Multiple Sclerosis and Disability Claims – What You Need to Know

Canada has one of the highest rates of multiple sclerosis (MS), with 1 in 340 people living with MS. The symptoms of multiple sclerosis can be significant and debilitating and affect a person’s ability to work and lead to a short-term or long-term disability claim. This blog post will discuss the symptoms of multiple sclerosis, the different types of multiple sclerosis and what happens during disability claims.

What is Multiple Sclerosis?

Multiple sclerosis is classified as an autoimmune disorder of the central nervous system. An autoimmune disorder is where the body “attacks” its own healthy tissues According to the Multiple Sclerosis Society of Canada, multiple sclerosis attacks “myelin” of the brain and spinal cord. Myelin is the protective covering of the nerves, and MS causes inflammation to/ damages the myelin. Our brain and spine need myelin because it is an important component for the transmission of nerve impulses to the nerve fibres (communication system between your brain and body). If enough serious damage happens to the myelin, the nerve impulses themselves can be completed disturbed and the actual nerve fibres can be damaged.

What are the symptoms of multiple sclerosis?

There are several symptoms of multiple sclerosis and symptoms depends on what part or parts of the central nervous system are affected. Signs and symptoms will depend on the amount of damage to the nervous system and which nerves have been impacted and the location of these nerves.

Symptoms include:

• Numbness or weakness in one or more limbs (also called “extremities”) on one side of your body at a time, or your legs and trunk of your body
• Tingling or pain in different parts of your body
• Electric-shock like sensations that happen with certain neck movements
• Tremors
• Balance issues/dizziness
• Unsteady gait/lack of coordination
• Muscle stiffness/spasms
• Visual disturbances such as partial or complete loss of vision and/or painful eye movements, usually one eye at a time, also known as optical neuritis and prolonged double vision
• Slurred speech
• Fatigue
• Difficulties with bowel and bladder function
• Sexual dysfunction
• Cognitive difficulties/memory impairment
• Depression

​Types of Multiple Sclerosis

There are different types of multiple sclerosis including clinically isolated syndrome, relapsing-remitting MS, secondary-progressive MS and primary-progressive MS. As explained by the Multiple Sclerosis Society of Canada, the 4 types are:

Clinically isolated syndrome

The earliest form of MS, where a single episode of neurological symptoms is suggestive of multiple sclerosis.

Relapsing-remitting MS

This involves unpredictable but clearly defined relapses (MS attacks/exacerbations/flare-ups). During these relapses, new symptoms appear or symptoms worsen. In-between relapses, recovery can be complete or nearly complete to a level of function pre-remission.

Secondary-progressive MS

This follows the diagnosis of relapsing-remitting MS. In this case, the relapses and remissions are less apparent and there is steady disease progression, sometimes with plateaus and with increasing levels of disability.

Primary-progressive MS

This is a slow, steady progressive form of MS. There are no defined relapses, though there may be some periods of stability. Remission does not occur.

​How it is diagnosed?

There are no specific tests for multiple sclerosis and doctors often try to rule out other diseases/conditions before they can confirm a diagnosis of MS. This is why it is important to discuss your complete medical history with your doctor. You would be asked to describe all your symptoms and your doctor would look for neurological abnormalities or abnormal physical responses.

Testing that you might have to participate in could include:

• Bloodwork to look for other diseases that might have similar symptoms to MS;
• MRI scans of the brain and spinal cord which could show if there are any lesions that could explain your symptoms and demonstrate MS;
• A lumbar puncture test (a.k.a. spinal tap) where a sample of fluid is collected from the spinal canal to look for abnormalities in antibodies and to look for any signs of other infections or conditions with symptoms like MS;
• Evoked potential tests where your response to stimuli is recorded. This test involves recording electrical signals produced by the nervous system using visual or electrical stimuli with electrodes.

What happens during my claim for disability?

When you apply for disability benefits, your doctor is asked to provide a primary diagnosis and to describe your subjective symptoms and their objective findings. As with any type of medical condition, the insurance company is looking for information about your level of functional impairment.

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There is a “scale” used to define the level of disability for multiple sclerosis called the Expanded Disability Status Scale (EDSS) is a way for neurologists to measure the “severity” of impairment of MS and monitoring the level of disability over time. The scale looks at different “functional systems” including sensory function, brainstem function, bowel/bladder function, visual function, mental function, pyramidal function (weakness/moving limbs). The higher the score, the higher the level of disability. However, according to this site, the scale uses walking as its main measure of disability in order to be considered at a “severe level” of disability and may not give enough weight to other functional areas.

Your treating doctors’ records will be requested as the insurer will want to see your MRI reports and neurology records. Your doctor might be asked periodically to provide the EDSS score and will be asked to comment on your level of function.

It is important to see your treating physicians (family doctor, neurologist) regularly so that your symptoms can be recorded. It is important to be able to demonstrate how your symptoms have or have not improved, have worsened or if new symptoms developed. Because testing does not show your symptoms, your symptoms should be documented to show consistency and how they impact your functioning and quality of life.

In many claims, the insurance company will write to your treating physician to ask if you can return to some form of work and are medically able to participate in a gradual return to work plan.

Your insurer also uses a medical consultant to review your claim (maybe on more than one occasion) when your restrictions and limitations are not clear to them or the impact of a diagnosis is not clear, and to ask for recommendations and for clarifications regarding restrictions and limitations.

What is the insurance company looking for?

With any medical condition, the insurance company looks for evidence that you are totally disabled from working in your own occupation during the own occupation period, and any occupation you can perform and are qualified for by way of education, training or experience when the own occupation period ends (usually a 2-year period).

If your own occupation at the time of the onset of disability was physical in nature, your insurance company may suggest that you could still work a sedentary position. If your pre-disability employment was sedentary, your insurance company may not understand why you are unable to work.

The psychological symptoms that can develop in relation to a diagnosis of multiple sclerosis or as part of the illness may not always be taken into consideration by your insurance company. It is important that you demonstrate how all aspects of your life are affected.

To demonstrate the impact of your symptoms and diagnosis, you should

• See your doctor (s) on a regular basis so your symptoms are documented
• Report all symptoms and concerns
• Make best efforts to comply with treatment recommendations (medications, exercise, specialist referrals, testing)
• Report all your progress or regression (i.e. more fatigue, medication makes you feel worse, balance issues, memory difficulties, bowel/bladder difficulties)
• Be honest about how you are feeling (have you developed depression/anxiety?)
• If you are prescribed medication, take it as prescribed (take it regularly)
• If you are unable to attend an appointment, document or have your doctor document why
• Report all limitations (what are you no longer able to do? i.e. drive, sit for long periods of time, walk without support, difficulty with vision)

It is important that your insurer to understand your limitations and restrictions

• What are you unable to do?
• Have you stopped driving or doing tasks that require concentration and focus?
• Do you need help with everyday tasks?
• Do you have difficulty with mobility due to balance/gait issues or require a walking aid?
• Have you developed memory difficulties/other signs of cognitive impairment?
• Do you notice symptoms of depression or other psychological symptoms?

Your doctor may impose restrictions because you have physical and or cognitive/psychological impairments because of your illness and it is necessary that these be communicated to the insurance company.

What if my claim is denied?

Your claim may be denied at the outset, or you may be paid benefits for several months or longer. In either case, when you receive a denial letter, it is important to remember that you can fight the insurance company’s decision. You can consult a lawyer to find out your rights as an insured person and what your options are.

Sources:

• https://mssociety.ca/about-ms/what-is-ms
• https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
• https://mssociety.ca/about-ms/types
• https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274
• https://www.mstrust.org.uk/a-z/expanded-disability-status-scale-edss