Qualifying Medical Conditions for Long Term Disability (LTD) Benefits

The prevalence of disability has increased with age, rising from 13% for those aged 15 to 24 years to 47% for those aged 75 and over. If you are a Canadian resident living in Ontario and have an insurance plan through your employer or an independent insurance broker, and you have a permanent disability or a serious and long-term medical condition that prevents you from working, you may be eligible for Long-Term Disability benefits (LTD). 

Long-Term Disability (LTD) is a kind of income replacement benefit that pays you a portion of your income if you are unable to work due to illness or injury for an extended period of time. It is worth emphasizing that long-term disability benefits are often part of a private insurance plan purchased and paid for by an employee via his or her employer, rather than a government disability plan such as CPP Disability.

For this article, we will be introducing you to the qualifying medical conditions for Long-Term Disability (LTD) Benefits to help you gain a greater understanding of the following:

1. What Medical Conditions Are Eligible for Long-Term Disability Benefits?
2. Common Types of Disabilities Covered by Long-Term Disability Insurance
   • Chronic Pain (Back Pain, Fibromyalgia, Arthritis, IBS, Nerve Pain, Sciatica)
   • Mental Health & Psychological Illnesses (PTSD, Anxiety, Depression, Schizophrenia, Bipolar Disorder)
   • Cardiovascular Conditions (Hypertension, Chronic Heart Disease, Heart Attack, Stroke, Coronary Artery Disease)
   • Neurological Disorders (Stroke, Parkinson’s Disease, Multiple Sclerosis, ALS, Epilepsy)
   • Respiratory Conditions (COPD, Chronic Lung Disease, Asthma)
3. Summary

 

What Medical Conditions Are Eligible for Long-Term Disability Benefits?

In Ontario, most illnesses or injuries qualify you for long-term disability. Because disability insurance claims are not based on a diagnosis. Rather, their authorization is based on your medical condition’s limitations. It’s crucial to remember, however, that how a policy defines “disability” determines how much, and even if you may receive LTD payments after an injury or sickness.

For example, you might have a major illness like Multiple Sclerosis (MS) but not be labeled “totally disabled” right away. Some insurance providers, however, may cover you regardless of the degree or type of illness or injury you are suffering from. That is if you have a disability that prohibits you from completing all or most of the obligations of your current employment.

However, a diagnosis alone is not sufficient to approve LTD compensation. When filing a claim, insurance companies still require a thorough diagnostic. A firm diagnosis defines your treatment plan, which is also necessary for insurance companies to approve a claim. Thus, it is vital to remember that the specified treatment plan must be approved by your insurance carrier. Considering that, if they disagree with your treatment plan, they might reject your claim and cease paying you.

NOTE: Some insurance may exclude coverage for current WSIB-covered injuries or illnesses.

 

Common Types of Disabilities Covered by Long-Term Disability Insurance

Each long-term disability insurance (LDTI) policy in Ontario differs from the next. Given that each insurance company has its own definition of what constitutes a “disability,” this will influence what, if any, benefits you may be eligible for. Having said that, certain disability insurance plans will continue to pay you a monthly benefit as long as your accident or disability prohibits you from working at your regular employment. Whether or not you are still capable of performing other forms of job. Other policies, on the other hand, will not pay benefits if you can work in another field, even if you make less money.

Furthermore, it is essential to understand that many disability insurance policies exclude particular conditions. In these circumstances, to be eligible for LTD benefits such as income replacement and medical treatment coverage, your medical condition or accident must fulfill the criteria of “disability” as defined by the insurance policy.

The following are some illnesses and injuries that qualify as “disability” under most insurance policies:

• Musculoskeletal Issues (Arthritis, Sciatica, Scoliosis, Fibromyalgia, Carpal Tunnel, Spinal Stenosis, Back, Degenerative Disc, etc.)
• Personal Injuries (accident, slip, fall, penetrating head injury, brain injury, trauma, fractured spinal injury)
• Chronic Pain (back pain, Fibromyalgia, Arthritis, IBS, Nerve Pain, Sciatica)
• Mental Health and Psychological Illnesses (PTSD, Depression, Schizophrenia, Bipolar Disorder)
• Cardiovascular Conditions (Hypertension, Chronic Heart Disease, Heart Attack, Stroke, Coronary Artery Disease)
• Neurological Disorders (Stroke, Parkinson’s Disease, Multiple Sclerosis, ALS, Epilepsy)
• Respiratory Conditions (COPD, Chronic Lung Disease, Asthma)
• Cancer
• Diabetes

NOTE: When selecting an LTDI plan, we recommend that you consult with the provider or insurance agent to understand what constitutes a “disability” under that plan.

 

Musculoskeletal Issues (Arthritis, Sciatica, Scoliosis, Fibromyalgia, Carpal Tunnel, Spinal Stenosis, Back, Degenerative Disc, etc.)

Medical conditions such as arthritis and musculoskeletal issues are a leading cause of long-term disability in North America. As they account for nearly one third of disability insurance claims.

Musculoskeletal conditions often cause pain, stiffness, and a loss of mobility and dexterity, as well as physical and mental health issues, all of which can lead to long-term disability. Studies indicate that individuals with osteoarthritis have a high frequency of developing more than one disease or condition at a time. Such as hypertension, depression, and metabolic syndrome and its components in isolation. What is more, the negative effects of these serious medical conditions can affect your health and well-being for even longer, as you get older.

Common symptoms often associated with long-term musculoskeletal conditions are pain, disability, poor general health, and even mortality. Thus, impeaching on one’s mental health. Musculoskeletal functionalities include supporting the body, protecting internal organs, and facilitating movement. 

When affected, long-term disability may cover some common musculoskeletal conditions, such as:

• Arthritis and Osteoarthritis
• Scoliosis
• Fibromyalgia
• Carpal Tunnel
• Spinal Stenosis
• Degenerative Disc
• Neck and Cervical Disorders

 

Personal Injuries (Accident, Slip & Fall, Penetrating Head Injury, Brain Injury, Trauma, Fractured Spinal Injury)

A personal injury can be debilitating and may hurt your financial well-being. With long-term disability insurance, you can help protect your finances, whether you are currently working full-time, part-time, or not at all.

In Canada, if you have been in an accident resulting in a personal injury through no fault of your own, you are entitled to receive monetary compensation from disability benefits. In accordance with insurance policies, monetary compensation (‘damages’) is intended to cover any medical costs, lost wages, emotional suffering, physical pain, mental anguish, diminished quality of life, loss of support and companionship, as well as disability accommodations for your home and vehicle that you might incur as a result of your injury. Canada offers two ways to seek compensation for a personal injury and other losses: a lawsuit or you can file a claim and negotiate a settlement.

The personal injuries for which you can seek monetary compensation include:

• Dismemberment
• Significant scarring or disfigurement
• Bone fractures
• Significant limitation or loss of a body organ
• Serious injuries that require expensive surgery (herniated discs)
• The death of a loved one

Some of the most common personal injury claims you can file in Ontario are as follows:

• Motor Vehicle Accident (MVA) Claims (car, truck, motorcycle, or bus)
• Pedestrian Accident Claims
• Slip & Fall Accident Claims
• Assault Claims
• Wrongful Death Claims
• Workplace Accident Claims

 

Chronic Pain (Back Pain, Fibromyalgia, Arthritis, IBS, Nerve Pain, Sciatica)

Chronic pain conditions are defined as pain that persists much longer than is normally expected, often due to a variety of causes. What is more, chronic pain may affect a specific part of the body, particularly if it is the result of a previous injury. Otherwise, it may occur in various parts of the body, sometimes simultaneously. Statistics show that approximately 6 million Canadians suffer from chronic pain, which can often be a debilitating illness. 

Moreover, it can be recognized that people suffering from chronic pain have the lowest quality of life among long-term conditions.

Additionally, people suffering from chronic pain may also experience additional physical and mental health issues, such as constant fatigue and reduced energy levels, often due to nonrestorative sleep. Ongoing fatigue and persistent pain can often lead to depression, which can further reduce a person’s ability to perform activities of daily living or regular work. In addition to depression, chronic pain sufferers may also experience heightened anxiety levels.

If you have coverage under long-term disability insurance and suffer from chronic pain as a result of an injury or disability that is both serious and long-lasting, then you may qualify for LTD benefits in Ontario. Particularly, if your medical condition is disruptive to your life emotionally and physically, and it affects your ability to perform the duties of your job. Some of the most common disabling chronic pain conditions eligible for LTD benefits are as follows:

• Chronic Nerve Pain
• Chronic Back & Neck Pain (Nerve Damage, Arthritis, especially Osteoarthritis)
• Cancer
• Endometriosis in women
• Psychogenic Pain (also known as Psychosomatic Pain, caused by psychological issues and triggers)
• Fibromyalgia (a chronic condition characterized by widespread pain, MS)
• Injuries sustained from an accident (MVA or falls)

According to research performed by the Mayo Clinic, some of the most common forms of pain are as follows:

• Back & neck pain
• Headaches
• Joint pain
• Pain from nerve damage or injury
• Pain due to cancer or fibromyalgia

 

Mental Health & Psychological Illnesses (PTSD, Anxiety, Depression, Schizophrenia, Bipolar Disorder)

Suffering from a mental illness can often impact your ability to perform activities of daily living. Fortunately, most mental health and psychological illnesses can be managed so long as you are provided adequate treatment and support. For instance, long-term disability benefits, aid those who are suffering from mental health and psychological illnesses by covering a portion of their monthly salary. That is as long as their mental illness impedes their ability to perform the regular duties of their job for an extended period. 

Some of the most common mental health conditions covered under LTD are as follows:

• Mental Retardation
• Depression
• Posttraumatic Stress Disorder (PTSD)
• Bipolar Disorder
• Alcohol or Drug Disorders
• General Anxiety Disorders

Over the years, mental health and psychological illnesses have become increasingly common within Canada. In fact, according to the Canadian Mental Health Association, close to 50% of the Canadian population will have suffered from some sort of mental illness by the time they’re 40. What’s more, because mental health issues are often considered an invisible disabilities, employers often get suspicious when their employees seek out disabilities for conditions such as depression, anxiety, or PTSD. 

However, so long as your employer offers disability insurance coverage, under their policy, you are entitled to claim LTD benefits in the event that you are able to prove that you are disabled and unable to work. That being said, it is always a good idea to examine your disability insurance policy to determine whether other options are available to you.

NOTE: Nearly every LTD policy has an outlined pre-existing condition clause, which can cause problems for mental health claims. Since insurance companies often take a more relaxed approach when determining whether or not a mental health disorder is a pre-existing condition.

 

Cardiovascular Conditions (Hypertension, Chronic Heart Disease, Heart Attack, Stroke, Coronary Artery Disease)

Cardiovascular conditions like heart disease, also known as ‘coronary artery disease (CAD) or ‘ischemic heart disease,’ are caused by fatty deposits, calcium deposits, inflammatory cells, or plaque buildup in the arteries. This creates a constriction in the bloodstream, which causes the heart to suffer from a lack of oxygen—a condition known as ischemia. But this can also lead to a wide range of other cardiovascular conditions, such as angina, arrhythmia, atrial fibrillation, and heart failure, all of which have the potential to slow down or completely stop a patient’s heart.

In recent years, heart disease has become a fairly common condition among the working class in Canada. In fact, according to the Heart Research Institute, approximately 29% of deaths in Canada are the result of heart disease. Moreover, in January 2017, the Government of Canada reported that about 2.4 Canadians aged 24 years or older suffer from ischemic heart disease.

What is more, a large percentage of patients who suffer from CAD often experience few if any symptoms, indicating a problem prior to a potentially life-threatening episode, such as a heart attack. While it is possible for anyone to develop CAD throughout their lifetime, your odds are significantly increased if you have a family history of CAD, smoking, hypertension, or diabetes. However, in rare situations where you begin to develop noticeable symptoms prior to a heart attack, the most common symptoms you might experience are as follows:

• Angina
• Chest, shoulder, back, jaw, or neck pain
• Shortness of breath
• Nausea
• Vomiting
• Fatigue
• Sweating
• Irregular heartbeat

In Canada, there are two main sources of disability benefits for cardiovascular conditions, such as the Canada Pension Plan (CPP) or Long-Term Disability (LTD). However, claiming Canadian disability benefits for cardiovascular conditions such as heart disease can be difficult to prove legitimate. This is due to the unique and undetectable nature of the disability. However, in recognizing the unique nature of your condition, you will be able to choose the right approach for your claim. This includes finding a suitable doctor to properly diagnose your condition and, if necessary, a lawyer who is well-informed about CAD.  

The approval of all cardiovascular disability claims is based on the negative impact of the disease and its symptoms on your overall work performance. Specifically, with regards to how your condition makes it impossible for you to maintain optimal performance. As such, in order to claim disability benefits for heart disease, you must be able to prove that your symptoms are due to myocardial ischemia—a blockage of the coronary artery. Additionally, by tracing the root cause of your disease back to the workplace, you can further strengthen your chances of having your claim approved. It also becomes crucial to proving that the best treatment for heart disease sufferers is to avoid any activity that might trigger the symptoms of CAD to begin with. 

Some of the most common cardiovascular conditions, for which you might be eligible to claim LTD benefits are as follows:

• Chronic congestive heart failure (the heart’s natural pump is compromised)
• Ischemic coronary heart disease (reduced blood flow to the heart)

• Symptomatic congenital heart disease (structural defects leading to malfunction, causing cyanosis—bluish skin from oxygen deprivation)
• Aneurysm of the aorta or other major heart branches (swelling due to weakness in the blood vessel wall)
•  Chronic venous insufficiency (ineffective circulation of blood from the veins in the leg to the heart)
• Peripheral arterial disease (obstruction of large arteries to the extremities)
• Heart transplant (to remedy end-stage heart failure or severe coronary heart disease)

NOTE: Ensure that you keep records of any and all medical tests run by your doctor, as well as records of any specialists that you were referred to and visited.

 

Neurological Disorders (Stroke, Parkinson’s Disease, Multiple Sclerosis, ALS, Epilepsy)

Neurological disorders are conditions that affect the brain and the central nervous system, including the peripheral nervous system and spinal cord. The scope of these disorders is wide-ranging, with over 600 types of neurological disorders in existence. Symptoms of neurological disorders can range from mild to severe, depending on the individual’s condition. For instance, some neurological disorders are episodic in nature, meaning the sufferer will only experience symptoms periodically, such as seizures. Some neurological disorders can be managed by things like diet, medication, and physical therapy. However, many neurological conditions often result in large-scale changes to a sufferer’s quality of life.

That being said, you are qualified to receive LTD benefits if you have a neurological disorder that renders you “totally disabled” as that term is defined under your long-term disability policy. The important component in establishing a claim for long-term disability benefits connected to a neurological disorder is demonstrating how the condition affects your capacity to work. This can be a complicated procedure depending on the policy language. Seeing as different LTD policies may have different definitions of what qualifies as being “totally disabled,” which is what you will be required to prove in order to receive benefits. 

Some examples of common neurological disorders that may qualify you for LTD benefits are as follows:

• Alzheimer’s Disease
• Huntington’s Disease
• Dementias
• Epilepsy among other Seizure Disorders
• Multiple Sclerosis (MS)
• Parkinson’s Disease and other Movement Disorders (Muscular Dystrophy)
• Stroke and Transient Ischemic Attack (TIA)
• Cerebral Palsy
• Brain Tumors (Benign and Malignant)
• Traumatic Brain Injury (TBI)
• Meningitis
• Severe Migraine Headaches
• Spinal Cord Injuries

Moreover, the approval of your neurological disability claim is largely determined by the documentation of your symptoms. Because people with neurological illnesses are unable to see themselves during an episode, having someone who has experienced your symptoms document their own third-party observations about the extent and severity of your neurological events is critical. In this case, your doctor should be the one to record and report on your symptoms, though it is understood that this is not always possible.

NOTE: You should maintain a journal of all of your symptoms, including the duration, severity, and overall effect on your activities of daily living.

 

Respiratory Conditions (COPD, Chronic Lung Disease, Asthma)

Chronic respiratory conditions are diseases of the airways and lungs that persist over a long period of time, significantly interfering with the breathing and proper lung functions of the sufferer. Asthma and chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, are currently some of the most common chronic respiratory conditions affecting Canadians. The symptoms of respiratory conditions may include coughing, wheezing, and shortness of breath. In fact, COPD patients’ respiratory capacity is often diminished due to blocked airflow into and out of the lungs. Furthermore, it should be noted that as you become older, the severity and impact of chronic respiratory conditions on your health and well-being worsens.

Moreover, if you have a respiratory ailment like asthma or COPD, it might affect your ability to work successfully in a variety of ways. For instance, if your profession requires physical activity, such as heavy lifting or prolonged standing, and you have trouble breathing or are constantly fatigued, you may not be able to perform these tasks, especially on a long-term basis. In such cases, you may qualify to receive LTD benefits. Those covered under a long-term disability plan are eligible for LTD benefits when their symptoms prevent them from performing optimally or returning to work. Additionally, if you are recovering from treatment for your ailment or your doctor recommends that your work environment would worsen your condition due to the severity of your symptoms, you may also be eligible for LTD benefits.

However, long-term disability insurance companies demand you produce well-documented, objective medical evidence, such as pulmonary function tests, when filing an LTD claim for a chronic respiratory condition. This is to demonstrate the seriousness of your condition and its impact on your ability to perform basic activities of daily living. Furthermore, regular treatment from your healthcare provider and/or a suitable expert, such as a pulmonologist, is a crucial step in determining your eligibility. 

Some examples of common chronic respiratory conditions, that may qualify you for LTD benefits are as follows:

• Chronic Obstructive Pulmonary Disease (COPD)
• Cystic Fibrosis
• Asthma or Chronic Asthmatic Bronchitis
• Restrictive Lung Disease (“RLD”)
• Emphysema

 

Summary

At Disability Credit Canada, we specialize in assisting disabled Canadians with their disability claims and applications, such as long-term disability (LTD).

To date, we have helped hundreds of Canadians apply for CPP disability and the Disability Tax Credit. Allow us to help you get approved for long-term disability benefits today! Our purpose is to help educate and inform Canadians about the many aspects of the LTD application and approval process.

If you are interested in applying for LTD benefits or if your LTD application has been denied, please contact us at 1-844-800-6020 for a free consultation. If we can’t, nobody else can help you to get approved!