Hearing Loss and Long-Term Disability Benefits in Canada

Hearing loss is a common sensory impairment that can significantly impact an individual’s quality of life, communication abilities, and employment opportunities. For individuals facing challenges due to hearing loss, pursuing long-term disability (LTD) benefits can be essential for financial stability and access to necessary support services. However, denials of LTD benefits for hearing loss are not uncommon, leading to additional hardships for affected individuals. Understanding the nuances of hearing loss, its impact on employment, considerations for LTD coverage, common reasons for benefit denials, and strategies to address denials are important steps for individuals navigating this process in Canada.

Understanding Hearing Loss

Hearing loss can result from various factors, including genetics, aging, exposure to loud noises, medical conditions, and ototoxic medications. According to Statistics Canada, it affects approximately 3 in 5 adults. It can manifest as:

Conductive Hearing Loss:

Caused by problems in the outer or middle ear, such as earwax buildup, fluid accumulation, or issues with the ear canal or eardrum.

Sensorineural Hearing Loss:

Due to damage to the inner ear (cochlea) or auditory nerve, often caused by aging, noise exposure, or certain medical conditions.

Mixed Hearing Loss:

Combination of conductive and sensorineural hearing loss, affecting both the outer/middle ear and inner ear/nervous system.

Tinnitus:

A common condition characterized by perceiving ringing, buzzing, or other noises in the ears or head without an external sound source. Tinnitus can vary in intensity and may be intermittent or constant, significantly affecting an individual’s quality of life and ability to concentrate.

Hearing Loss and Long-Term Disability

Hearing loss can significantly impact an individual’s ability to work, especially in roles requiring clear communication, auditory processing, and sound awareness. Common challenges faced by individuals with hearing loss in the workplace include difficulty understanding speech, participating in meetings, using telephones, and navigating noisy environments. Accommodations such as hearing aids, assistive devices, and communication strategies may help mitigate these challenges but may not fully restore functional capacity.

Is Hearing Loss Covered by my LTD Policy?

Whether hearing loss or tinnitus is covered by your LTD policy depends on the specific terms, definitions, and criteria outlined in your insurance contract. Most LTD policies cover disabilities that prevent individuals from performing the material duties of their occupation or any gainful occupation for which they are reasonably suited based on education, training, and experience.

Hearing Loss Disability Benefits

To support your hearing loss disability claim, you will typically need:

Audiological Evaluation:

Comprehensive assessment by an audiologist documenting the severity and type of hearing loss, speech recognition abilities, and recommendations for assistive devices or treatments.

Functional Limitations Documentation:

Reports from healthcare providers detailing how hearing loss impacts your ability to perform work-related tasks, communicate effectively, and participate in job duties requiring auditory skills.

Accommodation History:

Documentation of accommodations used in the workplace, such as captioning services, communication devices, modified job duties, or environmental adjustments.

Can My Hearing Loss Benefits Be Denied?

Denials of LTD benefits for hearing loss can occur due to various reasons, including:

Insufficient Medical Evidence:

Lack of detailed audiometric testing results, functional assessments, or limited documentation of how hearing loss affects work capacity.

Change in Disability Definitions:

Differences between “own occupation” and “any occupation” definitions of disability in LTD policies can lead to a claim denial. The first two years a claimant receives their LTD benefits, it will be because they meet the “own occupation” definition, which means that they cannot perform the tasks associated with their job. After that period, claimants will need to satisfy the “any occupation” definition, which requires that they prove that 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.

Claimed Impact vs. Third-Party Findings:

Discrepancies between subjective symptoms reported by the claimant and medical evidence observed by the insurer’s preferred medical examiners may raise concerns.

Policy Limitations or Exclusions:

Some policies may have limitations on coverage for certain types of hearing loss or exclude coverage for pre-existing conditions.

Why Are Invisible Illnesses Like Hearing Loss Denied?

Invisible illnesses like hearing loss are often misunderstood or underestimated in their impact on daily functioning and work capacity. Insurers may require more evidence to validate the severity of symptoms and functional limitations, which can be challenging for conditions like hearing loss, where symptoms are not always externally visible.

What To Do If My LTD Benefits Have Been Denied?

If your LTD benefits for hearing loss have been denied:

Review Your Policy:

Understand your LTD policy terms, appeal procedures, and timelines.

Get Your Denial in Writing:

Many insurance companies will communicate their denial of benefits over the phone. Once your claim has been denied, be sure to get the denial in writing, as it’s important to have a record of when and how the company communicated it to you, as well as their clearly stated reasoning, which you can later appeal.

Gather Strong Documentation:

Obtain comprehensive audiometric reports, functional assessments, employment records, and any correspondence related to your claim.

Appeal with Support:

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

Seek Legal Assistance:

Consult with an LTD disability lawyer familiar with hearing loss-related claims. A lawyer can review your case, provide legal guidance, advocate during the appeals process, and escalate the case if necessary.

Contact a Disability Lawyer About Your LTD Denial Today

Seeking legal assistance is crucial in challenging LTD benefit denials for hearing loss. A disability lawyer at Preszler Injury Lawyers can assess your case, navigate complex legal processes, and advocate for your rights to obtain the benefits you deserve. Contact our law firm today to discuss your situation and take proactive steps towards securing your LTD benefits for hearing loss.