Does Crohn's disease qualify as a disability in Canada?

Crohn’s disease does qualify as a disability within Canada, but it can be difficult to prove since this disease attacks silently from within. Canada recognizes this disease’s devastating effects on a person, both physically and mentally. Sometimes those who have Crohn’s feel they must suffer in silence due to a lack of physical evidence of the disease.

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If your Crohn’s disease makes it impossible to maintain employment without relapsing, you’re entitled to disability benefits. You deserve financial peace of mind while focusing on your health and wellness. Read on to learn about your rights, and the types of disability claims you may qualify for.

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Employment and disability rights for Crohn's disease

Managing Crohn's disease's pain, symptoms, and flare-ups can be complicated. Some cases of Crohn’s disease become debilitating enough that working full-time isn’t possible. But the idea of stress leave can be scary, and no one wants to be fired due to their health.

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In Canada, any person who has a disability has the right to a discrimination-free workplace. The employer also has a duty to accommodate their employee. Employers may indeed fire anyone with proper notice and reasoning. However, they cannot fire you for a discriminatory reason regarding your Crohn’s disease. If your Crohn’s disease has progressed and become too severe for you to continue working, then a leave of absence is not an unreasonable request. Most employers will not object to this if the employee provides a doctor’s note.

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The note should state the need for time off and the amount of time required. If this is a prolonged absence, the employer may request that a doctor’s note be resubmitted every three to six months. During this time, the individual has a right to submit their claim for long term disability benefits. If the claim is denied, the employee may stay on a leave of absence and appeal.

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If you apply for long term disability benefits and your claim is denied, you can remain on sick leave while you appeal. Most employers will not object to this if you’re still providing doctor’s notes regularly.

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You have legal rights if your employer tries to fire you while on sick leave or while you’re applying for long term benefits due to your Crohn’s disease. If you are terminated as a direct result of your Crohn’s disease, you have the right to severance pay and may be able to have your employment reinstated. These situations are tricky and challenging to navigate. Having a lawyer with experience in these types of claims can help speed along the process. You deserve expert legal advice and someone on your side to help get you the benefits you deserve.

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Types of disability rights for Crohn's disease

‍‍Not all disability insurance plans are the same. Here are the typical benefits included in Canadian disability insurance plans:

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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How to win disability benefits for Crohn's disease

Crohn’s disease is complicated, and managing symptoms can be a full-time job. Some people can manage their disease, but others may find their symptoms too exhausting to maintain full or part-time employment. If this sounds like you, your first step towards winning your disability claim is getting a complete diagnosis from a medical professional.

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A well-documented medical file is the first step toward receiving your benefits. This file should include symptoms, flare-ups, medical history, medications, and anything relevant to your Crohn’s disease. Insurance companies will often try to reduce the severity of Crohn’s, so it is up to the patient to prove how intensely they’ve been affected.

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Insurance companies will try to minimize and diminish the effects of Crohn’s disease, but it is a fully debilitating disease for some. It is worth fighting for your right to disability benefits, but there are some things to prepare first.

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Even if you’ve been fully diagnosed by a doctor, that may not be enough to secure immediate approval for your benefits. What you must do now is prove that your symptoms make it impossible for you to maintain full or part-time employment. The insurance providers will take your age, work experience, and job title into consideration.

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Presenting a strong, detailed claim is vital to the success of your application. If you have been successfully employed before, they’ll use that against you. You must present evidence that your condition has gotten worse, and that you’re no longer able to perform like you once did. Keep a detailed record of your symptoms, your good and bad days, and anything relevant to your claim. If you had to go to the doctor, make sure to get a note! Any extra evidence provided by you can make or break your claim. Credibility and effort are everything in the eyes of the insurance providers. 

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How to hurt your long term disability claim for Crohn's disease

• Present a folder of well-documented medical evidence, including your diagnosis, medications, and any tests you’ve taken regarding Crohn’s
• Having statements that match what is in your medical file
• Detailed record of symptoms, flare-ups, and changes in your condition
• Keep a polite and friendly attitude towards those working on your claim
• Taking responsibility for any problems within your claim
• Being willing to accept and follow through with recommendations, even if you disagree with them

How to improve your long term disability claim for Crohn's disease

• Incomplete medical file missing an official diagnosis or relevant tests
• Unnecessarily blocking or stalling reasonable requests
• Fighting with the doctors who have run your tests
• Medical records or personal statements that contradict your claim

Common reasons for denial of Crohn's disease claims

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Since Crohn’s disease is an invisible illness, insurance companies often seek to minimize the severity of the condition. They will try to undermine your claim and prove it is a minor condition that shouldn’t prevent you from working. Any slight discrepancy or missing document in your medical or employment file will be enough for them to deny your claim.

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A doctor’s diagnosis often isn’t enough to convince an insurance company to grant long term benefits. To prevent your claim from being denied, you will need a file full of information and the official diagnosis. All doctor visits, prescriptions, tests, and even stays in the hospital must be documented and presented with your claim.

If you have been at work while suffering from Crohn’s disease, your insurance company will use this as proof that you’re well enough to keep working and deny your claim. This is why keeping a journal of missed time at work, flare-ups, and other instances will strengthen your claim. If the insurance company doesn’t have it in their records, they will use that to deny your long term disability benefits claim. 

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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