Appeals Process When Long-term Benefits Claims Are Denied

by | Mar 14, 2019 | Disability Claims | 0 comments

How to Win When Your Chronic Pain Disability Claim is Denied

Chronic pain can be debilitating. And since it’s impossible to work when you’re in pain all the time, sufferers often have difficulty holding down a job. For many, there’s disability insurance. But applying can be a long, drawn-out process, with no guarantees that your claim will be approved.

While chronic pain hurts us as individuals, it also has a deeper impact across our society. Every year, this condition costs Canada millions in lost wages and medical expenses. With one in five adult Canadians suffering from chronic pain, the problem is reaching epidemic proportions and cannot be ignored any longer.

What is chronic pain?

Chronic pain is loosely defined as any type of pain that doesn’t go away quickly. It can persist for weeks, months, or years, and some patients suffer for the rest of their lives. Doctors now recognize chronic pain as a standalone condition. But it can also be a part of other issues, such as:

  • arthritis
  • carpal tunnel syndrome
  • Crohn’s disease
  • fibromyalgia
  • injuries from car accidents
  • sports related injuries
  • etc…

In addition, chronic pain may also be part of a neurological or spinal disorder or an issue with your back or neck.

People who suffer from chronic pain sometimes also have compromised immune systems, which can affect the body’s natural healing processes.

Diagnosing chronic pain

To claim benefits for chronic pain, you often have to prove that the pain comes from a known medical condition or trauma. Your case will be reviewed with clinical precision which can create a barrier for people who are legitimately suffering from getting the benefits they need.

It’s important to go through comprehensive medical examination and testing, including X-rays and MRI scans to attempt to determine the cause of the pain. Sometimes the cause is easy to diagnose and is clearly visible from your test results, however in many cases, the root cause can be elusive even for highly trained medical professionals – chronic pain is often an invisible condition. There’s not always a direct cause and effect. And because of this, they have to deal with doubt and disbelief from doctors, employers, colleagues, and sometimes even from friends and family.

If you’re going to claim for disability benefits because of chronic pain, you will need to show that you have pursued treatment recommended and available to you to ease your pain. It is important to show that you are attempting to mitigate the pain and trying to determine its root cause.

The psychological impacts of chronic pain

Many people only think of chronic pain as a physical affliction, never considering the effect that living in pain has on one’s psyche. Chronic pain can lead to many psychological problems, from depression and thoughts of suicide to self-destructive behavior. In fact, according to the Canadian Pain Society, chronic pain sufferers are 50% more likely to commit suicide.

Chronic pain sufferers find the pain has a way of insinuating itself into many aspects of their lives. This can have devastating consequences with side effects ranging from:

  • poor job performance
  • reduced enjoyment of life
  • diminished interest in personal care/grooming
  • decreased interest in social/leisure activities
  • destructive behavior with family & friends

Sleep deprivation is another common side effect of chronic pain. Pain can reduce the quality of your sleep, which can alter your pain complaints.

Make sure that any sleep issues you have as a result of chronic pain are properly documented in your disability claim as well. Trouble sleeping, especially due to chronic pain, can also have a direct impact on job performance.

Feelings of depression and isolation may amplify as you start to see yourself as a prisoner of your pain. You may also experience anxiety and feelings of hopelessness.

As a result, it is vital that you show well-documented, ongoing treatment for the psychological impact of your chronic pain. Your case could depend on it.


When making a claim for disability benefits due to chronic pain, you need to bear in mind the old saying: honesty is the best policy.

Your credibility will be called into question at every turn. This is because chronic pain is a disorder that most people simply don’t understand. There are some, even medical professionals, that will doubt your claims as a result.

Proving chronic pain through objective medical testing, such as MRI’s, X-rays and other objective medical imaging is very important. If there isn’t a clear-cut cause for your pain, it is vital that you don’t do anything to undermine the credibility of your case. Participating in activities that seem out of character for someone in pain, or inconsistent descriptions of your pain won’t reflect well on you.

It’s important that you keep a record of everything you do to try to minimize your pain. Track your symptoms as well as all your treatments. And pay special attention to everything you did to modify your work habits so you could keep your job while dealing with your pain. Likewise, if being in pain led to you having to change jobs, make sure you document that, too.

Common types of disability benefits

There are typically two ways Canadians can claim long-term disability benefits for chronic pain:

  • Canada Pension Plan (CPP)
  • Work or private long-term disability insurance plans

CPP disability benefits

Most people think of CPP in terms of retirement pension, but it also has provisions for disability benefits if you’re disabled and under the age of 65.

Eligibility is limited to people who’ve worked at least four of the last six years and contributed to CPP through payroll taxes. To claim disability benefits from CPP, your disability needs to be severe and prolonged, meaning you can’t work because of it.

Long-term disability benefits

Many Canadians have disability insurance through group insurance policies. Its often a part of the health benefits provided by an employer, but there are also plans available for the ever-growing number of self-employed professionals these days. These policies usually include coverage for both short- and long-term disability.

Chronic pain sufferers could qualify for long-term benefits if they’re members of such a plan. The payments they receive, if approved, can help replace your monthly income during a prolonged absence to help make ends meet while being unable to work.

But what if your claim is denied?

Sometimes, even though you’ve done everything to seek every treatment option available and you’ve documented everything, your claim could still be denied. As a result, you might have to get another job to provide for yourself and your loved ones, despite the pain.

Rejection can hit hard. You may feel as though your insurer doubts your honesty and is denying the effects of your pain. It can be frustrating and humiliating and have a negative impact on both your physical and mental well-being.

They may not have to accept your claim, but you don’t have to accept their judgment. You can always appeal their decision.

Keep fighting the good fight

Being in constant pain can have a negative impact on every aspect of your life, but you should never give up hope. There are always new treatments and therapies you can try to ease your suffering. If your insurance company denies your claim for any reason, you always have the right to hire a lawyer and make sure you get the compensation you deserve.

Has your chronic pain disability claim been denied?

If you feel your group insurance or CPP disability benefits claim has been wrongfully denied, use the link below to contact the lawyers at Mackesy Smye today. We’ll do everything in our power to demystify the appeals process for you and help you get the compensation you deserve.

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