Are you suffering from the long-term symptoms of Chronic Fatigue Syndrome? Does your illness prevent you from fulfilling your duties at work? Are you wondering how to win disability benefits for Chronic Fatigue syndrome?
If you have started to apply for long-term disability benefits or are considering beginning the process to lift the financial weight off your shoulders, you probably already know that winning disability benefits is no walk in the park. Because insurance companies consider Chronic Fatigue Syndrome an invisible medical condition, you will have to prepare diligently for this fight.
You might have already managed the long-term symptoms, endured the social stigmas, and slugged through the difficult process of gaining a formal doctor’s diagnosis for Chronic Fatigue Syndrome. The last thing you want now is a bureaucratic nightmare on top of your debilitating long-term illness. We can help you avoid that extra pain and prepare you for the singular challenge of applying for long-term disability benefits.
Just because Chronic Fatigue Syndrome isn’t a leading cause of disability from the workplace in Canada doesn’t mean you shouldn’t get the benefits from the insurance you’ve already paid for. If you are suffering from Chronic Fatigue Syndrome in Canada, I can help you take the first steps toward securing the support you are entitled to. This article is part of our series examining medical conditions and disability benefits.
Diagnosing Chronic Fatigue Syndrome
A successful doctor’s diagnosis of Chronic Fatigue Syndrome isn’t a guarantee that your disability claims will also be successful, but it is a great start. You should take a gradual and patient approach to gain your diagnosis.
There’s no single test to diagnose Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis. Like other invisible illnesses such as arthritis or fibromyalgia, it can be difficult to secure a clear diagnosis and get acknowledgment from your employer, friends and family.
You may have already fought this uphill battle, but if you’re still at the diagnosis stage, remember there is no single test for Chronic Fatigue Syndrome. The reason for this is that the condition mimics other health problems. Your doctor must rule out sleep disorders, medical problems, and mental health issues.
In the case of sleep disorders, a sleep study can rule out insomnia, restless legs syndrome, or obstructive sleep apnea. Your doctor must account for common medical problems, possibly by using a blood test, including hypothyroidism, diabetes, and anemia. A counsellor can rule out other common health issues like anxiety, depression, or bipolar disorder.
Diagnostic criteria for Chronic Fatigue Syndrome
The diagnostic criteria for chronic fatigue syndrome include at least six months of unexplained and persistent fatigue with at least four of the following symptoms:
- Significant impairment in short-term memory or concentration
- Sore throat
- Enlarged lymph nodes in your neck or armpits
- Unexplained muscle pain
- Pain that travels from joint to joint without swelling
- A new type or pattern of headache
- Unrefreshing sleep
- Extreme exhaustion lasting a day or longer after physical or mental exercise
You may already have a firm doctor’s diagnosis and take medications such as antidepressants or sleeping pills. For therapy, you may already engage in graded exercise or psychological counselling. On top of this, you are probably setting aside time to reduce stress, improve your sleep, and maintain steady daily activity.
Because it can take some time to secure a winning disability insurance claim, therapy and support from family and friends can help you deal with the chronic illness while you prepare your case.
Once diagnosed, you’ve taken a critical step toward winning your disability benefits. The next step is preparing a successful disability insurance claim. You could be up against insurance companies willing to dismiss your illness to avoid paying the benefits you are entitled to. You’ve spent the time fighting chronic fatigue and meeting with doctors to gain the diagnosis—now it’s time to get the financial help you deserve.
Before I share details about insurance claims specifically related to Chronic Fatigue Syndrome, you should be aware of which disability benefits you qualify for.
Which Disability Benefits for Chronic Fatigue Syndrome Do I Qualify for?
When it comes to claiming long-term disability benefits, you might be eligible for one of two types of disability benefits if you are a worker. These are the Canada Pension Plan (CPP) disability benefits and long-term disability insurance benefits.
CPP Disability Benefits for Chronic Fatigue Syndrome
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. 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 Chronic Fatigue Syndrome
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 ad short-term disability benefits. If you are suffering from Chronic Fatigue Syndrome, 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.
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 Disability Benefits for Chronic Fatigue Syndrome
If you don’t qualify for long-term disability insurance or CPP disability, you may be eligible for one of the following disability programs.
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. If your job doesn’t, then you may be eligible for EI sickness 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 an employer who is covered by the program. That’s right; not all employers have coverage.
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 total family income falls below 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 Disability Benefits for Chronic Fatigue Syndrome
I’ve already described the difficulty of gaining a firm diagnosis of Chronic Fatigue Syndrome. The root of this is the simple fact that there is no single test to confirm a diagnosis of Chronic Fatigue Syndrome. Because of this difficulty, you probably won’t be surprised to find that this directly impacts how insurance companies and the CPP will handle your disability claim. The insurance companies and the CPP disability program generally aren’t enthusiastic about giving out disability benefits for an illness such as Chronic Fatigue Syndrome.
So, in order to win benefits, you will have to present a very well-organized application that includes well-documented medical evidence that rules out all other causes of your fatigue.
The CPP disability administration will not approve your CPP disability benefits just because a doctor diagnosed you with the condition. To win CPP disability benefits for Chronic Fatigue Syndrome, the true challenge is to prove that your symptoms render you unable to function in any workplace while considering your age and work experience.
The following are a few ways to improve your chances of getting approved.
Get a diagnosis and document it
As we discussed, securing a diagnosis of Chronic Fatigue Syndrome will not guarantee that you will get approved. However, you have a slim chance of winning benefits without one. If you haven’t already, book an appointment with your doctor to start your journey to getting diagnosed.
Include detailed medical documentation
While a diagnosis is important, it means nothing without the corresponding medical records and documentation.
In order to win benefits, your application must identify the diagnostic criteria for Chronic Fatigue Syndrome and these criteria must be clearly documented in the medical records by your treating physicians.
In addition, laboratory findings can be very important if they show elevated antibody titer to Epstein-Barr virus, capsid antigen equal to or greater than 1:5:120 or early antigen equal to or greater than 1:640.
If you have claimed any deficits in mental functioning, including short-term memory problems, information processing problems, concentration deficits, comprehension deficits, or visual-spatial problems, you must have medical documentation to support that as well.
Medical records that rule out other medical conditions
You must also have medical documentation to show your doctors have ruled out all other conditions, such as depression, anxiety, sleep disorders, anemia, or an underactive thyroid.
Get the appropriate treatment and document it
When considering your claim, disability benefits providers will look to see if you received the appropriate treatment for your condition. Not getting the right treatment is one of the most common reasons for denying benefits.
While there is no cure for Chronic Fatigue Syndrome, there are several treatments, including medications, psychotherapy (for those who experience depression and anxiety), specialized exercise programs, alternative therapies, and lifestyle adjustments. So, in order to win benefits, you must follow all medically accepted treatment avenues and document them.
Evidence of work-related limitations
You will also want to record all the ways in which you have modified your work habits in order to maintain employment while dealing with Chronic Fatigue Syndrome.
You should also try easier jobs within your workplace before you apply. Until you do, the disability benefits providers will always doubt you. You might show that while your job had medium duties on paper, your employer made accommodations to qualify your duties as light.
If you were forced to change jobs as a result of Chronic Fatigue Syndrome, make a note of that too.
Overall you need to prove that you are unable to do your regular work, past jobs you have held, and any other gainful employment.
Credibility is key
It is vital that a person seeking disability benefits for Chronic Fatigue Syndrome maintains a level of total honesty throughout the process. Credibility is intensely important when making a legal claim for disability benefits associated with Chronic Fatigue Syndrome. Any exaggerations or inconsistencies in descriptions of pain or disability can hurt credibility, even if the inconsistency is an honest mistake.
- 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 errors 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 if Your Claim is Denied?
You’ve filled out the forms, and you’ve compiled as much evidence as you could get – 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 your chronic fatigue. Having to force yourself back to work can have devastating consequences for your physical and mental health.
There is a light at the end of the tunnel. 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 Chronic Fatigue Syndrome. I know what you are going through, and I’m confident 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. Call us at (888) 732-0470 to book your free consultation today.
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