Applying for and winning short or long-term disability benefits for migraine and headache disorders in Canada can pose serious challenges.
Because headache disorders don’t always appear as abnormalities on CT scans and MRIs, doctors don’t always correctly diagnose them, and insurers often deny claims on that basis.
If migraines, cluster headaches, or tension-type headaches (TTH) are preventing you from being able to work, this article contains essential information that can help you prepare to file a winning claim for disability benefits. This article is part of our series looking at disability benefits and medical conditions.
You are not alone. Around four million Canadians suffer from migraines and other debilitating headache disorders. Severe headaches are so disruptive to quality of life that the World Health Organization (WHO) has classified them as one of the top 20 causes of disability worldwide.
Types of Migraines, Cluster Headaches, and Tension-Type Headaches
Debilitating headaches come in several types. These are some of the most common.
Migraine headaches. Migraine headaches are a primary headache disorder (meaning they are not caused by an underlying disease as is the case with secondary headache disorders) that usually emerges in adolescence and increases in severity with age. Migraines are caused by inflammation of the blood vessels and nerves in the brain. Migraines are recurrent headaches that come on quickly in the form of “attacks” and often affect sufferers for their entire lives.
Symptoms of migraines include a headache of moderate to extreme severity, nausea and sometimes vomiting, and pain that tends to be localized on one side of the head. They can last anywhere from a few hours to a few days. Physical activity and light tend to aggravate the symptoms. Some sufferers experience warning symptoms such as visual disturbances, a subcategory of a migraine known as a migraine with “aura.”
Cluster headaches. Cluster headaches are also a primary headache disorder and are quite rare, affecting fewer than one in 1000 adults. Men are six times as likely as women to suffer from cluster headaches, and the disorder is most likely to affect adults.
The disorder consists of recurring, extremely painful headaches that are very short in duration. The headaches are localized near the eye on one side and are accompanied by eye redness and tearing. Cluster headaches may be episodic or chronic.
Tension-Type headaches (TTH). The most common of the headache disorders, TTH affects at least 1% of adults. It often begins in adolescence and affects women more often than men. TTH can be caused by stress or by muscle tension in the neck. TTH can be episodic or chronic, with chronic TTH being much more debilitating.
Migraine, Cluster, and Tension-Type Headaches Come with Hidden Costs
Headache disorders come with severe costs for patients and their families. In addition to the physical pain, migraines and chronic headaches come with social and financial costs and a reduced quality of life. Sufferers are often unable to work, which results in a significant financial burden. Additionally, headache disorders frequently prevent sufferers from leading a full social life and can put a strain on family relationships.
Chronic headaches have been shown to be linked to an increased likelihood of clinical depression, and the fear of migraine or cluster headache attacks can cause significant stress and anxiety for the sufferer.
Which disability benefits for migraines and headache disorders do I qualify for?
Canadians who find themselves unable to work due to headache disorders can seek benefits from two different disability programs: CPP disability benefits, and long-term disability insurance benefits.
CPP Disability Benefits for Headaches
The Canada Pension Plan (CPP) is a federal government program designed to replace earnings lost due to disability, death, or retirement. The plan is available in all provinces other than Quebec, where the Quebec Pension Plan (QPP) offers a similar program. All workers over the age of 18 in Canada contribute to the Canada Pension Plan out of their earnings. To qualify for disability benefits, patients must meet three criteria:
- The disability must be “severe,” meaning that it prevents you from engaging in sustained paid work of any kind, and it must be “prolonged,” which means that it is a long-term disability that is either unlikely to be resolved or will result in death
- The patient must be under the age of 65
- The patient must have contributed to the fund for 4 of the last 6 years OR 3 of the last 6 years if you have contributed for 25 years or more
The eligibility requirements may seem simple, but in reality, the majority of disability claims filed with the CPP end up being rejected. Unfortunately, being disabled and providing truthful information about your condition is often not enough. However, those who are serious about obtaining disability benefits or who have recently had a claim denied do have options.
Long-Term Disability Insurance Benefits for Headaches
Group disability insurance programs are a common benefit employers offer to workers in Canada. They usually pay a set percentage of your income in the event that you become disabled and find yourself unable to work.
Benefits are paid out until you return to work, or until you die or reach the age of 65. Group disability policies come in two varieties:
Any Occupation. With this type of policy, you are required to prove that you cannot perform any type of work in order to receive benefits
Own Occupation. Far preferable, these policies provide benefits once you prove you cannot perform the job you had when you became disabled
You can also purchase an individual disability insurance policy if your employer does not offer one, if you are self-employed, or if the benefit amount of your policy does not meet the level of income you would need if you were to become disabled.
Winning disability insurance claims when you are covered by a group or individual insurance policy can be just as difficult as securing benefits from the CCP. Private insurance companies exist to make a profit, while paying disability benefits comes at the expense of their bottom line, which means they will often go to great lengths to deny your claim.
How to Win Disability Benefits for Migraine and Headache Disorders
Unfortunately, headache disorders such as a migraine, cluster and tension-type headaches are often under-diagnosed and under-treated, which leads to patients going without necessary treatment and can lead to disability claims being denied.
It is important to remember that CCP and insurance company administrators are looking for reasons to deny your claim. The most common reasons claims are denied are that the agency reviewing the claim decides there isn’t sufficient proof that a headache disorder is debilitating enough to warrant disability benefits, or that the patient has not explored every possible treatment option before submitting a disability claim.
Shore up your claim by making sure you have covered all the points administrators will be looking at when evaluating your application for disability benefits:
What disorder have you been diagnosed with, and how did your doctor reach that diagnosis? Insurance claims adjusters usually place a strong emphasis on CT scans and MRIs, which often do not indicate any abnormalities, despite the intense pain the patient suffers on a regular basis. It is therefore essential that your doctor follows proper diagnostic protocols and that your medical records contain the results of any and all tests necessary to rule out other conditions.
Make sure that your doctor keeps detailed records of your condition and treatment, and follows proper diagnostic and treatment protocols. It may also be helpful to keep a diary or journal of your symptoms, the extent to which they disrupt your activities, and the treatments you employ.
A diary or journal can be helpful both in helping your doctor arrive at a diagnosis and in demonstrating the degree of impairment a headache disorder causes.
Show That Your Headache Disorder is Disabling
Claims administrators will be looking for evidence that will help them decide whether your headache disorder is actually debilitating to the point that it prevents you from working.
- How frequent are your headaches?
- How severe are they?
- How many times have you visited the hospital due to your migraines, cluster headaches, or tension-type headaches?
Your medical records must demonstrate that the headaches occur often enough and with enough severity to prevent you from working.
Explore All Treatment Options
In order to help ensure that your claim is taken seriously, your doctor must follow accepted treatment protocols for your headache disorder, and you must be able to demonstrate that you have tried a variety of treatments and medications that have not resulted in enough of an improvement to allow you to return to work.
Treatments for migraine and other headache disorders can include a variety of different pain medications, medications that aim to prevent migraines, anti-nausea medications, as well as anti-depressants and beta-blockers that have been shown to help with migraine symptoms.
Without detailed medical records of the treatments you have tried, claims administrators will attempt to deny your claim for lack of evidence that you have done everything you can to treat your headache disorder and return to work.
Still Feeling Unsure About Your Disability Claim? Sometimes a quick call with us can answer your concerns and help you move forward with confidence. Call us now at 888-732-0470 for a free consultation or click here to schedule one online.