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.
- Disability from Migraines and Headaches: You Are Not Alone
- Types of Migraines, Cluster Headaches, and Tension-Type Headaches
- Which Disability Benefits for Migraines and Headache Disorders Do I Qualify for?
- How to Win Disability Benefits for Migraine and Headache Disorders
- What To Do After a Denial of Disability Benefits for Migraines and Headache Disorders
- Next Step – Get Your Free Books
Disability from Migraines and Headaches: 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.
Headache disorders also 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 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 linked to an increased likelihood of clinical depression. Additionally, the fear of migraine or cluster headache attacks can cause significant stress and anxiety for the sufferer.
Types of Migraines, Cluster Headaches, and Tension-Type Headaches
Debilitating headaches come in several types. These are some of the most common.
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.
The two most common types of migraines fall under two categories: migraine with aura (complicated migraine) and without aura (common migraine). Migraines with aura refer to the visual disturbances that accompany a migraine. These visual disturbances include:
- Visual symptoms such as seeing wavy lines, shapes, dots or flashes
- Blurry vision or blind spots
- Temporary loss of vision
- Tingling or numbness in your arms and legs
- Weakness on one side of the body
- Changes to your sense of smell, taste or touch
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 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 headache disorder, 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.
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 six years OR 3 of the last six 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 credible isn’t always 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 common benefits 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 age 65. Group disability policies come in two varieties:
Any Occupation. In this 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 chronic migraines and cluster and tension-type headaches are often underdiagnosed 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 were you diagnosed with? And how did your doctor reach that diagnosis? Insurance claims adjusters usually place a lot of emphasis on CT scans and MRIs, which often do not indicate any abnormalities, despite the intense pain the patient suffers on a regular basis. Therefore, your doctor must follow proper diagnostic protocols and ensure 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
- anti-depressants and beta-blockers that 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.
Evidence of work-related limitations
The most common reason for a denial of benefits is “You didn’t try.” So in order to win benefits, you need to go well beyond saying you can’t do your job. You need to show that you asked for help from your employer to stay at work. Such changes could include fewer hours, easier duties, or changing roles within the company. If your job is medium or heavy, you have to try an easier job with light or sedentary duties.
You need to give evidence to show how hard you tried to stay at work. This evidence can include the following:
- Medical records discussing your work attempts
- Employment records that show places you tried to work and all accommodations made
- A written statement from you that details your work efforts
- Signed written statements from your employer or co-workers describing how they observed your struggle to work
If you give strong evidence showing you tried your best to stay at work, you have a good chance of winning benefits. On the other hand, if you have little evidence of your efforts or evidence that you made no effort, then you have no chance of approval.
Credibility is key
It is vital that a person seeking disability benefits for headaches and migraines maintains a level of total honesty throughout the process. Credibility is intensely important when making a legal claim for disability benefits associated with headaches and migraines.
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 To Do After a Denial of Disability Benefits for Migraines and Headache Disorders
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 migraines or headache disorders.
Despite your 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 your exhaustion. 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 cases involving headaches and migraines. I know what you are going through, and I’m confident I can help you. You have a choice. Don’t 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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