Brain Aneurysms and Long-Term Disability Benefits in Canada

Understanding Brain Aneurysms

A brain aneurysm, also known as a cerebral aneurysm or intracranial aneurysm, is a weak or bulging spot in the wall of a blood vessel in the brain. This bulging area can fill with blood and form a balloon-like structure. Aneurysms can occur in arteries anywhere in the brain but are most common in the network of blood vessels at the base of the brain called the “Circle of Willis,” named for an English physician.

There are multiple types of brain aneurysms that you should be aware of:

Saccular Aneurysms

These are the most common type of brain aneurysms and appear as small, berry-shaped sacs attached to an artery by a neck.

Fusiform Aneurysms

Less common, these aneurysms involve the entire circumference of a blood vessel, causing it to bulge outward uniformly.

Giant Aneurysms

These are much larger than saccular aneurysms and require specialized treatment due to their size and complexity.

The causes of brain aneurysms can vary and may include factors such as chronic high blood pressure, atherosclerosis, genetic predisposition, trauma to the head, smoking, and age. While some aneurysms remain stable and asymptomatic, others can rupture, leading to a sudden and severe headache, nausea, vomiting, loss of consciousness, and potentially life-threatening complications like subarachnoid hemorrhage.

Am I Covered for Brain Aneurysm on my Long-Term Disability Plan?

In Canada, coverage for aneurysms under long-term disability benefits depends on various factors, including the specific terms and conditions of the insurance policy, the individual’s medical condition and history, and the insurance provider’s assessment. Here are some key points to consider:

Insurance Policy Terms: Long-term disability (LTD) insurance policies typically outline the conditions and criteria for coverage, including which medical conditions are eligible for benefits. Some policies may explicitly include aneurysms and related complications as qualifying conditions, while others may not.

Medical Documentation: To qualify for long-term disability benefits due to an aneurysm, individuals typically need thorough medical documentation from healthcare professionals, including diagnosis, treatment history, prognosis, and how the condition impacts their ability to work.

Functional Impairment: Insurance providers assess disability claims based on the individual’s functional impairment and how it affects their ability to perform essential job duties. For aneurysms, factors such as cognitive impairments, physical limitations, and related complications (such as strokes) may be considered in the evaluation process.

Policy Waiting Periods and Coverage Limits: Long-term disability policies often have waiting periods (e.g., 90 days) before benefits become payable, and they may have limits on the duration and amount of benefits provided, depending on the policy terms.

Claim Evaluation Process: When filing a disability claim related to an aneurysm, individuals typically need to provide comprehensive medical records, supporting documentation from healthcare providers, and may undergo assessments by insurance company-appointed healthcare professionals to evaluate the claim.

It’s crucial for individuals to carefully review their insurance policy documents, understand the terms and conditions related to disability benefits, and work closely with healthcare providers and insurance representatives when filing a disability claim. Seeking assistance from a disability lawyer who is versed in disability claims can also be beneficial in navigating the process and advocating for appropriate coverage.

Can my Brain Aneurysm LTD Benefits be Denied?

Despite the severity and impact of a brain aneurysm on an individual’s ability to function normally, Long-term disability claims for brain aneurysms can be denied by insurance providers for various reasons.

Policy Limitations: The terms and conditions of your LTD insurance policy may contain specific criteria for eligibility, including waiting periods, coverage limits, and exclusions for certain medical conditions.

Insufficient Medical Evidence: Insurance companies often require comprehensive medical documentation to support disability claims. If the medical evidence provided does not sufficiently demonstrate the severity of your condition or its impact on your ability to work, your claim may be denied.

Dispute Over Disability Status: Insurance companies may dispute the extent of your disability, especially if there are discrepancies between your medical records, healthcare provider assessments, and their own evaluations.

Failure to Meet Policy Definitions: Some LTD policies have specific definitions of disability, such as the inability to perform “substantial gainful work,” which may differ from your healthcare provider’s assessment of your functional abilities.

What to Do If My LTD Claim For My Aneurysm Has Been Denied?

Facing a denial of your LTD claim for a brain aneurysm can be challenging and stressful, but it’s essential to take proactive steps to appeal the decision and seek the benefits you are entitled to:

Seek Legal Assistance: Consider consulting with a lawyer experienced in disability insurance claims to navigate the appeals process, advocate on your behalf, and ensure your rights are protected.

Review Your Policy: Carefully review your LTD insurance policy to understand the reasons for the denial, coverage limitations, appeal procedures, and deadlines for filing an appeal.

Document Everything: Keep detailed records of all communication, documents, and interactions related to your LTD claim and appeal process for reference and documentation purposes.

Gather Additional Evidence: Work with your healthcare providers to gather and submit additional medical evidence supporting the severity of your brain aneurysm and its impact on your ability to work.

File an Appeal: Follow the specific appeals process outlined by your insurance provider, including submitting a detailed appeal letter, supporting documentation, and any relevant legal arguments or opinions from healthcare professionals.

Get a Free Consultation With Our Long-Term Disability Lawyers

Navigating LTD benefit denials for individuals with brain aneurysms requires persistence, patience, and a thorough understanding of your insurance policy and rights. By taking proactive steps, gathering strong medical evidence, and seeking appropriate legal guidance, you can increase your chances of a successful appeal and obtain the financial support you need during this challenging time. Contact our long-term disability lawyers today.