Long-term disability claims are common. Regardless of the type of claim or how the injury came about, the claim process can be complex and frustrating, particularly when a claim is denied. However, if you have received a denial letter, it is important not to give up immediately. 

Chronic pain causes many individuals to experience significant impacts on their ability to engage in typical day-to-day activities. It is both physically and mentally unpleasant and is often associated with damage to tissues in the body or as a related symptom to various illnesses. Chronic pain is frequently described as pain from injuries or medical conditions that do not subside after approximately three months.

Symptoms of Chronic Pain and Its Impact on Individuals

Chronic pain can be caused by various factors, including motor vehicle accidents, sports accidents, or a symptom of a larger medical diagnosis. It can impair or prevent someone from being able to engage in their daily household activities, such as household maintenance, lawn care, or running errands. It can also impact someone’s ability to perform their job duties, regardless of the type of work, either wholly or in part. Further, there are known connections between chronic pain and psychological issues. 

Disability claims for chronic pain can include symptoms such as arthritis, chronic fatigue syndrome, fibromyalgia, and myofascial pain. While there may not be a direct and obvious physical cause of chronic pain, individuals can experience varying levels of pain on a daily basis. 

A surprising amount of Canadians live with chronic pain and while some are able to manage their symptoms and continue with their daily living activities, for others, it can have devastating effects with very little relief available, particularly when a claim for disability benefits has been denied. 

Applying for Disability Benefits Based on Chronic Pain

If you are unable to work due to chronic pain, you may be entitled to and should apply for long-term disability benefits as soon as possible. Ensuring that you provide sufficient and satisfactory medical documentation is key when applying or appealing a chronic pain claim.

A claim for chronic pain will be assessed based on various factors, including but not limited to:

  • The frequency and duration of your pain; 
  • Functional limitations and restrictions related to employment, household maintenance, sleep, cognitive impairments, impacts on social relationships;   
  • Conditions or factors which aggravate your pain; 
  • Treatments and medications being used to try to manage and treat the pain; and
  • Personal coping methods or management strategies.

Chronic Pain Denials and Appeals

Many long-term disability benefit claims get denied for various reasons. Insurance companies will consider whether it appears that an individual asserting a claim has made attempts to mitigate their losses, whether there is sufficient documentation to support the claim and injuries, and whether the claim condition is due to a pre-existing injury. 

When a claim is denied, it is important to continue with treatment and document anything which is relevant to the claim for the purpose of an appeal. For example, you may be unable to drive yourself to medical appointments due to the pain, and therefore your pain management progress has become delayed. Establishing credibility is an important component of long-term disability claims.

My Claim Has Been Approved… What’s Next?

Once a claim for chronic pain has been approved, it is still important to remain active in treatment and ensure that you are doing the most you can to focus on pain management and strategies to move forward. While it is often the goal of both the insurance company and the individual to return to work at some point, it is important to ensure that an individual continues to receive medical support and advice when navigating their “new normal”.

After two years of long-term disability benefits, the definition of disabled often becomes the question of whether an individual is reasonably able to perform duties and is qualified to perform duties of any occupation, as opposed to their own occupation at the date of the disability. Subsequent medical evidence and opinions are required to meet this test. Further, insurance companies may determine that you do not have a claim or that you are only partially disabled, meaning that you can return to work part-time or on modified duties, which may likely result in less income than the benefits provided. 

Appealing either an initial denial or a denial after two years of receiving benefits can be daunting. It is important to ensure that you have proper assistance and representation, especially should the claim proceedings before the courts, as advocacy for a non-obvious, visible injury is often an uphill fight against big insurance companies. 

Contact the Long-Term Disability Lawyers at Cuming & Gillespie LLP in Calgary for Trusted Advice on Chronic Pain Disability Claims

The experienced lawyers at Cuming & Gillespie LLP understand how frustrating it can be to manage a chronic injury, particularly after an accident, while navigating a long-term disability claim. Whether your claim has been denied or terminated before you are able to return to work, the added stress of deciding what to do next can be overwhelming. Our team will evaluate your claim and provide you with information to determine whether you should pursue a claim. We will advocate on your behalf so that you can focus on your recovery. Contact us online or call us at 403-571-0555 to schedule a free consultation.