Whether you have already started to apply or are considering beginning the process, you probably already know that winning disability benefits for bipolar can be an uphill battle. Bipolar mood disorder is an invisible illness. So, it presents additional challenges when proving your claim to disability providers.
You will need to prepare very diligently to win the benefits you deserve. Winning won’t cure your bipolar mood disorder, but removing the financial burden will certainly help.
As a former occupational therapist and current disability lawyer, I can help you avoid the bureaucratic nightmares you may encounter throughout the process. If you are suffering from bipolar mood disorder in Canada, I can help you take the first steps toward securing the support you deserve.
This article will highlight the types of disability benefits you might qualify for, specific challenges you may face, and what to do after a denial.
Does Bipolar Disorder Qualify for Disability Benefits in Canada?
Yes. All disability benefits providers in Canada recognize bipolar as a disability. And it is a condition that can qualify for benefits. However, a diagnosis on its own won’t win you benefits.
Providers pay benefits to people who can prove their conditions prevent them from working. When reviewing claims for bipolar, disability providers focus on the seriousness of your symptoms. They consider the medical treatment you’ve had and future treatment plans. They look at how your symptoms affect your employment and how hard you tried to keep working. And you must have this documented in medical records or other paperwork with your claim.
If you are interested in learning about other conditions that qualify as a disability in Canada, check out our article: Medical Conditions that Qualify for Disability Benefits.
Documenting your Diagnosis of Bipolar Mood Disorder
To win disability benefits for bipolar, you need a comprehensive strategy that accounts for three key factors: your medical condition, your job, and your disability benefits provider.
In the case of your medical condition, gaining a firm diagnosis is step one.
There are several types of bipolar mood disorder. For each type, the distinct symptoms can vary. So, your symptoms need to be well-documented as you proceed through the claims process.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the criteria for diagnosing bipolar. Under the DSM-5, there are now seven possible diagnoses for bipolar. However, the three main types are:
1. Bipolar I disorder: You have experienced at least one manic episode. This episode may have been preceded by or followed by hypomanic or major depressive episodes. Also, your life is interrupted by mania symptoms which may have put you in the hospital or triggered psychosis.
2. Bipolar II disorder: You have experienced at least one major depressive episode that lasted at least two weeks and at least one hypomanic episode, which lasted for a minimum of four days. However, you have never experienced a manic episode.
3. Cyclothymic disorder: You have experienced at least two years (one year for children and teenagers) burdened with periods of hypomania symptoms and periods of depressive symptoms. During these periods, you experience symptoms for a minimum of half the time, and they don’t disappear for more than two months.
It’s important to remember that bipolar II disorder is not a milder form of bipolar I disorder. They are completely separate diagnoses. The manic episodes in bipolar I can be dangerous, and the depressive periods in bipolar II can cause significant impairment. Both diagnoses are viable for disability insurance claims.
If you haven’t received a diagnosis, now is the time to start working towards that. A diagnosis alone will not automatically win you benefits, but it is an important starting point. Be steady and diligent in gaining a diagnosis. The clinical signs of your bipolar mood disorder must be well documented in your medical records as you approach the claims process.
It can be very difficult to secure a diagnosis. But once you are diagnosed with a bipolar mood disorder, you’ve taken a critical step toward winning your disability benefits.
The next priority is to start preparing a successful disability claim. You may have spent a long time fighting and living with a bipolar mood disorder. You’ve met with doctors and psychiatrists and taken many varieties of medication—but now it’s time to get the financial help you deserve.
You could be up against insurance companies who will do anything in its power to avoid giving you benefits. Before I share details about insurance claims related to bipolar, you should be aware of which disability benefits you may qualify for.
Disability Benefits for Bipolar Mood Disorder
There are several disability benefits available for people with a bipolar mood disorder in Canada. You might be eligible for disability benefits from the government, your employer, or your insurer.
This list covers the possible options for bipolar 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
Employment Insurance (EI) sickness benefits
The EI Sickness Benefits provide temporary income to people unable to work because of sickness, injury, or quarantine. They are paid through the federal government’s employment insurance (EI) program. For those who are eligible, EI 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. These are automatic. So, if you got an official paycheque, you paid into the EI program.
You apply for EI benefits online through Service Canada or in person at any Service Canada office. Your doctor needs to fill out a form to confirm that you can’t work for the 15 weeks that EI covers. And finally, your employer will need to issue a Record of Employment (ROE) to confirm your sick leave.
Please note: If you qualify for short-term disability, you can’t claim EI benefits at the same time.
You can learn more about EI by visiting our article on the EI sickness benefits program.
CPP disability benefits for bipolar
The CPP is designed to support you after retirement. But it also provides disability benefits that start once you become disabled and last until you are 65. After that, these disability benefits get converted into regular pensions. In order to be eligible for the CPP disability benefits, you need to have worked for four out of the past six years and paid payroll taxes. The CPP requires you to prove that your disability is both prolonged and severe, leaving you unable to work.
Currently, payments range from $524.64 to $1,457.45 per month. The amount is based on how much you paid into the program. The more you contribute, the more you’ll get back. If you had a job with a paycheque, you paid into CPP.
You can get long-term disability insurance benefits and CPP disability at the same time. However, the insurer usually has the right to offset your payments by the same amount. For example, if you get $900 from CPP, your insurer can reduce its payment by $900 for the same month.
You apply for the CPP disability benefits by submitting the required forms. Your doctor or nurse practitioner will have to fill out the medical report. Then, you send your application to a 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 this appeal within 90 days of denial. If denied again, then you appeal to the Social Security Tribunal. The deadline is 90 days as well.
At the tribunal, a judge or a three-person panel will decide your claim. You can attend the hearing to give evidence and answer questions.
Long-term disability insurance benefits for bipolar
As you may guess, long-term disability (LTD) benefits pay for a longer period of time. If you win a claim for LTD, the payments can last for many years. A policy will specify that the benefits last a certain number of years — 2, 5, or 10, for example. Or, it will say they last until you reach a certain age — usually 65.
LTD benefits usually cover 50 to 67% of your monthly salary. You will receive benefits once a month rather than every two weeks. Group and individual policies often include long-term disability benefits.
If your company offers a group medical plan, check to see if it includes LTD benefits. If you’re in a union, your medical plan will likely have LTD coverage.
You can also get LTD through private insurance policies. These policies are common among people who are self-employed or underinsured. 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. There should be one for you, your employer, and your doctor. And again, it’s your responsibility to submit them. You won’t get a decision until the insurer receives all the forms.
If your claim gets denied, you can appeal the decision. Your LTD plan may allow two to three internal appeals. After, you would need to do an appeal hearing with an outside judge — or a lawsuit.
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 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 you have a plan through your job. Not all employers offer this to their employees. If your employer doesn’t, you might be able to get EI sickness.
As I said before, if you qualify for STD, you won’t be eligible 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 insurance company. The application includes three forms: one for you, one for your doctor, and one for your employer. It’s up to you to get all the forms back to the insurer.
If your application gets denied, you can ask for a review. This is called an internal appeal. During the appeal, your claim gets reviewed by someone else in the company. You can have three or four of these appeals. After that, you have to appeal to an outside judge or file with the courts. Your options will depend on your situation.
Workers’ compensation benefits
Workers’ compensation pays short- and long-term benefits to people who miss time from work due to a work-related injury or illness.
Each province has its own program. To qualify, you must have suffered an injury at work or a work-related illness. Also, your employer must be covered by the program. Yes, you read that right; not all employers have coverage.
It’s extremely difficult — but possible — to prove a workplace injury caused or worsened your bipolar.
Historically, worker’s compensation programs only considered mental health claims caused by a single workplace incident. They wouldn’t recognize situations of chronic workplace stress caused over time.
But this is changing. In January 2018, WSIB in Ontario implemented a new policy to allow claims for “chronic mental stress” caused by a worker’s employment. However, not all workers’ compensation programs in Canada have adopted this policy. Check with the program in your province to see if it includes chronic mental stress.
To succeed in this claim, you need a doctor to support your belief that a substantial work-related stressor, incident, or injury triggered the bipolar or permanently made it worse. You will also need to have a diagnosis of bipolar or a related mental illness. And finally, you must prove that specific workplace conditions or events are to blame. Workplace harassment and bullying are two common reasons. The workers’ compensation program will also independently verify these events with your employer or coworkers.
This kind of claim is extremely difficult to prove, we highly recommend hiring a lawyer or advocate before you do anything.
If workers’ compensation denies your claim, you must follow the appeal procedures for your province. There are two levels of appeal: the internal reconsideration and the outside tribunal. In most provinces, the 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 must prove that a “service-related injury” caused or worsened your bipolar. You’ll also need a doctor to confirm it.
You apply for VAC disability 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 for bipolar
Each province in Canada pays income support benefits to people who can’t work because of a disability. If you are eligible, 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. That amount differs from province to province. Family income doesn’t affect the approval process for other types of disability benefits, however.
You apply for provincial disability benefits through your provincial agency or program. As usual, your doctor will need to provide a report or certificate that confirms you can’t work because of your condition.
If denied, 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 the income support program in your province for the proper procedures.
Disability tax credit for bipolar
The disability tax credit is a type of benefit that lowers your taxable income. However, this program has a higher standard than others. To qualify, you must have a prolonged impairment, marked restriction, have two or more significant restrictions or are dependent upon “life-sustaining” therapy.
Qualifying for this credit can get some of your previous taxes refunded. But it depends on the timeline of your condition.
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, you must go to the Tax Court of Canada to appeal again.
How to Win Disability Benefits for Bipolar Mood Disorder
Since you can’t physically see bipolar, benefit providers can’t verify the seriousness of your symptoms. So, they may view your claim with skepticism. After all, you could exaggerate your symptoms to appear more disabled than you are.
Many people with bipolar can manage their symptoms and continue working. So, you need to focus on proving that your case is different.
Appropriate medical diagnosis
As mentioned earlier, an official diagnosis alone is not enough, but you still need to have one. You must meet the Diagnosis and Statistical Manual for Mental Disorders (DSM) criteria for bipolar.
Your doctor must show a detailed medical history, as well as all the measures that were taken to rule out other possible conditions.
Following recommended treatments
When considering your claim, providers will check to see if you received the appropriate treatment for bipolar. Not following the recommended treatment is one of the most common reasons for denial.
Failing to comply with accepted treatments typically occurs in two ways: either your doctor didn’t follow standards for treatment, or you refused treatment. Even if you and your doctor believe that alternative methods may work better, you have to try the standard treatments to qualify for disability benefits. Otherwise, you leave the door open for someone to say that you could work if you had the right treatment.
Medication and psychotherapy are the most common and effective treatments for bipolar disorder. If you want to win disability benefits, you should follow a plan that incorporates both medication and therapy.
Documented treatment plan
A well-documented treatment plan is another way to improve your chances of securing benefits. Your doctor may have a plan, but if it isn’t documented, and communicated to the insurance company, then it’s the same as no plan. Even if you had the best treatment plan in the world, insurance companies would never approve disability benefits if there was no documentation of it.
Sometimes you can’t get appropriate treatment because you’re waiting for an appointment with a psychiatrist or psychologist. In these situations, you can still get approved for disability benefits if your doctor has a well-documented treatment plan. The plan should make note that you are waiting for a consultation with other specialists. It must also show that you’re doing all other recommended treatments in the meantime.
Medications and side effects
As you probably already know, medication is one of the most effective treatments for bipolar. The most common types of medication used to treat the disorder are mood stabilizers, antipsychotics and antidepressants.
However, there is no single medication or dose that will work for everyone. So, you will have to work closely with a specialist to find what drug or combination of medications works best for you. This means you must try all the recommended medications — even if you fear the side effects.
If you’re not taking the appropriate medication for your condition, insurance companies will think your symptoms aren’t serious enough to qualify for disability benefits. It’s common for doctors to prescribe multiple medications and different dosages to find the right treatment. So, if you have a bad reaction to one medication, you can’t refuse the troubleshooting that follows. You have to try all other options or try changing your dosage.
If you have a bad reaction to your medications, your medical records must report that in detail. And, if your doctor recommends against a medication, you need to have it documented that the side effects were worse than the condition. Again, you run the risk of denial if you stray too far from standard treatments without a good reason.
Evidence of work-related limitations
With an invisible illness like bipolar, disability benefits providers place great emphasis on how hard you try to stay at work.
It’s not enough to say you can’t do your current job. You also need to prove that you asked for help from your employer to stay in the workforce. Such changes could include fewer hours, easier duties, or changing roles within the company. If your job is medium or heavy work, you should try a less demanding job with light or sedentary duties.
You also need to provide evidence to show how hard you tried to stay at work.
This evidence could include the following:
- Medical records discussing your work attempts
- Employment records that show places you tried to work and all accommodations made
- A written statement from you that details your work efforts
- Signed written statements from your employer or co-workers describing how they observed your struggle to work
If you provide strong evidence that shows you tried your best to stay at work, you have a good chance of winning benefits. On the other hand, if you have little evidence of your efforts, you have a very slim chance of gaining approval.
Medical and employment evidence will give you some of the best support for your claim, but the decision-makers also need to believe you. In legal settings, credibility refers to a person’s trustworthiness or believability.
A decision-maker who finds you trustworthy may rule in your favour — even if you have weak evidence 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. Being credible gives you an invisible 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 or biased
- Using confrontational language in your claim or testimony
- Refusing or stalling reasonable requests for information
- Fighting with doctors over your diagnosis instead of focusing on the disability
- Acting like a medical expert
- Making sure what you say matches the medical records
- Taking responsibility for bad facts or problems with your claim; not blaming others
- Being cooperative and respectful of everyone in the claim
- Accepting expert advice and opinions
- Making good faith efforts to try all reasonable advice, even if you disagree with it
- Obvious efforts to keep working
What to do After a Denial
You have filled out the forms and compiled all the evidence you could —and yet, the letter you receive in the post denies your application for disability benefits.
This is a tough time, and I know that – I have seen it over and over again with my clients. A rejection letter can feel like an unjustified slap in the face.
The good news is that you don’t have to accept the decision. You can appeal it instead. I have accumulated years of experience with disability benefits claims, including cases of bipolar mood disorders. Insurance companies don’t understand bipolar very well and carry unrealistic expectations about recovery. But we can help them understand. I know what you are going through, and I’m confident our firm can help you.
You have a choice. You do not have to let insurance companies get away with denying you the support you are entitled to. Need help with your claim? Call us toll-free today at (888)-732-0470.
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