Invisible Illnesses and Long-Term Disability Claims

As long-term disability lawyers, we recognize there are various conditions that render a person unable to work. Many times, people are unable to work due to what are known as “invisible illnesses” or invisible disabilities. 

This blog will discuss:

• What is an invisible illness?
• Types of invisible illnesses
• Common reasons for claim denials
• What to do if your claim is denied
  

What is an invisible illness?

Invisible illness is a term used for any medical condition that is not easily visible to others. Invisible illnesses include chronic physical conditions such as fibromyalgia and chronic pain conditions, headache disorders, Lyme disease, traumatic brain injuries as well as mental illnesses. These are conditions where the symptoms cannot be seen on diagnostic imaging on blood tests or easily tested.

Types of invisible illnesses

Invisible illnesses can be physical conditions or psychological conditions. What follows are some examples of conditions that are considered “invisible illnesses”.

Chronic Pain Disorders

Chronic pain can develop after an injury or surgery. Chronic pain is pain that persists for more than 6 months or when a person experiences pain after the time for usual healing has passed. Chronic pain interferes with various realms including sleep, concentration, memory and can affect functional abilities like the ability to perform self-care and hygiene, drive and attend work on a regular basis.

Chronic pain disorders include conditions such as fibromyalgia, myofascial pain syndrome, chronic fatigue syndrome and arthritic disorders. There are several types of arthritis including rheumatoid arthritis, connective tissue disease, lupus and osteoarthritis. It is also important to consider that chronic pain conditions can also involve a psychological component as chronic pain can potentially lead to the development of depression.

Mental Illnesses

Mental illnesses include anxiety and depressive disorder, bipolar and mood disorders and post-traumatic stress disorder.

The Canadian Mental Health Association (CMHA) defines mental illness as “the term used to refer to a variety of mental disorders that can be diagnosed. Mental disorders are health conditions that are characterized by alterations in thinking, mood or behaviour (or some combination thereof) associated with distress and/or impaired functioning”.

Some important facts to consider are:

• 20% of Canadians will personally experience a mental illness in their lifetime
• Approximately 8% of adults will experience major depression
• Anxiety disorders affect 5% of Canadians
• Approximately 1% of Canadians experience bipolar disorder
• Schizophrenia affects 1% of Canadians

A mental illness can interfere with a person’s ability to sleep, ability to concentrate and focus, interfere with memory and the ability to attend work on a regular basis.

Traumatic Brain Injuries

According to Brain injury Canada, approximately 1.5 million Canadians live with an acquired brain injury and brain injury is the leading cause of disability and death for Canadians under the age of 40.

A traumatic brain injury can cause life-altering symptoms and challenges. Traumatic brain injuries can range from mild to severe.

A concussion is a type of mild traumatic brain injury and can also lead to prolonged symptoms such as ongoing headaches, memory difficulties and psychological difficulties if someone develops post-concussion syndrome.

A brain injury can result in various physical, cognitive and behavioural/emotional impairments which can be temporary or permanent.

Physical impairments include coordination and balance difficulties, chronic pain, fatigue, seizures and movement problems.

Sensory difficulties include vision or hearing difficulties. A brain injury can also cause difficulties with communication such as word-finding problems, impaired speech and emotional impairments such as depression, mood swings and anger. Cognitive difficulties can include memory loss, problems with attention and concentration, impaired judgement and social behavioural problems.

Headache Disorders

Headache disorders include migraines, tension-type headaches and cluster headaches.

A migraine disorder can be recurrent, life-long and is characterized by recurrent “attacks”.

According to the World Health Organization, headache disorders are among the most common disorders of the nervous system. It is estimated that 1.7-4% of the world’s adult population report experiencing headaches more than 15 days each month. In 2013, migraine was found to be the 6^th leading cause of disability worldwide.

A migraine can be accompanied by debilitating symptoms and can limit a person’s usual activities and ability to do both sedentary and physical work as it interferes with the ability to focus and is worsened by bright lights and loud noises. As well, the long-term efforts of coping with chronic headaches/migraine might lead to other illnesses such as anxiety and depression.

Lyme Disease

Lyme disease is an inflammatory infection spread through backlegged ticks (a.k.a. deer ticks). There are 3 stages of Lyme disease, including chronic Lyme disease which can last for months or even years.

There are over 100 known symptoms of Lyme disease and symptoms can affect your musculoskeletal system, mental capability, psychological wellbeing, digestive system, respiratory, circulatory and neurological symptoms.

Chronic Lyme disease is often mistaken for other illnesses which makes it difficult to diagnose and treat and prolonging the time it takes to diagnose. Lyme disease is also hard to diagnose because blood tests can show negative test results when the disease is actually present.

Lyme disease can be mistaken for other illnesses including fibromyalgia, chronic fatigue syndrome, colitis/Crohn’s disease, early ALS, encephalitis, lupus or inflammatory arthritis disorders, multiple sclerosis, psychiatric disorders, thyroid disease and sleep disorders.

Common reasons for claim denials

There are various reasons as to why an insurance company might deny a disability claim.

Lack of objective medical evidence

One of the reasons claims are often denied is due to a lack of objective medical evidence. This means that the insurance company did not feel there was enough medical information documented to support your disability and to show how your condition/illness restricts or limits you from performing your job duties or any job you could be qualified for.

Treatment is not appropriate

Another common reason is that you are not under the care of appropriate physicians/treatment provider or receiving appropriate treatment. You may be waiting on a referral to a specialist due to long wait times and may not have had specialized treatment yet when you are waiting for a diagnosis. For example, while you may be seeing your family physician or a social worker/psychotherapist regularly while waiting for a psychiatrist appointment, your insurance company might feel this is not sufficient treatment for a mental illness.

You have been able to work with your condition

Your claim might also have been declined because you demonstrated an ability to work in the past with your condition. Perhaps you have a chronic condition and had been working modified duties or hours at your job for some time but found you were unable to keep up with your duties. You may have had an exacerbation or worsening of symptoms but your insurance company might not understand how or why your condition currently prevents you from working.

You can perform some type of work

Your insurance company may be aware of your symptoms but may take the position that despite your symptoms and receiving treatment, you should be able to perform your job or some type of alternate employment. Your insurer might be of the opinion that you could still attend/seek treatment while working and decide to deny your application or discontinue benefits on that basis.

What to do if your claim is denied

We understand that experiencing a denial of benefits from your short-term or long-term disability insurer is stressful.

Report your symptoms

With an invisible illness or condition, one way to demonstrate how your condition impacts your life and functional abilities by reporting your symptoms to your family doctor and treating specialists/treatment providers. Be truthful with your treatment providers about how you are feeling and if and when you have changes to your symptoms/condition.

Keep attending treatment

When it comes to any type of disability claim, it is important to remember that even if your benefit has been denied, you should continue to seek treatment from your family physician, specialist (s) or rehabilitation clinic (physiotherapy, massage etc.) so you can document your symptoms and show you continue to comply with treatment recommendations.

If you are unable to work due to an invisible illness, you want to demonstrate that you are under the care of a physician/specialist and are following a recommended treatment plan. By regularly consulting with your treatment providers and physicians, you are documenting your symptoms and activity restrictions and these records are helpful for your claim.

Know your rights

If your claim for short-term or long-term disability benefits has been denied, you should contact an experienced disability lawyer as soon as possible to find out what your rights and obligations are as an insured person. Your lawyer can explain to you what your options are and how the legal process works.

Our lawyers have helped many clients whose claims for invisible illnesses have been denied. We offer a free consultation that can be conducted via phone or Zoom/Skype at a date and time that is convenient for you.