Heart Disease

Claiming Long-term Disability Benefits for Heart Disease

Heart disease is the second most common cause of death in Canada, after cancer, and according to the Heart Research Institute, about 29 percent of deaths in this country result from heart disease.  More Canadians are living with cardiovascular disease, including heart disease, than ever before.  In January 2017, the Government of Canada reported that approximately 2.4 million Canadians aged 24 and older, have ischemic heart disease.

The Heart and Stroke Foundation describes the incidence of heart failure as endemic, but the good news is that improvements in diagnostics and medical management means that many persons who sustained heart failure or are suffering from heart disease, are able to live longer with their damaged hearts.

What is Heart Disease?

Heart disease is a cardiovascular disease that affects the circulatory system. Heart disease involves the buildup of fatty deposits, calcium deposits, inflammatory cells or plaque in the coronary arteries. This buildup causes a blockage that limits the supply of blood to the heart, causing the individual’s heart to slow down and in serious cases, to stop.  The most common types of cardiovascular disease are myocardial infarction (or heart attack), ischemic heart disease, congestive heart failure and cerebrovascular disease (or stroke).

Nine in ten Canadians over the age of 20 have at least one risk factor for heart disease and 4 in 10 have three or more risk factors. The Heart and Stroke Foundation reports that 50,000 new cases of heart failure are currently diagnosed each year. Heart failure doesn’t necessarily mean that the heart stops beating, but rather, that the heart muscle is not as effective at pumping blood which results in the body getting insufficient amounts of oxygen, blood and nutrients.  Heart failure can affect either the right or left side of the heart (which pumps ‘used’ blood to the lungs or ‘fresh’ oxygenated blood to the body, respectively).

Common symptoms of heart disease or heart failure include the following, and symptoms generally become more pronounced as the person’s condition advances.

  • shortness of breath
  • swelling in the feet, legs, ankles, stomach or the base of the spine, due to retention of fluids
  • sudden weight gain or bloating
  • loss of appetite or a change in appetite
  • pain in the chest, shoulder, back, jaw or neck
  • nausea and vomiting
  • cold or cough symptoms lasting longer than a week
  • fatigue
  • sweating
  • irregular heartbeat

The narrowing of heart arteries associated with ischemic heart disease (or coronary artery disease) often leads to chest pain or discomfort, known as angina pectoris. The chest pain results from a lack of oxygen to the heart. In addition to chest pain, sometimes travelling into the arm, shoulder, neck or back, angina sufferers may also experience heartburn and shortness of breath. Angina or ischemic heart disease is often triggered by stress or exercise, and symptoms may improve when the person rests. Untreated ischemic heart disease may ultimately result in a heart attack.

Of course, many of the aforementioned symptoms are not specific to heart disease, which can make diagnosis of this condition difficult, particular in the early stages.  In fact, a person may have heart disease without showing any obvious symptoms or having only minor symptoms.  Yet, the greater the delay in receiving a diagnosis, the greater the damage and often, the sicker a patient becomes.

Many people suffering from heart disease find it increasingly difficult to maintain their daily activities as the disease becomes progressively worse.  As a result of symptoms, someone suffering from heart disease may not be able to function effectively in their job, particularly Canadians with occupations that require physical or strenuous activity.

The Heart and Stroke Foundation reports that heart disease is the leading reason for hospitalization in Canada.  Heart failure patients are often struggling with other medical issues, such as lung and kidney complications, as well as with psychological issues.  For this reason, heart patients often require repeated diagnostic testing and multiple medications, and medications must be frequently adjusted.  High rates of hospital readmission are common for heart failure patients – about one in five patients are readmitted to hospital within one month, about half of these for heart failure and the remainder due to a related issue.  Repeat visits to the hospital is clearly a very stressful situation for both the patients and their family.

Progressive heart disease or heart failure can affect all parts of the body and all of a patient’s issues and symptoms must be managed together.  Dealing with heart disease is not a quick fix.  After a patient’s symptoms are under control and they are discharged from the hospital, patients need to make lifestyle changes and partake in physical activity and a healthy diet, and patients typically require many months of controlled exercise as they regain some of their strength.   While heart failure can be treated and managed, it cannot be medically cured — ‘recovery’ is the stage where the heart patient learns to live an active and healthy life, within the limits of what is possible, given the severity of their condition.

A 2016 study of 12,000 heart patients, by the European Society of Cardiology, found that one third of the patients hospitalized for heart failure for the first time, did not return to work in their first year.  Older patients (over the age of 50) were found less likely to be able to return to work.  The study also found that patients who had a higher level of education were twice as likely to return to work as those with a high school education, which researchers suggest may be due to the fact that higher educated patients were less likely to have a physically demanding job and more likely to be able to arrange a flexible work life.  The study concluded that heart failure substantially undermines a person’s ability to maintain a normal life.

Filing a Disability Claim for Heart Disease

Canadians suffering from heart disease, who are covered under a long-term disability insurance plan, commonly rely on their long-term disability (LTD) benefits for income replacement when they are not able to complete the required tasks of their job. Many people have LTD coverage under a group insurance plan provided by their employer; others, particularly self-employed persons, may have purchased an individual LTD benefits plan, which similarly provides income replacement benefits when they are unable to work.

Making an LTD claim for heart disease requires that you submit medical evidence from your doctor or health care team, indicating that your symptoms are due to blockage of the coronary artery.  Three common conditions that meet this criterion include: myocardial infarction; stable or unstable angina; and silent ischemia, a condition where the flow of blood to a part of the body is restricted.

The are a number of diagnostic tests and medical imaging that are currently used to identify heart failure or heart disease, and heart patients typically undergo several of these tests in making a diagnosis:

  • Abnormal stress test or EEG (abnormal electrocardiographic testing) to indicate how the patient’s heart reacts to exercise
  • ECG or electrocardiogram
  • Blood tests and BNP tests (brain natriuretic peptide tests)
  • Chest X-ray to show the size of the heart
  • Echocardiogram creates picture of the heart and measures ejection fraction
  • Coronary Angiography and Cardiac Catheterization

An abnormal stress test (EEG) and electrocardiogram (ECG) are particularly helpful in identifying ischemic heart disease or angina, for persons who do not have clear outward symptoms of heart disease but have narrowed heart arteries and the potential for advanced symptoms.

In addition to providing medical evidence for your heart condition in your application for LTD benefits, your claim must include opinion evidence from your doctor which states how your symptoms prevent you from doing the required tasks of your job.  This requires that you, along with your work supervisor, document the critical and important aspects of your job, and you must provide testimony on how your symptoms specifically interfere with your ability to properly carry out these tasks.  Also, if your doctor believes that your condition may worsen if you try to perform work which may trigger your symptoms or are physically too taxiing due to your condition, this medical opinion evidence must be communicated in your claim.

One might think that a serious condition such as heart disease would never be questioned as a legitimate cause for disability coverage; however, insurance companies are in the business of making a profit and accordingly, insurers always closely examine disability claim applications for any potential grounds for rejecting a claim.  There are several common reasons for denying a long-term disability claim, and an experienced disability benefits lawyer offers a far better chance of successful resolution than the insurer’s internal appeal process, if your claim is at first denied.

At Kotak Personal Injury Law, we have helped many clients get the disability benefits they deserve when their application for benefits was rejected. It gives us great satisfaction when our clients receive the disability benefits they are counting on during a period of illness and uncertainty.  If your claim for LTD benefits arising from heart disease was denied or your benefits were terminated while you are still unable to work, talk to a disability claims lawyer at Kotak Personal Injury Law.