According to Statistics Canada, approximately 7.63 million Canadians suffer from chronic pain conditions. Fibromyalgia, arthritis, and migraine are some of the most common chronic pain conditions that affect millions each year. Persistent pain can affect all aspects of one’s life – work, school, family and community. Unmanaged pain symptoms also cause sleeplessness, hopelessness and significant mental stress. According to Canadian Community Health Survey, mood disorders can be three times more common in people with chronic pain conditions.
For too long, chronic pain has been unrecognized, and its far-ranging impacts ignored. It may be impossible to continue to work when suffering from a chronic pain condition. Disability insurance may be one of the ways to support you when you are disabled from working. As a lot remains unknown about chronic pain conditions, many chronic pain disability claims get denied by insurance companies. In this blog, we provide tips for filing disability claims and discuss why insurance companies deny chronic pain claims.
Are you eligible to receive disability insurance for chronic pain?
Individuals who lost their income and are unable to work due to a chronic condition may be eligible to apply for disability benefits through their individual or group insurance plan. However, getting disability benefits may be especially challenging in case of a “subjective” medical condition like chronic pain.
To qualify for a group disability insurance plan, you will need to be actively at work at the time of making your claim. This may be challenging for people suffering from chronic pain conditions. The onset of chronic pain tends to be gradual, and the individual suffering from the illness may start missing more and more days at work and even lead to reducing their working hours over a prolonged period.
Unfortunately, failing to maintain your working hours may compromise your eligibility to receive disability insurance or may result in significantly reduced benefits. Some policies cover circumstances where you are partially disabled and other policies only cover you if you are totally disabled. Before you make drastic changes to your work schedule, you should read your disability policy to see under what circumstances you are covered. It is crucial to file disability insurance claims on time and be aware of the different factors which may lead you to lose coverage.
What you need to know before submitting a disability claim
If you are suffering from a mental health disorder and are planning to apply for a disability claim, you should take the following steps to increase the likelihood of your claim being accepted.
1. The definition of disability may vary depending on the insurer.
An insurance policy is a contract that outlines the terms and definitions which need to be met for you to qualify for coverage. To be eligible for disability insurance, you will need to demonstrate that your condition prevents you from performing your job duties.
Each disability insurance contract has a definition for a “total disability.” This term, most commonly, means that the claimant is unable to perform the substantial or necessary duties of her own occupation and following a prescribed time limit, the definition may change to include being disabled from any occupation.
To learn more about a change of definition from “own” to “any” occupation, read our blog about the common reasons for disability insurance denials.
2. Meet the deadlines
Review your insurance booklet and make sure you submit your claim within the outlined period for the “notice of claim.” You should also be aware of the deadline to submit the “proof of claim” – the supporting medical documentation showcasing your disability.
If your claim has already been denied, your insurer will notify you of a timeframe to file an appeal. Whether you choose to go through the internal appeal process or pursue litigation, it is in your best interest to seek legal advice the moment your claim is denied.
3. Provide the necessary evidence
Under the insurance policy, you have an obligation to provide sufficient medical evidence to support your claims. You should collect all evidence that demonstrates how your illness progressed and affected your ability to function. The evidence may include specialist and doctor’s notes, any test results such as X-rays, MRIs, CT scans, etc., and your medical history. It would help if you also tried to document the illness by recording the symptoms, frequency, and pain levels in a pain journal.
Make sure that you are being treated by a doctor experienced in treating mental health disorders. It can be your GP, but it is even better if the treatment comes from a psychiatrist or psychologist.
Why are chronic pain disability claims denied?
Getting a chronic pain disability claim denied can be extremely discouraging. Unfortunately, chronic conditions fall under the category of “invisible illness” — a long-term condition that, while disabling, cannot readily be “seen” or “understood”. Despite the prevalence of chronic pain conditions, there is no authoritative definition of chronic pain, which makes it easier for insurance companies to be dismissive of such claims.
One of the main reasons for chronic pain claim denial is the lack of objective medical evidence. It can be challenging to accurately diagnose chronic pain conditions because these conditions often cannot be supported by objective findings through medical tests. Yet, the experience of chronic pain is real and can be as disabling as other more visible conditions.
Why should you consider hiring an insurance denial lawyer?
Many insurance companies may struggle to understand chronic illness and the extent to which it limits one’s functional ability. If your claim has been denied, you may choose to file an appeal on your own. Yet, it is crucial to understand that an insurance appeal is an internal insurance process done by the insurance agents. This means that appeals often do not result in a different decision about disability claims.
Whether you have launched your appeal or just received a denial letter, speaking to an insurance denial lawyer can help you understand your chances of getting the disability benefits. An insurance denial lawyer will assist you in presenting the evidence and telling the story of your disability in a way that insurance companies will understand.
Chronic pain conditions may be highly disruptive to an individual’s life and ability to work. Chronic pain is complex, challenging to diagnose, and often misunderstood. Since chronic pain can be classified as an invisible illness, proving such a condition may be highly challenging.
Knowing your insurance policy, being aware of the deadlines to submit the claim, and collecting all necessary evidence can significantly improve your chances of getting a claim approved. However, if an insurance company denied your chronic pain disability claim, it is in your best interest to speak with an insurance denial lawyer. If you have any questions regarding your disability insurance claim, contact the experienced team of lawyers at McQuarrie.