Heart Conditions and Long-Term Disability Benefits in Canada

Heart conditions encompass a range of medical disorders affecting the heart and cardiovascular system. These conditions can significantly impact an individual’s daily life, including their ability to work. For individuals facing challenges due to heart conditions, seeking long-term disability (LTD) benefits becomes crucial for financial stability and access to necessary medical care. However, navigating the LTD claims process can be complex, and denials are not uncommon.

Understanding Heart Conditions

About 1 in 12 Canadian adults over the age of 20 live with a diagnosed heart disease, according to the Canadian Chronic Disease Surveillance System. Heart conditions can include:

Coronary Artery Disease (CAD):

Blockage or narrowing of coronary arteries, leading to reduced blood flow to the heart muscle.

Heart Attack (Myocardial Infarction):

Occurs when blood flow to a part of the heart is blocked for an extended period, causing damage to the heart muscle.

Heart Failure:

Inability of the heart to pump blood effectively, leading to fluid buildup in the lungs and other parts of the body.

Arrhythmias:

Irregular heart rhythms, including tachycardia (fast heart rate) or bradycardia (slow heart rate).

Valvular Heart Disease:

Damage or defects in heart valves, affecting blood flow within the heart chambers.

Cardiomyopathy:

Disease of the heart muscle, leading to reduced heart function.

Heart Conditions and Long-Term Disability

Heart conditions can significantly impact an individual’s ability to work. Symptoms such as chest pain, shortness of breath, fatigue, dizziness, and cardiac limitations can restrict physical activity and job-related tasks. Individuals with heart conditions may require frequent medical appointments, treatments, and lifestyle modifications that affect work capacity. LTD benefits can provide essential financial support during periods of disability caused by heart conditions, ensuring financial stability and access to necessary medical care.

Are Heart Conditions Covered by my LTD Policy?

Whether heart conditions are 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.

Heart Condition Disability Benefits

To support your heart condition disability claim, you will typically need:

Medical Documentation:

Detailed medical records, diagnosis confirmation, treatment history, specialist reports, and functional assessments outlining the severity of symptoms, functional limitations, and impact on work capacity.

Functional Assessments:

Assessments from healthcare providers or vocational experts detailing how heart condition symptoms impair your ability to perform work-related tasks, engage in physical activity, and maintain productivity.

Supporting Statements:

Statements from treating physicians or specialists describing the nature and extent of your heart condition-related disability, treatment modalities, and recommendations for accommodations or restrictions at work. Make note of everything that you can and cannot do because of your heart disease.

Can My Heart Condition Benefits Be Denied?

It’s not uncommon for heart condition related disability claims to be denied by insurance companies. Because a heart condition is not an immediately visible disability, there is much more scrutiny around paying out benefits. Heart condition disability benefit denials can occur due to various reasons, including:

Insufficient Medical Evidence:

Lack of detailed documentation regarding symptom severity, functional impairments, treatment history, and ongoing limitations.

Change in Disability Definitions:

Interpretation differences between “own occupation” and “any occupation” definitions in LTD policies.

Independent Medical Examinations (IMEs):

Insurers may request IMEs to assess disability claims. IME reports that contradict treating physicians’ opinions or downplay symptom impacts can lead to denials.

Policy Limitations:

Some policies may exclude certain conditions, have waiting periods, or impose limits on coverage based on specific criteria.

What To Do If My LTD Benefits Have Been Denied?

If your LTD benefits for heart conditions have been denied:

Review Your Policy:

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

Get Your Denial in Writing:

Some insurance companies may deny your claim over the phone. If they don’t send you a letter with a written statement, you can ask them to provide one for your records as soon as possible. Getting it in writing will also help clarify the reason for the deny, which you can later challenge.

Gather Strong Documentation:

Compile comprehensive medical records, functional assessments, supporting statements, and any correspondence related to your claim. Speak with your doctor or healthcare professional about your denial, and whether they support that claim. If they disagree with the insurer’s decision, get that disagreement in writing. Your doctor should be able to outline why you are no longer able to perform your regular duties at work.

Appeal with Support:

Submit a thorough 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 experienced in heart condition-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 heart conditions. 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.