Does psoriatic arthritis qualify as a disability in Canada?
Psoriatic arthritis counts as a disabling condition in Canada, due to the chronic nature of the condition and how it worsens over time. If your psoriatic arthritis has worsened to the point where you are unable to complete your duties or function at work, then you are likely eligible for long term disability benefits.
However, it can be challenging to prove this to an insurance company and be approved for long term disability benefits. Many people aren’t even aware the condition exists, and it’s not widely discussed. This can make it difficult for the insurance company to fully understand the scope of the condition. Although it may feel like an uphill battle, it’s not impossible, and quite necessary to preserve your joints.
Employment and disability rights for psoriatic arthritis
If you have psoriatic arthritis, you have rights in Canada and at your workplace. Likewise, your employer must accommodate your needs at work. The only option for this condition is pain and symptom management, as there is no cure. Your place of work should work with you to help you minimize triggers and prevent flare-ups as a result of your duties at work.
If you have psoriatic arthritis, you have rights in Canada and at your workplace. Likewise, your employer must accommodate your needs at work. The only option for this condition is pain and symptom management, as there is no cure. Your place of work should work with you to help you minimize triggers and prevent flare-ups as a result of your duties at work.
If your psoriatic arthritis makes it impossible for you to continue to work, then sick leave is a reasonable request that employers should accommodate. A doctor's note is required to be granted a leave of absence. The contents of this letter should indicate that you’ll need time off and the length of time needed. When it comes to more prolonged bouts of absence, these notes must be provided consistently. Every three to six months is a general standard for proving you’re still unable to return to work. You can apply for long term disability benefits while you are on sick leave, and if your request is denied, you can continue to appeal and stay on leave as long as you continue to provide doctors’ notes.
You have legal rights if your employer tries to fire you while you’re away on sick leave or applying for long term disability benefits due to your psoriatic arthritis. You have the right to severance pay, and you also may be able to have your termination reversed if their reasoning involves your condition. These situations can become challenging, so having a lawyer to help you navigate these strenuous situations can be an immense relief.
Types of disability rights for psoriatic arthritis
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 psoriatic arthritis
Winning disability benefits for psoriatic arthritis can be challenging because you must prove to the insurance company that your condition is entirely disabling. The best way to win disability benefits is by submitting a complete and persuasive claim. To win, you must present evidence that fully displays the scope of your condition.
The first step in making your claim is to provide a file full of medical evidence. A complete diagnosis comes after taking a blood test that confirms the presence of arthritis and diagnostic imaging that displays the damage within the joints. A doctor will also need to examine the deterioration of your joints and the loss of strength throughout your body. This will involve several doctor visits, so mentally prepare to commit to that. Provide your doctor with as much information about your pain and symptoms. When submitting your claim, include treatments, prescriptions, and supplements you take to manage your psoriatic arthritis.
Many people with psoriatic arthritis can continue working, so you will have to prove why you cannot do so to the insurance provider. Make sure to include all the information about your pain, how your job affects your duties at work, and anything else to your claim. Insurance companies won’t know what you don’t tell them – and they won’t ask. Being honest with your doctor and advocating for yourself is essential to winning the long term disability benefits you deserve.
How to hurt your long term disability claim for psoriatic arthritis
- Having a medical file missing important tests or an official diagnosis
- Missing your doctors appointments or leaving prescriptions unfilled
- Having a negative attitude towards those involved with your claim
- Giving vague details about how your condition affects you at work
How to improve your long term disability claim for psoriatic arthritis
- Having a file full o medical evidence that supports your claim
- Working with your doctor and providing them with plenty of information
- Cooperating with everyone involved in your claim
- Demonstrating effort to minimize your duties at work and stay employed
- Being polite and friendly to the insurance providers, even if you’re frustrated
Common reasons for denial of psoriatic arthritis claims
The most common reason a psoriatic arthritis disability claim is denied is a lack of evidence. This could mean an incomplete medical file or missing information regarding how it affects your ability to work.
Sometimes doctors don’t fully understand what is needed when filing a long term disability claim, so working with your doctor and being honest with them is the best way to file a claim with all the necessary information.
Insurance companies will often deny a claim because they feel you’re still able to keep working. Even if you know that your condition is making working difficult, if not impossible, insurance providers will still doubt the severity of your psoriatic arthritis.
You’re still able to appeal the decision, but this can take time. Having a lawyer to help you navigate the process and help you fill in gaps within your claim can help ensure 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.
