Are the long-term symptoms of Crohn’s Disease preventing you from doing your job? Are you wondering how to win Crohn’s Disease disability benefits in Canada?
Whether you have already started applying for long-term disability benefits or are considering beginning the process, you probably already know that winning disability benefits is a real challenge and a process you need to prepare diligently for. Although Crohn’s disease is a visible illness, you will nevertheless need to prepare well to win the benefits you deserve. If you do win, removing the financial burden from your shoulders will be worth it.
As a former occupational therapist and current disability benefits lawyer, I can help you avoid the extra pain of bureaucratic nightmares in preparing you for the application process for long-term disability benefits. If you are suffering from Crohn’s disease in Canada, I can help you take the first steps toward securing the support that you are entitled to.
This article will highlight reminders during your diagnosis and treatment, types of disability benefits you might qualify for, specific challenges in preparing your claim for Crohn’s disease, and final thoughts on approaching the overall process and how to face denial of your claims. This article is part of our series examining medical conditions and disability benefits.
Documenting Your Diagnosis of Crohn’s Disease
Your Crohn’s disease has inflamed your digestive tract’s lining leading to some or all of the following: abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation varies from person to person. You may already be in serious pain, but the condition can worsen when the disease spreads to the affected bowel tissue’s deeper layers. On top of the pain and debilitation, Crohn’s disease can bring on life-threatening complications.
With no known cure, Crohn’s disease can be very tricky to manage. Heredity and a malfunctioning immune system are likely contributing causes, so warding off the disease, to begin with, is rare. Once developed, treatment can be difficult. Common treatments for Crohn’s disease can include immunosuppressives, antibiotics, antidiarrheal, or corticosteroids. Recent research has also shown that Stem cell therapy may also be a viable treatment option for those suffering from Crohn’s. While therapies can reduce symptoms and bring on long-term remission, there are no guarantees. Even though treatments allow many people with Crohn’s disease to function well, for you, the disease may be debilitating and prevent you from working. In this case, gaining a firm diagnosis is the beginning of the process of securing long-term disability benefits.
You may already know you have Crohn’s disease, but scanning the following symptoms will ensure you approach the diagnosis or documentation process as thoroughly as possible. Diarrhea and intensified intestinal cramping can also lead to loose stools. Inflammation or infection often yields low-grade fever and fatigue. Abdominal pain and cramping can stem from inflammation and ulceration: nausea and vomiting may result. Blood, either bright red or darker, mixed with the stool is another symptom. Mouth sores, reduced appetite, and perianal disease also signify Crohn’s disease. Additional symptoms include inflammation of the skin, eyes, joints, liver, or bile ducts. Delayed growth or sexual development in children is also a symptom.
You should go to your doctor when major lasting changes occur in your bowel habits. These include abdominal pain, blood in your stool, ongoing diarrhea that is unaffected by over-the-counter drugs, or unexplained fever or weight loss.
A successful doctor’s diagnosis of Crohn’s Disease is no guarantee your disability claims will also be successful, but it is a great start. Be gradual and diligent in gaining your diagnosis. The clinical signs of Crohn’s disease must be well documented in your medical records as you approach the claims process.
It can be very difficult to secure a diagnosis, get acknowledgment from your employer, or understand from family and friends. But once you are properly diagnosed with Crohn’s disease, you’ve taken a critical step toward winning your disability benefits. The next step is preparing a successful disability insurance claim. You’ve spent a long time fighting chronic pain and meeting with perhaps multiple doctors to gain the diagnosis—now it’s time to get the financial help you deserve.
You could be up against insurance companies willing to confuse your illness to avoid paying the benefits you paid for. Before I share details about insurance claims specifically related to Crohn’s disease, you should be aware of which disability benefits you qualify for in general.
Which Crohn’s Disease Disability Benefits in Canada Do I Qualify For?
As a worker, you might be eligible for one of two types of disability benefits in Canada. These are the Canada Pension Plan (CPP) disability benefits and long-term disability insurance benefits.
CPP disability benefits for Crohn’s disease
The CPP, designed to support you after retirement, also covers disability benefits that start once you become disabled and last until you are 65. After that, these disability benefits are converted into regular pensions. In order to be eligible for the CPP disability benefits, you have to have worked for four out of the past six years and paid payroll taxes. In addition, the CPP requires you to prove that your disability is both prolonged and severe, leaving you unable to work.
You apply for CPP disability by filling out the 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 a reconsideration appeal within 90 days of denial. If denied again, 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.
Long-term disability insurance benefits for Crohn’s
Group disability insurance policies are Canada’s most common type of disability insurance. If your employer has insured you as part of a group, you are receiving your disability insurance through your job. These group disability insurance policies, provide both long-term and short-term disability benefits. If you are suffering from Crohn’s disease, you can apply for long-term disability benefits if eligible. If successful, these will provide you with monthly income payments during long absences from work to ease the financial pressure weighing you down.
You apply for LTD by filling out forms and sending them to the insurer. You will probably have to complete three forms. There will be one for you, your employer (if applicable), and your doctor. Again, it’s on you to get those forms back in. You will not get a decision until the insurer receives all the forms.
If your application gets denied, your LTD plan may allow two to three internal appeals. If those fail, you will have an appeal hearing with an outside arbitrator or judge.
Other Chrohn’s Disease Disability Benefits in Canada
If you don’t qualify for CPP disability or long-term disability insurance benefits, you may qualify for one of the following benefits:
Employment Insurance (EI) sickness benefits
EI sickness benefits are temporary disability benefits paid through the federal government’s employment insurance (EI) program. EI pays 55% of your salary for 15 weeks. As of January 1, 2022, the maximum amount you can receive in a year is $60,300. This means you can receive a maximum amount of $638 per week.
To qualify, you must have paid into the EI program recently. You pay through deductions from your paycheque. These deductions are automatic. So, if you got an official paycheque, you paid into the EI program.
You apply for EI benefits online through Service Canada, from home or at any Service Canada office. You also need your doctor to fill out a form that confirms your inability to work for 15 weeks. Finally, your employer has to issue a Record of Employment (ROE) to verify your sick leave.
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 weekly.
Employers offer these benefits through the company or a group insurance policy. In both cases, employers hire an outside agency to run the program for them.
You only qualify if your employer has one of these plans. Not all jobs offer this option. You may be eligible for EI sickness benefits if your job doesn’t offer STD benefits.
You apply by getting the forms from your employer or the right insurance company. The application will include three forms. There is one for you, one for your doctor, and one for your employer. It’s your job to get all the forms filled and back to the insurer.
If your application gets denied, you can ask for an appeal. First, someone else in the company reviews your claim. This is called an internal appeal. You may have multiple of these appeals — up to three or four. If you aren’t successful with the internal appeals, you may have to appeal outside of the company. Your options will depend on your situation. You may have to go to an arbitrator or judge.
Worker’s compensation pays short- and long-term benefits to people injured on the job.
Each province has its own compensation program. To qualify, you must suffer a workplace injury or illness and work for a covered employer. That’s right; not all employers have coverage.
It’s possible to prove a workplace injury caused or worsened your Crohn’s disease.
To succeed in this claim, you need a medical doctor to support your belief that your condition was caused or exacerbated by a workplace injury or illness.
Workers’ compensation payments can overlap with EI, CPP, and short- and long-term disability. You should seek legal advice for any concerns about payments. Depending on your province, you may keep some (or all) of your CPP disability and the workers’ compensation.
If workers’ compensation denies your claim, you should 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).
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.
You can qualify for provincial benefits even if you’ve never worked. However, they only apply if your family income exceeds a certain amount. This amount differs from province to province. Keep in mind family income doesn’t affect the approval process for other types of disability benefits.
You apply for provincial disability benefits with your local agency or program. As usual, your doctor will need to provide a report or certificate confirming you cannot 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. However, this benefit has a higher standard than the others.
Qualifying for this credit can get some of your previous taxes refunded — depending on your condition’s timeline. 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, then you must go to the Tax Court of Canada to appeal again.
How to Win Crohn’s Disease Disability Benefits in Canada
People with Chrohn’s disease have to work extra hard to prove they need and deserve disability benefits. Here are some key things to do throughout the claims process to improve your chances of success.
Appropriate medical diagnosis and treatment
An official medical diagnosis on its own won’t guarantee benefits; however, it is a critical part of the process. Without a diagnosis, you may find it very difficult to get any type of disability benefits. Furthermore, a lack of an official diagnosis can make it very difficult to establish Chrohn’s disease as the reason behind your difficulties.
As part of the disability claim process, benefits providers will also look at what treatment you have received for Chrohn’s disease and whether that treatment aligns with the accepted standards of treatment for your condition. Not getting the appropriate treatment is one of the most common reasons for a denial of benefits.
Failing to get the proper treatment can happen for two reasons: either your doctor didn’t follow accepted standards for treatment, or you refused to participate in the treatment plan. 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.
Documented treatment plan
When you apply for disability benefits for Chrohn’s disease, you will need to show documentation of your current treatment plan. This includes your former treatment plans and how you intend to move forward with future treatment.
Without a well-documented treatment plan, insurance companies will never approve disability benefits for Chrohn’s disease. 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.
Sometimes you can’t get appropriate treatment because you’re waiting for an appointment with a specialist. In these situations, you can still be approved for disability benefits if your doctor has a well-documented treatment plan. The plan should include the fact that you’re 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
Are you taking medication for your Chrohn’s disease or pursuing any other medically accepted treatment options? Medical treatment for Chrohn’s disease often means using appropriate medications to help limit symptoms. If you aren’t using medication to deal with your Chrohn’s disease symptoms, you may have trouble winning disability benefits.
Evidence of work-related limitations
With a condition like Chrohn’s disease, disability benefits providers place great emphasis on how hard you try to stay at work.
You must go well beyond saying you can’t do your job. You need to show that you asked for help from your employer to stay at work. Such changes could include fewer hours, easier duties, or changing roles within the company.
You need to provide evidence that shows how hard you tried to stay at work. This evidence can 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 give strong evidence showing 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 or evidence that you made no effort, then you have no chance of approval.
Medical and employment documents will give you some of the best support for your claim, but the decision-makers need to believe you, too. 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, 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
- 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 If Your Disability Benefits for Crohn’s Disease are Denied
You’ve filled out the forms and compiled as much evidence as possible—and yet, the letter you get politely denies you the right to disability benefits, effectively forcing you back to work.
This is a tough time, and I know that – I’ve seen it over and over again with my clients. You don’t know what you’ve done wrong, and a rejection can feel like an unjustified slap in the face.
Being told your condition doesn’t warrant financial support to give you some space to breathe and focus on your recovery adds humiliation and frustration to the chronic pain. Having to force yourself back to work can have devastating consequences for your physical and mental health.
The good news is that you don’t have to simply accept that your rightful claims have been denied. You can appeal the insurance company’s decision instead. I have accumulated years of experience with disability benefits claims, including cases of Crohn’s disease. It’s unfortunate that insurance companies don’t understand Crohn’s disease very well. But we can help them understand. I know what you are going through, and I’m confident that I 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 by law. Book a free consultation today by calling us at (888) 732-0470.
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