Does irritable bowel syndrome qualify as a disability in Canada?
Due to the unpredictable nature of the condition and the physical toll it takes on the body, IBS falls under the umbrella of conditions that qualify as a disability in Canada. However, proving your case of irritable bowel syndrome is debilitating enough to keep you from working is another issue.
To receive disability benefits for your irritable bowel syndrome, you must prove that your condition is too severe to maintain regular employment. You must also prove that you’ve made every effort to stay employed and accommodate your IBS symptoms. Due to the sensitive nature of this condition, many people don’t report their condition, and insurance providers will use this to downplay the overall severity of IBS. So, yes, it does qualify as a disability in Canada, but it can be tricky to prove this to your insurance providers and receive long-term disability benefits.
Employment and disability rights for irritable bowel syndrome
If your irritable bowel syndrome has become too severe for you to stay employed, you have rights in Canada. Human rights laws dictate that no one may be fired as a direct result of their disability and that employers must make accommodations for disabled employees. True, anyone can be fired with proper reasoning and enough notice – however that reasoning cannot be linked to a disabling condition.
Since employers have a duty to accommodate their employees, requesting sick leave isn’t an unreasonable request. Most workplaces will have no issue granting this leave, as long as a doctor recommends it. A doctor’s note is sufficient, and this note should include the need for time off and the amount of time required. A doctor’s note must be resubmitted every three to six months for extended leaves of absence.
If you apply for long term disability benefits while on sick leave and your claim is denied, you may remain on leave while you appeal. Know your legal rights if your employer attempts to terminate you while you’re on sick leave. You may be entitled to severance pay, and if the reason for your termination is unjust, you may be able to have the decision reversed.
Types of disability rights for irritable bowel syndrome
Not all disability insurance plans are the same. Here are the typical benefits included in Canadian disability insurance plans:
Paid Sick Leave
Some workers will have a bank of sick time to use in the first days of disability. The intent of this benefit is to allow the worker to have a few days to get back to work. Some workers may have many weeks or even months of accrued time to use.
If you do not believe that you will be able to return to work before your paid sick leave is exhausted, be sure to complete an application for disability insurance benefits right away. You do not need to wait until you have used all your paid sick leave before submitting your application. Also, it is always easier to work on a disability application while you are being paid so don’t wait until your benefits have run out.
Another major reason not to wait to apply for STD Benefits is because of deadlines that may apply. You may miss the deadline to apply for benefits because you are being paid sick leave benefits.
Employment Insurance Sickness Benefits
Your alternative to paid sick leave is government provided employment insurance (EI) benefits. Most workers have fewer than 15 weeks of paid sick leave so EI benefits will make up the difference between the expiry of paid sick leave and a STD Benefit. EI Benefits must be applied for through the government. In order to apply, you must obtain a medical report from your doctor and a Record of Employment (ROE) from your employer.
Go to www.servicecanada.gc.ca for information on the EI sickness benefit and to download the application forms. Service Canada will not process your application until both the medical form and the ROE has been submitted, so be sure to book a doctor’s appointment and request your ROE right away.
Short-Term Disability Benefits
The first of two main benefits in most disability benefit plans are STD Benefits. The purpose of STD Benefits is to provide you with income while you are unable to work due to illness or disability. The Benefit is designed to cover short absences and not intended to be a long-term solution.
STD Benefits provide a weekly or bi-weekly payment for a number of months. The short pay periods are designed to provide you with uninterrupted income while you are absent from the workplace. Most often, you will be required to use accrued paid sick time before accessing your STD Benefits. While cashing in sick time may be frustrating for some, it is wise to accept this condition because the sick time should provide you with more income than the STD Benefit.
The STD payment typically provides for a percentage of your regular weekly earnings or a specific amount of money. The benefit payment calculation details are specific to the policy and set out in the insurance policy document.
Payment examples include:
• The worker will be paid 60% of his or her pre- disability weekly earnings, or
• The worker will be paid $500 per week, or
• The worker will be paid their pre-disability weekly earning, up to a maximum of $500 per week.
Most STD Benefits last between three and six months. If the group plan does not have a LTD Benefit, the worker will have no further benefits under the group policy.
Long-Term Disability Benefits
LTD Benefits are the second major element of most group disability plans. There are some plans, however, that only include LTD Benefits. If your plan has both STD and LTD Benefits, a disabled worker will ‘roll over’ to the LTD Benefit at the expiry of the STD period if they are eligible to do so.
Eligibility for LTD Benefits is not always a given. Workers often earn their eligibility to the Benefits through working continuously for the employer for a number of months.
Eligible workers will be able to make a claim for LTD Benefits if they have been out of work continuously for a specific period of time. This period of time is typically the length of the STD Benefit. This period of time set out in the policy wording is referred to as a “waiting period” or “elimination period”. LTD Benefits will not be paid prior to the elimination period; however, benefits will be paid for the total period of continuous disability if the claim is approved.
Benefit payments under a LTD Benefit are assessed based on a percentage of your pre-disability income. Typically, the benefit will be between 55% and 75% of your regular earnings, or a set amount of money per month. Other polices will have a net formula.
Payment examples include:
• The worker will be paid 66.7% of their monthly pre-disability earnings, or
• The worker will be paid $3,000 per month, or
• The worker will be paid 66.7% of his or her monthly pre-disability earning up to a maximum of $3,000 per month.
The exact payment formula will be set out in the policy document. Be sure to refer to your policy to confirm what the applicable payment formula is for your claim.
The LTD Benefit will make payments on a monthly basis for a set number of years (e.g. 5, 10, 20), or until you reach a certain age (e.g. 60, 65, 67). Some plans may have a benefit termination formula where a mixture of the years a claimant received benefits and the claimant’s age is used to calculate an end date. Generally speaking, the latest date where a claimant will be eligible for Benefit payments is called the Maximum Benefit date.
How to win disability benefits for irritable bowel syndrome
To win disability benefits for irritable bowel syndrome, you must prove that your condition is debilitating enough to prevent you from working full or part-time. The first step to filing any long term disability benefits claim is to present a file full of medical evidence, including an official diagnosis.
Along with your official medical diagnosis, your file should also state other symptoms correlated to or because of your IBS. Since the nature of this condition can be stressful and sometimes embarrassing, it is not unusual for those with IBS to suffer from decreased mental health. Constantly being on edge about when you might need the bathroom and where the nearest bathroom is located can cause depression and anxiety. Having your doctor diagnose these issues and the physical symptoms are crucial evidence supporting your claim.
Even with your medical file supporting your claim, you also need to prove to the insurance company how and why each of your symptoms keeps you from working. For instance, if you are constantly up all night making trips to the bathroom, recording your extreme fatigue can help support your case. This evidence supports your claim if you have had to be late to work, cut a presentation short, or put a call on hold because you needed the washroom. Some workplaces track when an employee is working on a task, and if you have a significant amount of time ‘off-task’ due to needing the washroom at work, this also supports your long term disability benefits claim.
Showing the insurance provider how severely your IBS impacts your ability to perform at work is key to being successful in claiming long term disability benefits. It can feel uncomfortable to discuss such personal matters, but remember they’re the ones asking for proof, and you’re only telling the truth. These personal details are necessary when it comes to winning your benefits claim.
How to hurt your long term disability claim for irritable bowel syndrome
- Inconsistent statements or diagnosis in your claim or medical file
- Not having an official diagnosis or relevant testing done to confirm your IBS
- Having a negative attitude towards those working on your claim
- Lack of effort in altering duties at work to stay employed
How to improve your long term disability claim for irritable bowel syndrome
- Present a file full of medical evidence supporting your claim
- Keep a record of missed time at work, and instances where your IBS directly affected your ability to stay employed
- Provide ample evidence of your efforts to stay employed and how you worked with your employer to lighten your task load
- Cooperate with those who are working on your claim
- Be honest, and provide factual truths when discussing your claim
Common reasons for denial of irritable bowel syndrome claims
Most often, long term disability claims are denied due to a lack of evidence. This can mean either a lack of medical evidence or a lack of evidence supporting the claim that your IBS is too debilitating to keep working.
Any gaps or holes in your claim will be enough for an insurance company to justify denial. Insurance companies want to see plenty of data and documentation regarding your irritable bowel syndrome. This can include all prescription medications used to treat your IBS, any medical testing related to your IBS, and any other relevant mental health symptoms that stem directly from your IBS. Any missing data in your file is grounds to have your claim denied.
Even if your medical file is solid, your claim can still be denied. Insurance providers want to see precisely how and why your irritable bowel syndrome prevents you from working. Any missing information or reasoning will be enough to have your claim denied. Some may think that insurance companies can fill in the blanks themselves, but they are not in the business of approving benefits claims if they can prevent it.
If your claim for long term disability benefits is denied, you can still appeal. Before you appeal, you must fill in any holes in your claim to present a more robust argument. Hiring a lawyer to help you identify what you must do to strengthen your claim can tip the scales in your favor and help you receive the benefits you deserve.
What if your claim is denied?
Know that you are part of a large group of Canadians who have had their benefits denied by the insurer at some point during the course of a claim. Those who have been issued a denial letter are those who had their application rejected by the insurer. They were deemed eligible to apply for benefits, but not totally disabled and therefore were not approved for benefits. Those who have been issued a termination letter are those who were approved for benefits but were then found not totally disabled. The insurance company generally chooses to terminate benefits at or before the two-year mark from the date of disability.
For those who have been denied, some will be legit mate because the applicant is not in fact disabled. Other applicants are truly disabled but were simply denied by the adjuster because their application was not strong enough to warrant approval. Of course, the insurer would prefer that denied applicants forgo the appeal process and not sue for benefits.
For those who were approved and then cut off sometime afterwards, the insurer is attempting to ensure that the denial is accepted by the insured during the “own occupation” period. This is ideal for the insurer as it may prevent appeals or legal claims. Thus, it allows the adjuster to close the file well before the Change of Definition date occurs.
You cannot change the fact that the insurance company denied your claim. However, you do have complete control over what you do in response to the denial or termination of benefits.
The options available to the applicant will depend on what is permitted by their policy or plan. In most cases, the applicant can advance their claim to an internal appeal mechanism or commence a lawsuit. If a plan is through a non-profit disability benefit trust fund, it is likely that only an internal appeal mechanism will be available to them. For these workers, they have been denied the right to have a neutral court decide whether or not they are entitled to benefits.
WHAT IS THE DIFFERENCE BETWEEN A DENIAL LETTER AND A TERMINATION LETTER?
It is a bad day for any disabled worker when they receive a denial letter or termination letter. The letter is essentially a rejection of financial support in a time of need and it leaves most people very worried about their financial future. After receiving a letter, some disabled people experience severe declines in their mental or physical health because it feels like their expected safety net has been ripped out from beneath their feet.
What the disabled person does after receiving a denial letter or termination letter is critical. First, be sure that you keep a copy of the letter. Photocopy and safely store a copy of the letter before making any marks on the letter. Any competent disability lawyer will want to see a clean copy of the letter to review at an initial meeting.
The denial letter is also important as it offers a window into the insurance company’s decision-making process on your file. The letter should (but does not always) spell out what information was reviewed and what findings were made with respect to the information in your file. The insurer should explain why your application was denied, or why you are no longer entitled to benefits. For new claims, the denial will typically mention that while your injuries cause you to suffer some restriction, you do not meet the test for total disability. For cases where a benefit termination letter is sent, the insurer will often mention that activities (often from surveillance evidence or information from phone calls) are inconsistent with reported restrictions and limitations. The explanation provided in other circumstances will parrot select wording from the medical expert chosen by the disability insurer. Once you have sorted out why you were denied, you can then determine what you can do to attempt to overturn the unfavourable decision.
Warning! There is a lot of misinformation about insurance policies and the rights that come with them. Do not rely on the word of a union representative, co-worker, or supervisor to explain your rights and ideal strategy when facing an insurance benefits claim. This is especially so where there is no right to sue. While they may have the best intentions, they may not have the best advice. Contact an experienced disability lawyer to avoid a major claims mistake.
