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 for knee disorders can be an uphill battle. Although knee disorders are visible, you will still need to prepare very diligently to win the benefits you deserve. Winning won’t cure your knee disorder — but 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 preparing your application. If you are suffering from knee disorders in Canada, I can help you take your first steps toward securing the support that you are entitled to.
This article will highlight things to keep in mind during your diagnosis and treatment, types of disability benefits you might qualify for, specific challenges in preparing your claim for knee disorders, and final thoughts on approaching the overall process. This article is part of our series examining medical conditions and disability benefits.
Is Knee Pain a Disability?
Yes. Knee disorders and knee pain are considered disabilities in Canada, and those who suffer from them can qualify for disability benefits.
However, a diagnosis on its own will not qualify you.
Benefit providers pay benefits to people who can prove their condition prevents them from working. When reviewing claims for knee disorders, providers focus on the seriousness of your symptoms. They will consider the medical treatment you have had and future treatment plans. They look at how your symptoms affect your work and how hard you try to keep working.
Documenting Your Diagnosis is Key
A comprehensive strategy to win payment of disability benefits must take into account three key things: your occupation, the specific disability benefits provider, and your medical condition.
In the case of your medical condition, gaining a firm diagnosis is step one. You could be suffering from a wide variety of knee related-pain. Your pain could be dull and achy or sharp and severe. It could be gradually worsening, sudden, or persistent. The location may vary, too. Your pain might be along one or both sides of the knee, behind the knee, around the kneecap, or in the knee joint itself.
The pain could be triggered in various ways. You might be encountering pain in everyday activities, by overuse, or by an actual injury. You’ll have noticed if the pain is worsened by moment, rest or inactivity, or by prolonged sitting and standing.
Many symptoms may accompany your knee pain. Bruising and discolouring, locking and catching, a decreased range of motion, popping and snapping, or a feeling of instability could go hand in hand with the pain. Other accompanying symptoms might be skin redness, a grating sensation, swelling, the inability to bear weight, warmth to touch, and joint weakness.
If you haven’t received a diagnosis, now is the time to start working toward that. When you go to your doctor, understanding your pain will help your doctor make the diagnosis. He or she will ultimately diagnose one of many knee disorders.
Types of knee disorders:
- knee bursitis,
- a torn meniscus,
- patellar tendinitis,
- Patellofemoral pain syndrome,
- sprains and strains,
- an ACL injury,
- Baker’s cyst, fractures,
- or Osteochondritis dissecans.
As you get this diagnosis, begin to record what potential recovery periods and the likelihood of full recovery might be.
The knee is a complicated area, so be aware this is only a short list of possible diagnoses. If you haven’t already, you should see a doctor as soon as possible to help confirm a diagnosis. A knee disorder that prevents you from working is good enough to start the process of applying for disability benefits.
A successful doctor’s diagnosis of a knee disorder is no guarantee your disability claims will also be successful, but it is an important starting point. Be steady and diligent in gaining your diagnosis. The clinical signs of your knee disorder must be well documented in your medical records as you approach the disability benefits claims process.
It can be very difficult to secure a diagnosis and get acknowledgment from your employer. But once you are properly diagnosed with a knee disorder, you’ve taken a critical step toward winning your disability benefits. The next step is preparing a successful disability insurance claim. You may have spent a long time fighting chronic knee 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 knee disorders, you should be aware of which disability benefits you qualify for in general.
Types of disability benefits for Knee Disorders
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 knee disorders
The CPP program, 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.
Long-term disability insurance benefits for knee disorders
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 a knee disorder, 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.
How to Win Disability Benefits for Knee Disorders
There are specific challenges in preparing your long-term disability benefits to claim for knee disorders.
I’ve already described the steps you should take to gain a firm diagnosis for knee disorders. Remember, an insurance company or the CPP disability administration will not approve your long-term disability benefits for a knee condition just because a doctor diagnosed you with the condition.
If only it were that easy.
To win disability benefits for a knee disorder, the true challenge is to prove that your symptoms render you unable to function in any workplace while taking into account your age and work experience.
You will have to present a well-organized application with well-documented medical evidence. In addition to the comments and descriptions made above, here are the main points to consider for knee disorders.
Get a diagnosis
As discussed earlier, securing a diagnosis 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 the denial.
This requirement covers all other conditions as well. For example, if you also have a sleep disorder or depression, along with a knee disorder, 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 knee disorders without the proper documentation, you received no treatment from the insurer’s standpoint.
Monitoring and recording your difficulties
Knee disorders 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 of getting approved for disability benefits for knee disorders.
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.
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 a knee disorder.
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 knee disorders maintains a level of total honesty throughout the process. When it comes to making a legal claim for disability benefits associated with knee disorders, credibility is intensely important.
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
Have You Been Denied Disability Benefits for a Knee Disorder?
You’ve filled out the forms, and you’ve compiled as much evidence as you could —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 knee pain. Having to force yourself back to work on knees that aren’t healthy can have increasingly 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 knee disorders. Unfortunately, insurance companies don’t understand knee disorders very well or carry unrealistic expectations about recovery from knee injuries. 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.
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