Vestibular Disorders

What is a vestibular disorder?

Vestibular dysfunction is a disturbance of the body’s balance system. The vestibular system involves the ears and their connection to the brain. The ear is an intricate system made of bone and cartilage, with a network of canals inside. The channels fill with fluid which changes with movement, and a sensor within relays the message to the brain. The brain then uses this information to control the body’s sense of balance and spatial orientation.

There are various vestibular disorders and different root causes for each. The condition can develop over time or result from an incident. Some vestibular orders come from brain injuries, chemical exposure, adverse reaction to medications, or environmental factors.Symptoms of vestibular disorders include dizziness, vertigo, visual impairment, difficulty focusing, issues with hearing, and spatial disorientation or imbalance. Vestibular disorders often come with mental side effects like depression, anxiety, and a loss of confidence in everyday life. In some cases, cognitive issues accompany the other symptoms, resulting in trouble with memory. Many vestibular disorders will come with physical symptoms like nausea and motion sickness. 

Does a vestibular disorder qualify as a disability in Canada?

Many people develop a vestibular order while they are of prime working age in their adult life. These conditions can deteriorate over time and make it impossible to function at your former level of competence. In some cases, depending on the job, it may not even be safe for someone with a vestibular condition to continue working if they struggle with balance. Vestibular disorders qualify as a disability in Canada due to the struggle and risk associated with these conditions.

Some of the vestibular conditions that qualify as a disability include vertigo, acoustic neuroma, and Ménière’s disease, to name a few. There are many kinds of vestibular disease, so it is strongly recommended to seek out medical testing and identify exactly which condition you have.

Depending on where you work, there are different disability benefits available. Working with your employer and insurance provider to find the right plan is the first step in applying for disability benefits. 

Employment and disability rights for vestibular disorders

Canada’s Human Rights Act dictates that no one may be fired for a discriminatory reason regarding their disabling condition. Employers must respect the duty to accommodate and work with their employees to ensure their comfort at work.

Whether your condition comes from environmental factors or developed over time, sick leave isn’t an unreasonable request. Most employers will not object to a leave of absence if a doctor’s note is provided. The note’s contents should include the need for time off and the amount of time required. If the absence must be extended, the notes should be resubmitted every three to six months.

You may be entitled to short term benefits if your condition can heal in under six months. If not, long term disability benefits may be the only option. If your application for benefits is denied, you may remain on leave while you appeal the decision. 

Types of disability rights for vestibular disorders

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 a vestibular disorder

The first step in receiving long term disability benefits is to receive an official medical diagnosis to include with your claim file. It can be challenging; the symptoms of vestibular disorders imitate many different conditions. Some testing will likely be required to narrow down the exact type of vestibular disorder you have. Testing will involve examining and stimulating the inner ears, eyes, and head to identify abnormalities. Some tests include MRIs, hearing and vision tests, CAT scans, and probes within the ear canal. Working with your doctor and being as honest as possible about your symptoms can help them decide which tests to administer and speed along the diagnosis process.

Your medical file should include diagnosis, any tests administered, and relevant prescriptions and therapies you use to treat your vestibular disorder. Presenting a fill full of medical information is essential, but more is needed to win your claim and begin receiving long term disability benefits.

Your claim should also include a detailed job description that fully demonstrates the scope of your duties at work. It may feel unnecessary, but your insurance provider may not fully understand your role, and they won’t ask. They may not understand why your vestibular disorder prevents you from working since these conditions aren’t widely understood. Describing your job and your vestibular effects on your ability to function at work will be vital in winning your claim. Be as detailed as you can about your condition and how it makes it impossible to continue working. Describe your physical symptoms, like if you have vision impairment or sudden bouts of vertigo, and how that relates to your duties at work. Likewise, include how your cognitive symptoms affect your job, like if you’re experiencing memory loss or are unable to focus.

To win your claim, you must be credible and consistent. Make sure you’re honest about your condition and transparent with friends, family, and your employer. Insurance companies may ask about your situation, and they want people who can corroborate. Credibility is key to winning your long term disability benefits. 

How to hurt your long term disability claim for a vestibular disorder
  • Submitting an incomplete medical file
  • Not having relevant medical tests done to identify your vestibular disorder
  • Unneccesary stalling or blocking of information
  • Having a negative attitude towards those involved with your claim
  • Providing vague or insufficient details regarding your vestibular disorder
How to improve your long term disability claim for a vestibular disorder
  • Having a file full of medical evidence including appropriate testing and an official diagnosis
  • Cooperating with those involved in working on your claim
  • Acting on recommendations from the doctors and insurance providers, even if you don’t agree with them
  • Being polite when interacting with those involved with your claim
  • Being honest, and credible, and consistent

Common reasons for denial of vestibular disorder claims

Vestibular disorders are not widely understood or discussed. This can pose a challenge when trying to win long term disability benefits. Often insurance companies will downplay or minimize the severity of your condition or misunderstand how the side effects affect your ability to continue working.

 

The most common reason for claims regarding vestibular disorders being denied is a lack of evidence to support the severity of your condition. Insurance companies may not understand how your condition affects you when you have a low-impact job. They don’t fully understand the scope of your vestibular disorder, and they won’t ask.

 

Claims are also often denied if the insurance provider finds you’re missing tests to diagnose your condition correctly. Your doctor might feel they’re doing you a favor by streamlining the diagnosis. Without specialized medical testing like an MRI, the insurance provider will claim your diagnosis is insufficient and use that to deny the claim. It is essential to work with your doctor and provide as much information as possible about your condition and what you need for long-term disability benefits.

 

Lastly, insurance companies want to see that you’re using the claim for long term disability benefits as a last resort. If they feel you haven’t tried everything you can to minimize the impact your job has on your symptoms, they will use that as a reason to deny your claim. It can be frustrating to work fewer hours or switch positions when you know your condition is entirely disabling. However, this effort will help you present a more robust claim in the end. 

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.