Crohn's Disease and Long-Term Disability Benefits in Canada

Crohn’s Disease is a chronic inflammatory condition that primarily affects the digestive tract, causing symptoms such as abdominal pain, diarrhea, fatigue, weight loss, and complications such as intestinal strictures or fistulas. Managing Crohn’s Disease can be challenging, and for some individuals, the symptoms and complications can significantly impact their ability to work. In such cases, long-term disability (LTD) benefits can be a crucial financial lifeline. However, securing these benefits is not always straightforward, and many individuals with Crohn’s Disease face denials or challenges when applying for LTD benefits.

Understanding Crohn’s Disease

Crohn’s Disease is a type of inflammatory bowel disease (IBD) that can affect any part of the digestive tract, from the mouth to the anus. The inflammation in Crohn’s Disease can lead to various symptoms, including:

Abdominal Pain:

Chronic or intermittent abdominal pain, cramping, and discomfort are common in Crohn’s Disease, often occurring after meals or during flare-ups.

Diarrhea:

Frequent diarrhea, sometimes with blood or mucus, is a hallmark symptom of Crohn’s Disease, leading to dehydration, electrolyte imbalances, and nutritional deficiencies.

Fatigue:

Persistent fatigue and low energy levels are common due to the body’s ongoing inflammatory response and nutrient malabsorption.

Weight Loss:

Unintentional weight loss can occur due to decreased appetite, malabsorption of nutrients, and metabolic changes associated with chronic inflammation.

Complications:

Crohn’s Disease can lead to complications such as intestinal strictures (narrowing of the intestines), fistulas (abnormal connections between organs), abscesses, bowel obstructions, and increased risk of colorectal cancer.

Long-Term Disability Benefits for Crohn’s Disease

Individuals with Crohn’s Disease may be eligible for LTD benefits if their symptoms and functional limitations prevent them from performing substantial duties of their occupation. LTD benefits can provide financial support when individuals are unable to work due to Crohn’s-related symptoms, medical treatments, hospitalizations, or recovery periods after surgeries or flare-ups.

Why Are My LTD Benefits Denied?

Unfortunately, many individuals with Crohn’s Disease face denials or termination of LTD benefits despite their legitimate need for support. Common reasons for LTD benefit denials include:

Lack of Sufficient Medical Evidence:

Insufficient documentation of Crohn’s Disease symptoms, functional impairments, treatment history, and their impact on work capacity can lead to benefit denials.

Inconsistent Medical Records:

Inconsistencies or gaps in medical records, treatment compliance issues, or lack of specialist evaluations (such as gastroenterologists) can raise concerns for insurers.

Change in Definitions:

Differences between “own occupation” and “any occupation” definitions in LTD policies can lead to benefit terminations if insurers argue that individuals can work in alternative occupations, despite limitations from Crohn’s Disease.

Generally, when an individual first receives their LTD benefits, they must only satisfy the “own occupation” definition, meaning that so long as they cannot reasonably perform the duties of their own job, then they qualify as disabled under the policy.

After a period of two years, insurance policies typically require individuals to also satisfy the “any occupation” of disability, which considers the insured person disabled if they are unable to perform the substantial and material duties of any gainful occupation for which they are reasonably suited by education, training, or experience.

Independent Medical Examinations (IMEs):

Insurance companies may request IMEs by their chosen healthcare professionals to assess disability claims. IME reports that contradict treating physicians’ opinions can be used to deny benefits.

What To Do If Your LTD Benefits Have Been Denied

If your LTD benefits for Crohn’s Disease have been denied or terminated, taking proactive steps can help protect your rights:

Review Your Policy:

Carefully review your LTD policy to understand coverage terms, definitions of disability, appeal procedures, and timelines for appeals.

Gather Medical Evidence:

Compile comprehensive medical records, specialist reports (gastroenterologists, surgeons), treatment history, medication records, functional assessments, and supporting statements from healthcare providers detailing the impact of Crohn’s Disease on your ability to work. If your specialists do not agree with the insurance company’s denial, then it’s a good idea to get that in writing to support your appeal.

Appeal with Strong Documentation:

Submit a thorough appeal with strong medical and vocational evidence supporting your disability claim. Address any concerns raised in the denial letter and provide additional context or explanations as needed.

Seek Legal Assistance:

Consider consulting with a disability lawyer experienced in handling Crohn’s Disease and disability claims. A lawyer can review your case, provide legal guidance, advocate on your behalf during the appeals process, and escalate the case if necessary.

Why You Should Contact an LTD Disability Lawyer

Navigating LTD claims for Crohn’s Disease can be complex, especially when facing denials or challenges from insurance companies. Disability lawyers at Preszler Injury Lawyers understand the legal complexities, protect individuals’ rights, ensure fair treatment, and can help secure the disability benefits needed for financial stability during challenging times of CRPS-related disability.