Applying for disability benefits for heart disease in Canada is no easy task.
Even truthful and legitimately disabled people are not guaranteed the payment of benefits, as countless reasons can be given for denying claims. However, those who find themselves unable to work due to heart disease should still look at their qualifications and consider getting disability benefits despite the challenges.
This article is part of our series on medical conditions and disability benefits and provides general information on how to increase your chances of winning disability benefits for heart disease.
Claiming for heart disease is difficult because of the uniqueness of the disability. Unlike other disabilities, it is difficult to prove the condition is legitimate. It truly is a silent killer. People with heart disease usually look relatively healthy. They don’t normally show any physical signs of being “disabled” or unfit to work.
- What is Heart Disease?
- Heart Disease Statistics
- Testing for Heart Disease
- Which Disability Benefits for Heart Disease Do I Qualify For?
- How to Win Disability Benefits for Heart Disease
- Challenges of Applying for Disability Benefits for Heart Disease
- Moving Forward With a Disability Claim for Heart Disease
- What To Do After a Denial of Disability Benefits for Heart Disease
- Next Step – Get Your Free Books
What is Heart Disease?
Heart disease, also known as coronary artery disease (CAD) or ischemic heart disease, is a category of cardiovascular disease that is caused by a build-up of fatty deposits, calcium deposits, inflammatory cells or plaque in the coronary arteries. This creates a block that limits blood supply to the heart, leading to ischemia or cell starvation due to a lack of oxygen. The patient’s heart could slow down or stop completely. Symptoms include chest, shoulder, back, jaw or neck pain, shortness of breath, nausea and vomiting, fatigue, sweating, and an irregular heartbeat.
In order to claim disability benefits for heart disease, the worker must be able to prove that his or her symptoms are due to myocardial ischemia—a blockage of the coronary artery. Diseases that fall under this category include myocardial infarction, stable angina, unstable angina and silent ischemia.
Types of heart disease
- Myocardial infarction/ heart attack. This happens when blood stops flowing to a part of the heart, damaging the heart muscle. The pain feels like heartburn that lasts for a few minutes.
- Stable angina / effort angina. It is usually triggered by physical activity like running or walking. It can also be triggered by emotional stress. Stable angina presents as chest discomfort that dissipates when the trigger is removed or ceases.
- Unstable angina / crescendo angia. Unlike stable angina, it can happen even when the patient is at rest. It usually occurs following a crescendo pattern, with each new incident being more severe than the previous one. This is often an indicator of an impending heart attack.
- Silent ischemia. It is also possible for a patient to suffer from CAD but not exhibit any obvious signs or symptoms. This is aptly called silent ischemia. It can be detected in the same way as the other types of heart disease.
Heart Disease Statistics
Heart disease has reached epidemic levels in Canada. According to 2017–2018 data from the Canadian Chronic Disease Surveillance System (CCDSS), about 1 in 12 (or 2.6 million) Canadian adults aged 20 and over live with diagnosed heart disease.
Heart disease is as common as it is deadly. Every hour, about 14 Canadian adults aged 20 and over diagnosed with heart disease die. Heart disease is truly a silent killer. If you are struggling with heart disease, know that you are not alone. And know that you deserve disability benefits just as much as anyone else.
Testing for Heart Disease
Those claiming disability benefits for heart disease must subject themselves to an abnormal stress test or electrocardiographic testing (EET). Physicians rely on this test to find evidence of blockages in the coronary arteries. The test is conducted by increasing the heart rate, whether through drugs or exercise, and the increase in blood flow to the heart is measured. If the blood flow is not sufficient to meet the demand, then parts of the heart muscle start to starve. The next course of action would be an invasive procedure to open the artery, such as bypass surgery.
EET should not be mistaken for exercise tolerance tests or ETTs. Claims are often denied due to the results of ETTs, which are not very reliable in conclusively diagnosing CAD. False positives or false negatives can occur due to several factors, including medication. Moreover, the results of ETTs can be misleading. Exercises like walking or bicycling done under controlled conditions do not accurately capture the activities done by an employee in a work setting. Cold temperatures, hunger, and stress experienced in the workplace while performing duties would exacerbate the symptoms of heart disease. Thus, a normal ETT does not always indicate a healthy heart.
Which Disability Benefits for Heart Disease Do I Qualify For?
There are two sources of disability benefits for Canadian workers suffering from heart disease: the Canada Pension Plan and Long-term Disability Insurance Benefits.
CPP Disability Benefits for Heart Disease
The Canadian government mandates that employers are required to deduct Canada Pension Plan (CPP) contributions from the salary of their employees. The CPP is a retirement pension, but unknown to many employees, other benefits are also payable under the plan, including survivor, post-retirement, and disability benefits. The last type begins when an individual becomes disabled before the retirement age of 60 or 65 years old. Anyone who has “a severe and prolonged disability” and is considered a recent contributor to the CPP can qualify for benefits. The CPP administration defines a “recent contributor” as someone who has contributed to the CPP in:
- Four of the last six years, or
- Three of the last six years, if he or she has contributed for at least 25 years.
There are two types of disability benefits under the CPP. One is paid to the disabled worker. While the other goes to their children. Those who are approved for CPP disability benefits would receive a taxable monthly payment.
Long-term Disability Insurance Benefits for Heart Disease
Another common type of disability benefits plan in Canada is an insurance-based disability plan. Insurance protects individuals from the risk of accidentally losing the ability to earn income. As such, many workers have group disability insurance policies as part of their employee benefits packages. This means that member employees were insured as part of a group with a common sponsor, usually an employer, professional organization, union or bank. The sponsor buys the policy from an insurance company for the benefit of the group’s members. The coverage can be short-term or long-term, depending on the benefits.
There are also individual disability policies sold to professionals or self-employed business people. These are bought directly from an insurance broker, and the coverage continues as long as the monthly premiums are paid.
For long-term disability benefits, the employee can become eligible for monthly income payments during long absences from work. These payments are computed as a percentage of the worker’s salary, a specific monthly amount, or a combination of the two. These amounts are specified in the insurance policy, along with the maximum period of time that the benefits will be received.
How to Win Disability Benefits for Heart Disease
Heart disease is a disease frequently dismissed because those who suffer from it usually seem relatively healthy. 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 heart disease.
Get a diagnosis
You can’t win disability benefits for heart disease without a diagnosis. If you haven’t already, book an appointment with your doctor to get a diagnosis.
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 the denial of disability benefits.
This requirement covers all other conditions as well. For example, if you also have a sleep disorder or depression, along with heart disease, you must get treatment for each condition. This can include medications, consultations with psychiatrists, or psychological treatments.
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 heart disease without the proper documentation, you received no treatment from the insurer’s standpoint.
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 heart disease.
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 heart disease, make a note of that too.
Credibility is key
It is vital that a person seeking disability benefits for heart disease maintains a level of total honesty throughout the process. Credibility is intensely important when making a legal claim for disability benefits associated with heart disease.
Because the condition is so hard to win disability benefits for, you must not pursue any activities that could undermine your believability.
Any exaggerations or inconsistencies in descriptions of symptoms 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
Challenges of Applying for Disability Benefits for Heart Disease
1. The abnormal stress test has its limitations in detecting myocardial ischemia.
The abnormal stress test is the universal screening test for plaque in the coronary arteries. However, the blockage must be significant enough order to be detected by most types of EETs. As such, they are usually unable to detect the early onset of CAD; EETs are most effective during the latter stages of the development of heart disease. The most accurate type of stress test, the nuclear stress test, has a high sensitivity but also exposes the patient to a high level of radiation, making it not a recommended option.
2. The insurance company will examine the impact of heart disease on your work performance
The approval of a claim is usually not based on the type of heart disease and its level of seriousness. For instance, someone who had a heart attack does not necessarily have a better chance of getting approved than someone who has stable angina. What is more important is the negative impact of the disease and its symptoms on the employee’s performance of his or her work tasks. The CPP administration and insurance companies look at how heart problems make it impossible for a worker to be optimally productive.
3. You need to document the effect work stress has on your symptoms.
A disability benefits claim for CAD can be further strengthened by tracing the root cause of the disease to the workplace. Aside from the worker’s own testimony, evidence about this link could also be gathered from his or her examining physician’s medical documents as well as reports from the immediate supervisor and co-workers. Having a supportive workplace would certainly be advantageous. Also, it is crucial to be able to prove that the best treatment is to avoid any work that might have triggered the symptoms of CAD in the first place.
Moving Forward With a Disability Claim for Heart Disease
Heart disease is a fairly common condition that affects many Canadian workers. Those who suffer from it will find their work adversely affected to the point that claiming disability benefits becomes a necessity. However, the CPP administration and insurance companies make honest workers jump through hoops before they can even get a chance to consider their applications.
Doing the bare minimum is not enough—almost everyone does it to no avail. Recognizing the unique nature of heart disease will allow afflicted employees to choose the right approach for their claims. This includes finding a suitable doctor who will properly diagnose one’s illness and, when necessary, a lawyer who is well-informed about CAD.
Insurance companies commit a lot of time, money and effort to disprove a claim.
Winning CPP disability benefits does not guarantee approval from insurance companies. Just because an employee was successful with a CPP claim does not already prove that he or she is disabled. The CPP administration and the insurance company are two different entities. The latter would dedicate more resources toward finding negative information and evidence against a claim. This could happen even when the same facts and requirements were presented to both institutions. Thus, it is important to create a solid case for disability benefits. The guide above provides specific details on strengthening a claim, especially for long-term insurance.
Your benefits can be terminated without prior notice.
Keep in mind getting approved for benefits is only half the battle. Insurance companies will proceed to find reasons to terminate payments as soon as they get the opportunity. This could take years or just a few weeks. Be wary of any conditions that are stipulated in approvals and be diligent in fulfilling continuing disability reviews. There are insurance companies that become even more ruthless after approving a claim. They might require monthly medical reports or regular calls for updates. Those who have more resources might do undercover surveillance, like secretly videotaping the employee or monitoring his or her online activities. You may also have to participate in rehabilitation programs and counselling. Though these are ultimately for the benefit of the insurance companies, employees might as well take advantage of them so they can make the transition to going back to work.
What To Do After a Denial of Disability Benefits for Heart Disease
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 heart disease.
Despite your need for rest, 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 your symptoms. 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 accept this as a harsh reality simply. You can appeal the insurance company’s decision instead. I have years of experience with disability benefits claims, including many cases of heart disease. 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 filling out the form at the bottom of the page or by calling (888) 732-0470.
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