions qualify for disability benefits?

Any medical condition can qualify for disability benefits. Generally speaking, most disability benefits programs in Canada do not give benefits based on a medical diagnosis. Rather, they provide benefits based on the level of disability caused by the medical condition. So the focus will always be on the level of disability caused by your medical condition, rather than only the name of your medical condition or 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.

Following is a list of common medical conditions that qualify for disability benefits. For each of these conditions we discuss the unique challenges you will face.

2. List of medical conditions

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

• Back Problems & Conditions
• Bipolar Mood Disorder
• Carpel Tunnel Syndrome
• Chronic Fatigue Syndrome
• Chronic Pain
• Complex Regional Pain Syndrome
• Crohn’s Disease
• Depression
• Fibromyalgia
• Heart Disease
• Headache and Migraine
• Irritable Bowel Syndrome (IBS)
• Knee Disorders
• Lupus
• Lyme Disease
• Multiple Sclerosis
• Neck and Cervical Disorders
• Psoriatic Arthritis
• Sleep Disorders
• Vestibular Disorders
• Visual Disorders

3. What medical conditions qualify for short-term disability?

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

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

Most short term disaibltiy plans will require you to be continuously disabled for 7 days or so before you can qualify for benefits. This is called a waiting period or elimination period.

Following is an example of typical wording of the disability requirement for a short-term disability plan. Please note this is only an example, the exact wording is different for each plan:

An employee is entitled to payment of a short-term disability benefit if that employee proves that:

• the employee became totally disabled while covered
• the total disability has continued beyoned the elimintation period
• the employee has been following appropriate treatment for the disabling condition

An employee wil be considered totally disabled while the employee is continuously unable due to an illness to do the essentional duties of the employee’s own occupation in any setting.

4. What medical conditions qualify for long-term disability?

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

Assuming you don’t have an excluded condition, then you can qualify for long-term disability benefits if your medical conditions prevents you from doing your regular work. You won’t qualify to apply right away. Most long-term disability plans require you to be continuously disabled for a number of weeks before you are eligible to apply. This called the waiting period or elimination period.

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

Most long-term disability plans have a two tier requirement for disability. For the first 2 years you can qualify for benefits if your medical condition prevents you from doing your regular work.

However, after 2 years, you can only qualify for long-term disability benefits if your medical conditions prevents you from doing any gainful work (not just your regular work).

Following is an example of a long-term disability requirement fround in a group long-term disablity plan. This is only an example and these 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 folloing 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 memeber does not affect the determination of total disability

5. 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, then CPP disability will fast-track your application.

Following is the offical requirement for CPP disability benefits. Your medical condition must cause a level of disaiblity 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 prlonged 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 pursing 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…

In common terms, you can only qualify for CPP disability if your medical condition causes permanent disablity that prevents you from regularly doing any employment.

6. What Medical Conditions Qualify for the Disability Tax Credit?

The disability tax credit is different from other disability benefits plans. The above disability plans focus on how your medical condition affects your ability to work. The is not focused on your ability to work. Rather, it focuses on impairment with your daily activities.

Eligibility Criteria for the Disability Tax Credit

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

You will automatically qualify for the disability tax credit if your medical condition causes blindness or you to 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.

To qualify under the life sustaining therapy requirement, the therapy must be needed to support a vital function, and you must need it at least 3 times per week for an average of 14 hours per week.

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

To qualify for the disability tax credit you must show that you are markedly restricted in one of these areas. A marked restriction means that you are unable to do the BADL or take an inordinate amount of time to do it. This restriction must be present 90% of the time.

Alternatively, you can still qualify for the disability tax credit if you show that your medical condition causes cumulative effect of significant restrictions in 2 or more of the BADL. A signficiant restriction is one that doesn’t quite meet the reqirement for marked restriction and is present at least 90% of the time.

In summary, the diability tax credit is complicated. Keep in mind it is not focused on your ability to work. Rather, it is focused on the extent to which your medical condition(s) results in marked impairment with the basic activities of daily living. Or the extent to which your medical condition(s) resulted in cumulative effect of significant restriction in 2 or more of the basic activities of daily living.