Living with chronic pain can make every workday feel impossible, yet many working Canadians don’t realize that long term disability chronic pain claims are both valid and potentially payable under their workplace benefits. However, insurers routinely scrutinize chronic pain LTD benefits requests because symptoms can’t always be confirmed by a single test, leading far too many workers to see their long term disability claim denied for “insufficient proof.”
In this guide, we explain how insurers define chronic pain, outline the medical documentation you’ll need, and show you how an experienced disability lawyer for chronic pain can overturn an unfair denial. By understanding the insurer’s criteria and providing robust medical evidence for chronic pain, you can secure the financial support you deserve while focusing on healing, not paperwork.
What are long term disability benefits?
Your workplace benefit package may include long-term disability (LTD) benefits. Your long-term disability benefit is income replacement, designed to provide financial stability while you are unable to perform your job. It replaces a portion of your income, typically between 50% and 80%, if a serious illness or injury prevents you from working. The exact amount depends on the terms of your policy. This monthly income is meant to provide “peace of mind” when you are not well.
What happens when your injury or illness leads to chronic pain that lasts for months or years? Does your long-term disability benefit cover chronic pain?
Long term disability and chronic pain claims
Chronic pain can interfere with daily life, lasting months or years and can affect any part of your body. Depression and anxiety can often develop for those dealing with chronic pain. Chronic pain can also impact daily functions. Those suffering from a slipped disc may experience shooting pain when their chronic pain symptoms flare up. Others may experience depressive episodes from pain experienced from a longstanding rotator cuff injury. People suffering from chronic pain often use different treatment modalities including medications, therapies and lifestyle changes.
Regardless of your condition, if your chronic pain condition keeps you from working, you should consider applying for long term disability.
How is chronic pain defined for long-term disability benefits?
From a medical standpoint, chronic pain is pain that lasts for over three months. The pain can be felt consistently or it may come and go. Chronic pain can occur anywhere in your body and has countless causes. Pain is your body’s indicator to you that something is wrong. When the pain indicator is on for a prolonged period, your mental and physical health takes a significant toll.
Common types of chronic pain:
- Arthritis or joint pain
- Fibromyalgia
- Headaches, including migraines
- Nerve pain
- Back pain, including herniated or degenerating discs,
Why do long term disability providers deny claims for chronic pain?
When you submit a claim for long term disability based on chronic pain to your insurance company, it often has an objective and subjective component to it. The objective component measures how the symptomology or flare up impacts your body. The subjective component measure is reported by you in describing the pain you are feeling along with frequency and intensity.
LTD insurers find it difficult to navigate through the objective and subjective components of a chronic pain claim. Consequently, it is not uncommon to have a claim denied. Consider this example – Joe is a long tenured welder, who herniated his disc when he was a teenager. When Joe is younger, his body is able to support himself through rigorous hours of work. As his body becomes older, the pain increases to a point where he is no longer able to continue pushing through due to his back injury. If Joe makes an LTD claim, the insurer will most likely question how he was capable of welding for several years before he said he was unable due to his back.
If Joe is denied his claim for LTD, he may need to hire a disability lawyer to challenge the denial of his benefits.
What documents need to be provided for a long-term disability chronic pain claim?
Aside from providing routine medical documents requested by the insurer, an insightful letter from your longstanding medical practitioner about how your chronic condition has changed impacting your ability to work would be of aid. This letter would help the insurance adjuster understand or provide some insight into why you are currently unable to work despite the chronic nature of your condition.
If your insurance provider for long term disability has denied your chronic pain claim it may be time to speak to a disability lawyer. Chronic pain conditions can be complicated so it’s important to work with a knowledgeable disability lawyer who understands your condition. At Whitten & Lublin, the disability legal team offers a free consultation for short- and long-term disability matters. Contact us online or call 416 640 2667.
Author – Aman Chaggar
