Winning Disability Benefits for Chronic Pain

Are you unable to work due to chronic pain? Does your chronic pain keep you from gaining or maintaining full-time employment? Are you considering the idea or in the process of getting disability benefits for chronic pain?

If you answered yes to any of these questions, you are in the right place.

Applying for and winning long-term disability benefits for chronic pain in Canada can be an exhausting process. It can feel like benefit providers are purposely trying to make it harder for you to win the benefits you deserve — and unfortunately, sometimes they are.

This article will address the difficulties of applying for disability benefits for chronic pain. It will also explain how to navigate the long road to receiving the compensation you desperately need and deserve.

This article is part of our series examining medical conditions that qualify for disability benefits.

Contents

Understanding Chronic Pain

Chronic pain is different than immediate, acute pain in that it can last for months or even years. In fact, chronic pain can last a lifetime and present itself in any number of ways. When experiencing chronic pain, you may feel symptoms ranging from sore joints to headaches, muscle aches, and more. Chronic and uncontrolled pain can also compromise the immune system and the healing process as well as promote tumour growth.

There are two types of chronic pain: chronic primary pain and chronic secondary pain. However, in both types for pain to be considered chronic it must last for more than three months.

Types of chronic pain:

Chronic primary pain refers to pain that continues to occur after complete tissue healing or when there is no identifiable cause of pain.
Chronic secondary pain refers to chronic pain that occurs in association with underlying diseases or issues.

While chronic pain is now recognized as debilitating condition in itself, this serious medical issue can also be associated with a number of different disorders and diseases such as arthritis, gout, Crohn’s Disease, fibromyalgia, carpal tunnel syndrome, irritable bowel syndrome, neurological and spinal disorders as well as back and neck issues which may be related to an accident or physical trauma.

You are not alone

If you are dealing with a chronic pain disability claim, it is important to remember that you are not alone.

According Canadian Pain Task Force Report, one in five adults in Canada suffer from chronic pain. In fact, this disability is such a pressing concern that an entire week each year is dedicated to the condition. In 2022 National Pain Week will take place on November 6 through 12.

Chronic pain not only affects those who suffer from it; but it is also harmful and costly to the nation. The 2020 Canadian Pain Task Force Report found this condition costs Canadians billions of dollars a year in lost income and health expenses.

Chronic pain has reached nearly epidemic proportions and cannot be ignored or dismissed in Canada any longer.

Is Chronic Pain a Disability in Canada?

Yes. Chronic pain is considered a disability in Canada, and those who suffer from it can qualify for disability benefits. However, due to the invisible nature of the condition, winning benefits for chronic pain can come with additional challenges. No one but you can understand your pain. So, you will have to be extra diligent throughout your claim to win disability benefits for chronic pain. We will discuss how to do this in the following sections.

Diagnosing Chronic Pain for a Disability Case

Since chronic pain is an invisible illness, it is imperative to seek a diagnosis and medical attention as soon as possible. This will give you the best chance at winning disability benefits for chronic pain.

There are a few ways to do this; however, it will depend on your situation and the cause of your chronic pain.

One possible direction is to obtain a diagnosis for a pain-related impairment. These impairments could include but aren’t limited to arthritis, irritable bowel syndrome, gout, Crohn’s Disease, fibromyalgia, carpal tunnel syndrome, injury, as well as neurological and spinal disorders.

To do this, you must prove that your pain caused by a medical condition or trauma that is already known to cause pain.

In this situation, you need to show you have undergone medical testing to determine the cause of the pain. If the problem is easily diagnosable, such as back trauma as a result of an accident, the cause of your chronic pain will be visible on an x-ray. However, the causes of chronic pain are frequently vague and hard to understand, even for those in the medical field.

Chronic pain sufferers must also prove that they have completed all available treatments necessary to relieve the pain. These treatments may include taking appropriate medications, getting injections, doing physiotherapy or massage therapy, seeing a chiropractor and looking for help at pain clinics. During the disability claims process, a judge will be more likely to believe the pain is serious if a person has received treatment and it is ongoing.

If you are a victim of chronic pain, please do not be afraid to get the support you need. Seeing a doctor and exploring various avenues of treatment will not only benefit your health but can also be a big help in securing disability benefits.

Further effects of chronic pain

In most cases, chronic pain cooccurs with other conditions such as mental health problems and sleep disorders. We will discuss how these issues will affect your claim.

Mental health and chronic pain

Chronic pain is more than a physical disorder. The medical field has accepted that living with chronic pain also results in many psychological problems. So, when dealing with a chronic pain disability claim, you must also take your mental health into consideration.

The Canadian Pain Society supplies us with this devastating and frightening statistic: those who suffer from chronic pain are 50 percent more likely to commit suicide than those who do not.

Additionally, the Canadian Mental Health Association reports chronic pain typically affects every aspect of the sufferer’s life. The physical pain not only limits your ability to work but also inhibits your ability to enjoy the world around you. Trying to avoid or prevent chronic pain can seriously limit your usual activities such as personal care and grooming as well as social and leisure activities. It even encroaches on time spent with your family. You can become a prisoner, trapped in your own pain, which only enhances feelings of depression and isolation.

The stress associated with chronic pain is difficult enough to deal with on its own. But navigating the proper channels to assure you will receive benefits may also cause anxiety or feelings of hopelessness.

You should document and include any mental health issues in your claim. It is also important to provide documentation that shows you are seeking treatment for any psychological aspects of chronic pain. Failing to get this type of treatment can be fatal to you and your disability case.

Sleep disorders and chronic pain

Not only does chronic pain affect your mental well-being, but it can also lead to chronic sleep deprivation, as well. According to the Sleep Foundation, chronic pain and insomnia are frighteningly intertwined in a vicious cycle. A lack of sleep can change the way your body processes pain. And sleep deprivation can cause hypersensitivity that can enhance your pain. At the same time, pain usually makes it difficult to sleep or reduces your sleep quality. This creates the perfect concoction to worsen both your pain and sleep quality.

When applying for long-term disability benefits for chronic pain, you should also include that you are suffering from insomnia or other sleep-related issues. Lack of sleep inhibits your ability to function in the workplace and directly relates to an inability to work the way you did before you became a victim of chronic pain.

Types of Long-Term Disability Benefits for Chronic Pain

When it comes to claiming long-term disability benefits for chronic pain in Canada, you might be eligible for one of two types of disability benefits: the Canada Pension Plan (CPP) and long-term disability insurance.

CPP Disability Benefits for Chronic Pain

The CPP was designed to support Canadians after retirement. However, it also covers disability benefits that start once you become disabled and last until you are 65. After that, these disability benefits get converted into regular pensions.

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.

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 day 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 Benefits for Chronic Pain

Group disability insurance are the most common type of disability benefits in Canada. 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 often provide both long-term and short-term disability benefits.

You may also have an individual insurance policy. These policies are common with those who are self-employed or under insured. With private policies, the payment is usually a fixed amount. However, it might also be a percentage of your earnings.

If you are suffering from chronic pain, you can apply for the long-term disability benefits if eligible. If your application is approved, these benefits will provide you with monthly income payments during long absences from work in order to relieve some financial strain and pressure.

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 Common Disability Benefits for Chronic Pain

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.

Workers Compensation

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 chronic pain.

To succeed in this claim, you need a medical doctor to support your belief that the workplace injury or illness is the direct cause of your chronic pain.

Workers’ compensation payments can overlap with EI, CPP, 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 Pain

Chronic pain is a disease that is misunderstood and frequently dismissed. For that reason, you must be extra diligent in your claim.

Here are some things you can do to improve your chances of winning disability benefits for chronic pain.

Get a diagnosis

As discussed earlier, securing a diagnosis of chronic pain can be challenging. However, having a diagnosis will vastly improve your chances of winning disability benefits. Without one you are significantly less likely to get approved. If you haven’t already, book an appointment with your doctor to start your journey to getting diagnosed.

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 denial.

This requirement covers all other conditions as well. For example, if you also have a sleep disorder or depression, along with chronic pain, you must get treatment for each condition. This can include medications, consultations with psychiatrists, or psychological treatments. Multidisciplinary pain clinics now count as appropriate treatment option as well.

Make sure your doctor is accurately documenting all of this as well. At the end of the day, benefit providers base their decisions on the medical documents they have received. Even if you received world-class treatment for chronic pain without the proper documentation, you received no treatment from the insurer’s standpoint.

Document pain from sustained sitting or standing

Chronic pain can limit you from sitting or standing for prolonged periods of time. This is some of the best evidence of disability from work. Many jobs require you to sit at a desk for an extended time. If your pain seriously prevents you from doing this type of work, you have a good chance at getting approved for disability benefits.

You must document movements throughout the day to present as evidence. You have to prove that you cannot sit or stand for a long time without experiencing severe pain. The pain must prevent you from performing your job duties. If you can sit for more than two hours, your pain might not be as severe as it seems. However, if you are unable to do that, you have a strong case for winning disability benefits for chronic pain.

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 pain.

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 pain, make a note of that too.

Credibility is key

It is vital that a person seeking disability benefits for chronic pain maintains a level of total honesty throughout the process. When it comes to making a legal claim to disability benefits associated with chronic pain credibility is intensely important.

Because chronic pain cannot be objectively and exactly measured through traditional medical avenues such as blood tests or x-rays, it is important that the chronic pain sufferer does not pursue any activities that could undermine believability in regards to his or her status as a chronic pain sufferer.

Any exaggerations or inconsistencies in descriptions of pain or disability can hurt credibility, even if the inconsistency is an honest mistake.

Credibility killers

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

Credibility boosters

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 to do After a Denial of Disability Benefits for Chronic Pain

You’ve filled out the forms, and you’ve compiled as much evidence as you could, and yet, the letter you get in the post informs you that you have been denied disability benefits for chronic pain.

Despite the pain, you find yourself forced back into the working world to provide for yourself and your family.

This is a tough time. I’ve seen it over and over again with my clients. Being told that your condition doesn’t warrant financial support only adds humiliation and frustration to the chronic pain. On top of that, forcing yourself back to work can have devastating consequences on your physical and mental health.

The good news is that you don’t have to simply accept this as a harsh reality. You can appeal the insurance company’s decision instead. I have years of experience with disability benefits claims, including many cases of chronic pain. I know what you are going through, and I’m confident I can help you. You have a choice. You don’t have to let the insurance company deny you the support you are entitled to by law. Book a free consultation today by filing out the form at the bottom of the page or by calling (888) 732-0470.

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