When a serious medical condition prevents you from working, long-term disability (LTD) benefits can provide crucial financial support. However, getting your claim approved is not always straightforward. Many people find their applications denied, often because the insurance company questions the severity of their condition or the evidence provided. Understanding which medical conditions commonly qualify for LTD benefits is the first step toward building a successful claim.
Navigating the complexities of a disability claim can be overwhelming, especially when you are focused on your health. Insurance policies have specific definitions of “total disability,” and providing the right medical documentation is key. An experienced disability lawyer can help you understand the fine print, gather the necessary evidence, and advocate on your behalf to secure the benefits you deserve. This post will explore the top 10 medical conditions that often qualify for long-term disability benefits in Canada and what you need to know for each.
Understanding “Total Disability”
Before diving into specific conditions, it’s important to understand what insurance companies mean by “total disability.” This term doesn’t always mean you are completely helpless.
Typically, for the first two years, you are considered totally disabled if your illness or injury prevents you from performing the essential duties of your own occupation. After two years, the definition often shifts. To continue receiving benefits, you must prove you are unable to perform any occupation for which you are reasonably suited by education, training, or experience.
- Depression and Anxiety Disorders
Mental health conditions are one of the most common reasons for long-term disability claims. Conditions like major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD) can be debilitating, making it impossible to concentrate, manage stress, or interact with others in a work environment.
Why it qualifies: These conditions directly impact cognitive functions and emotional regulation, which are essential for most jobs.
Strengthening your claim: Consistent treatment records from a psychiatrist or psychologist are vital. A detailed report from your specialist outlining your symptoms, treatment plan, and how your condition functionally limits you from working is powerful evidence.
- Chronic Pain
Chronic pain is a persistent pain that lasts for weeks, months, or even years. It can stem from an injury, an ongoing condition like arthritis, or have no clear cause. Unlike a broken bone that heals, chronic pain is an invisible illness that can make performing even simple tasks incredibly difficult.
Why it qualifies: Constant pain can affect concentration, mobility, and endurance, preventing you from sitting, standing, or focusing for extended periods.
Strengthening your claim: Keep a detailed pain journal documenting the intensity, frequency, and location of your pain. Reports from pain specialists, physiotherapists, and other medical experts can corroborate your experience and its impact on your daily life.
- Heart Disease and Stroke
Cardiovascular conditions like congestive heart failure, coronary artery disease, or the aftermath of a heart attack or stroke can have a lasting impact on your ability to work. These events can lead to physical weakness, fatigue, cognitive difficulties, and an inability to handle physical or emotional stress.
Why it qualifies: The physical and cognitive impairments following a serious cardiac event can make returning to a demanding job unsafe or impossible.
Strengthening your claim: Medical records from cardiologists or neurologists are essential. Diagnostic tests such as stress tests, echocardiograms, and MRIs can provide objective proof of your condition’s severity. A functional capacity evaluation can also demonstrate your physical limitations.
- Cancer
A cancer diagnosis is life-altering. The disease itself and its treatments, including chemotherapy, radiation, and surgery, can cause extreme fatigue, pain, nausea, and cognitive issues (often called “chemo brain”). These side effects can make it impossible to maintain a regular work schedule.
Why it qualifies: Both the illness and its aggressive treatments are physically and mentally draining, preventing individuals from meeting the demands of their job.
Strengthening your claim: Your claim should include comprehensive reports from your oncologist detailing your diagnosis, treatment plan, and prognosis. Document all side effects and how they interfere with your ability to perform daily and work-related tasks.
- Fibromyalgia
Fibromyalgia is a complex disorder characterized by widespread musculoskeletal pain, fatigue, and issues with sleep, memory, and mood. As an “invisible illness,” it is often misunderstood, and individuals with fibromyalgia may face skepticism from insurance adjusters.
Why it qualifies: The combination of chronic pain, severe fatigue, and cognitive fog (known as “fibro fog”) makes sustained work activity extremely challenging.
Strengthening your claim: A diagnosis from a rheumatologist is crucial. Your medical file should include documentation of tender points, ongoing symptoms, and treatments you have tried. Testimony from family and friends about how the condition affects your daily life can also be helpful.
- Chronic Migraines and Headaches
Chronic migraines are much more than just a bad headache. They are a neurological disease that can cause debilitating, throbbing pain, nausea, and extreme sensitivity to light and sound. When migraines occur frequently, they can make consistent employment impossible.
Why it qualifies: The unpredictable and severe nature of chronic migraines prevents individuals from reliably performing their job duties.
Strengthening your claim: A headache diary is critical for tracking the frequency, duration, and severity of your migraines. A report from a neurologist confirming your diagnosis and outlining failed treatment attempts can show that your condition is resistant to management.
- Irritable Bowel Syndrome (IBS) and Crohn’s Disease
Digestive diseases like Irritable Bowel Syndrome (IBS), Crohn’s disease, and ulcerative colitis can cause severe abdominal pain, cramping, and an urgent, frequent need to use the washroom. The unpredictable nature of these symptoms can make it difficult to be present and productive at work.
Why it qualifies: The frequency and urgency of symptoms, combined with chronic pain and fatigue, can severely disrupt a person’s ability to adhere to a work schedule.
Strengthening your claim: Medical records from a gastroenterologist, including results from colonoscopies and other diagnostic tests, are necessary. A personal journal tracking your symptoms and their impact on your daily routine can provide compelling evidence.
- Organ Failure
When a major organ like the kidneys, liver, or lungs begins to fail, the body cannot function properly. Conditions like chronic kidney disease requiring dialysis or advanced liver disease lead to extreme fatigue, weakness, and a host of other debilitating symptoms that make work impossible.
Why it qualifies: Organ failure is a critical, life-limiting condition that requires intensive medical treatment and severely impacts a person’s energy and overall health.
Strengthening your claim: The medical evidence for organ failure is typically clear and objective. Your file should include diagnostic imaging, lab results, and reports from specialists outlining your diagnosis and treatment requirements, such as dialysis schedules.
- Degenerative Disc Disease and Back Injuries
Back problems, including degenerative disc disease, herniated discs, and spinal stenosis, are a leading cause of disability. These conditions can cause chronic pain, numbness, and weakness in the back and limbs, limiting your ability to sit, stand, walk, or lift objects.
Why it qualifies: Persistent pain and physical restrictions directly hinder your ability to perform the tasks required in most occupations, whether sedentary or physically demanding.
Strengthening your claim: MRI or CT scan results provide objective evidence of spinal issues. Reports from an orthopedic surgeon or physiotherapist detailing your physical limitations are key. A Functional Capacity Evaluation can also provide an unbiased assessment of what you can and cannot do.
- Multiple Sclerosis (MS)
Multiple Sclerosis is a progressive, unpredictable disease of the central nervous system that disrupts communication between the brain and the body. Symptoms vary widely but can include fatigue, numbness, mobility challenges, vision problems, and cognitive impairment.
Why it qualifies: The progressive and fluctuating nature of MS symptoms makes it increasingly difficult to maintain consistent work performance over time.
Strengthening your claim: A diagnosis from a neurologist is the first step. MRI scans showing lesions on the brain or spinal cord offer definitive proof. Documenting the progression of your symptoms and how they affect your functional abilities is essential for a successful claim.
What to Do if Your Claim is Denied
Having one of these conditions does not guarantee your LTD claim will be approved. Insurance companies often deny valid claims, hoping you won’t fight back.
If your claim has been denied, or you need help starting your application, it is important to act quickly. You have a limited time to appeal the decision. Don’t navigate this difficult process alone. Seeking legal advice can make all the difference. An experienced disability lawyer at Kotak Law understands how to challenge an insurer’s decision and build a strong case to get you the compensation you rightfully deserve.
Contact us today for a free consultation to discuss your case and learn how we can help you fight for your rights.
