Hemophilia and Long-Term Disability Benefits in Canada

Hemophilia is a rare but serious genetic disorder that affects the blood’s ability to clot properly. The Canadian Hemophilia Society says that Hemophilia A affects fewer than 1 in 10,000 people, and Hemophilia B is even less common, affecting approximately 1 in every 50,000 people. Individuals with hemophilia face unique challenges due to the risk of excessive bleeding from minor injuries or even spontaneously. Managing hemophilia requires specialized care, frequent medical monitoring, and may result in limitations that impact daily life and employment. Understanding how hemophilia intersects with long-term disability (LTD) benefits is crucial for individuals navigating the complex process of securing financial support and access to necessary medical care.

Understanding Hemophilia

Hemophilia is characterized by a deficiency in clotting factors, specifically Factor VIII (hemophilia A) or Factor IX (hemophilia B). This deficiency leads to prolonged bleeding episodes, which can occur internally or externally. Symptoms may vary depending on the severity of the condition, ranging from mild bleeding tendencies to severe and potentially life-threatening bleeding episodes.

Hemophilia A (Factor VIII Deficiency):

Hemophilia A is the most common type of hemophilia, accounting for about 80-85% of cases. It is characterized by a deficiency in clotting factor VIII, which plays a crucial role in the blood clotting cascade. Individuals with Hemophilia A experience prolonged bleeding episodes due to the inability of their blood to clot effectively.

Hemophilia B (Factor IX Deficiency or Christmas Disease):

Hemophilia B is less common, accounting for about 15-20% of hemophilia cases. It is characterized by a deficiency in clotting factor IX, also known as Christmas factor. Like Hemophilia A, Hemophilia B results in prolonged bleeding episodes due to the lack of factor IX, which is necessary for proper blood clotting.

While both types of hemophilia share similarities in terms of symptoms and treatment approaches (such as clotting factor replacement therapy), they differ in the specific clotting factor deficiency involved. Genetic testing is typically used to diagnose the specific type of hemophilia and determine the appropriate treatment plan for individuals affected by these conditions.

Hemophilia and Long-Term Disability

For individuals with hemophilia, the condition can impact various aspects of life, including employment. Factors such as joint damage from recurrent bleeding episodes, limitations on physical activities to prevent injuries, and the need for regular infusions of clotting factors can affect work capacity. In professions requiring physical exertion or exposing individuals to potential injury risks, accommodations may be necessary to ensure safety and well-being in the workplace.

Risk of Bleeding Episodes:

Individuals with hemophilia are at an increased risk of spontaneous bleeding or bleeding from minor injuries. This risk can be especially challenging in physically demanding jobs or occupations involving repetitive movements that may strain joints or tissues.

Joint Damage and Pain:

Recurrent bleeding into joints, such as knees, ankles, and elbows, can lead to joint damage, chronic pain, and limited mobility. This can affect tasks that require standing, walking, lifting, or performing manual labor.

Medical Treatment Needs:

Regular prophylactic or on-demand clotting factor infusions are essential for managing hemophilia and preventing bleeding episodes. Scheduling these treatments and managing potential side effects may require adjustments to work hours or responsibilities.

Fatigue and Recovery Time:

Bleeding episodes and medical treatments can contribute to fatigue and the need for recovery time. This variable may impact productivity, concentration, and the ability to consistently perform job duties at optimal levels.

Adaptive Equipment or Accommodations:

Depending on the severity of hemophilia and specific job requirements, individuals may benefit from adaptive equipment, ergonomic modifications, or accommodations to mitigate physical strain and reduce injury risks.

Emotional and Mental Health Impact:

Coping with a chronic health condition like hemophilia can also affect emotional well-being and mental health. Stress, anxiety, or concerns about managing the condition at work may require additional support or accommodations.

Is Hemophilia Covered by my LTD Policy?

Whether hemophilia 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.

Hemophilia Disability Benefits

To support your hemophilia disability claim, you will typically need:

Medical Documentation:

Detailed records confirming the hemophilia diagnosis, severity classification, treatment history, and functional limitations resulting from the condition.

Treatment Plan Details:

Documentation outlining the prescribed treatment regimen, including prophylactic or on-demand clotting factor infusions, physiotherapy for joint management, and other supportive therapies.

Functional Assessments:

Reports from healthcare providers or vocational experts assessing how hemophilia impacts your ability to perform work-related tasks safely and effectively, considering physical limitations and risk management strategies.

Can My Hemophilia Benefits Be Denied?

Hemophilia LTD claims may be denied due to challenges in proving the severity of the condition, demonstrating functional limitations that impact work capacity, or facing policy-related restrictions or exclusions. Insurers may also scrutinize the necessity of treatments or accommodations required for managing hemophilia in a work setting.

Insufficient Medical Evidence:

Lack of detailed documentation regarding hemophilia diagnosis, severity, ongoing treatment, functional impairments, and limitations impacting work capacity.

Change in “Total Disability” Definitions:

The assessment of total disability is based on the insured person’s ability to work in their specific “own occupation” at the time of disability onset. After a two-year period, the focus shifts from the insured person’s current occupation to their ability to work in “any occupation” based on their skills, education, and experience.

Policy Limitations or Exclusions:

Some policies may have limitations on coverage for certain pre-existing conditions or exclude coverage for specific treatments or services related to hemophilia management.

What To Do If My LTD Benefits Have Been Denied?

If your LTD benefits for hemophilia 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:

Compile comprehensive medical records, treatment plans, functional assessments, 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 versed in hemophilia-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 can make a world of difference in challenging LTD benefit denials for hemophilia. 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 hemophilia.