Headaches and Migraines

The Challenges when making an LTD Claim for Headaches and Migraines

Anyone who has experienced a severe headache, such as a migraine, will tell you that the pain can make it impossible to think or work effectively, if at all. A single migraine may last as long as three days, during which time the sufferer is generally rendered wholly incapacitated. Although the pain begins in the head, migraines can present physical symptoms throughout the body.

Chronic migraines affect hundreds of thousands of Canadians every year. Typical symptoms of a migraine include throbbing pain, unsettled stomach, nausea, and pain caused by use of the senses – especially sight. Yet even when they are not currently experiencing a headache or migraine, the sufferer may be subject to symptoms caused by an oncoming headache or by recovery from one. These symptoms may be similar to the experience of a migraine, but may also include mood swings and vision problems. Non-migraine headaches may have fewer or no additional symptoms beyond pain in the head, but can be similarly debilitating.

The product of these agonizing symptoms is that severe headaches and migraines force many Canadians out of the workforce. Headaches and migraines create difficulty in performing any type of work because the main symptom-aggravators are exposure to light, and both physical and mental exertion, which are conditions present in almost any work environment. Yet, despite the potential severity of headaches and migraines, and the devastating impact they can have on one’s work-life, insurance companies often treat this ailment as an illegitimate reason for a long-term disability claim. This is, in large part, due to a lack of understanding of headaches and migraines as well as the difficulty in measuring symptoms.

While prevalent globally and one of the earliest ailments to be studied by humans, many aspects of headaches and migraines remain poorly understood. Headaches are considered either ‘primary’ or ‘secondary’ headaches. Secondary headaches are indicative of, or result from, an underlying disorder such as a concussion or brain tumour. These represent the minority of headaches.

Most headaches are primary headaches. Primary headaches are not indicative of another condition or injury, but can nevertheless be chronic of their own accord. Some environmental and genetic factors may spur on primary headaches, but scientists still cannot make definitive statements about what causes them. Primary headaches are apt to be misdiagnosed as secondary headaches, and cannot be identified by MRIs or CT scans, unlike other brain disorders. Even if identified, there remains no outright cure for primary headaches. As a result of the lack of information on this ailment, insurers can be skeptical of long-term disability (LTD) claims stemming from migraines or headaches.

As detailed in a previous article on why long term disability benefits may be denied, LTD claims may encounter several common snags which can form the basis for a denial. Because headaches and migraines can be difficult for medical professionals to diagnose and treat, disability claims for these conditions are more vulnerable to denial and have their own pitfalls which can hinder individuals making disability claims.

Due to the challenges in making an LTD claim for chronic migraines or headaches, it is particularly important that you are proactive in terms of your healthcare and especially, with respect to keeping records. The most important step that you should take is to keep a diary of your condition, including how you felt and were impacted by symptoms on a given date. Without tangible evidence of your symptoms, your records will be a crucial authority. It is important to note that these daily records are dramatically more authoritative than merely providing after-the-fact testimony on what you remember.

The unexplainable nature of headaches denotes the importance of advocating firmly for yourself with your healthcare providers. Feel free to seek out a second opinion if you are not satisfied with your current physician, and ensure that your doctor is keeping suitable records. Unrecorded visits to your doctor or therapist are valueless with respect to your claim. The evaluation of your long-term disability claim will consider the verve with which you sought out treatment and whether you received ongoing treatment over time.

While headaches and migraines have no simple cure, there is medication that can dull or minimize the symptoms. Migraine treatment may include medication to alleviate the effects of persistent nausea or vision problems that often accompany the headaches, and/or simple pain medication for the headaches themselves.

To prove that you are entitled to long-term disability benefits, you must provide evidence of specific symptoms associated with your migraines or headaches. These symptoms may not entirely preclude you from all work-related activity, but they must be both substantial and relevant, in terms of affecting your ability to perform the necessary aspects of your employment.

Be prepared for a thorough assessment by your insurer. Your LTD insurance provider will evaluate your personal and medical records, check into your background, and may choose to interview you and/or require that you submit to an independent medical examination. Your credibility will be partly assessed on whether you were accurate, consistent and forthright in reporting your symptoms and whether you sought treatment for your migraine or headache symptoms over some time. Inaccuracies or contradictions in your statement can provide the basis for a denial of your claim.

Be aware that all LTD insurance policies have time limits on when you can make a long-term disability claim after suffering a disability. It is important that you know your specific policy’s terms and submit your LTD claim as early as possible.

When a disability benefits claim is denied, many claimants first attempt to pursue justice via the insurance company’s own appeals process; however, the appeals process promises no quick decision and claimants may wait years for a decision. Not only is this frustrating, but it can mean you may pass the time frame in which you can bring a law suit against your insurer (as the insurer can argue that this time frame begins when they first denied your claim). Also, your insurance company has greater capacity to scrutinize your records during the internal appeal process than they would during litigation. Thus, the insurance companies’ internal appeals process is a snare intended to delay and deny your disability claim, and often, the insurer will not budge from their original judgement in denying your claim.

If your disability claim was denied, a knowledgeable disability claims lawyer provides the best option for favourable resolution of your claim. The lawyers at Kotak Personal Injury Law possess a wealth of experience in successfully resolving long-term disability disputes for our clients. Contact our office for a free consultation today.