Living with a disability presents significant hardships. Not only do you have the challenges of adjusting to a new way of living, but you also have to find ways to support yourself and your dependent loved ones financially. Fortunately, there are options available. Disability benefits such as the Canada Pension Plan (CPP) for disability or the Persons with Disabilities (PWD) program in British Columbia offer essential financial support. Private insurance plans for short term or long term disability also offer a safety net to those who paid into a plan before their disability occurred. However, actually securing these benefits can be difficult. Even British Columbians with valid disabilities see their claims denied.
Gathering proper medical evidence is key to proving the severity of your condition. Getting your doctor involved in your claim can also help you successfully obtain benefits. This is particularly true during an appeal, where clear, compelling medical documentation can strengthen your case.
Common Reasons for Disability Claim Denials
Disability claim benefits are often denied for several reasons, including:
Insufficient medical evidence
Claims may be rejected if the provided documentation lacks detailed evidence proving the severity and duration of the disability.
Condition fails to meet requirements
For CPPD benefits, disabilities must significantly limit your ability to work and either last indefinitely or be considered fatal. For PWD benefits, the disability must restrict daily living activities and last at least two years.
Lack of recent or consistent treatment
Insurers and CPPD administrators may require proof of ongoing treatment or rehabilitation attempts. A lack of recent and consistent treatment presents the idea that you are not actively managing your condition.
Pre-existing conditions
Private insurance policies usually exclude coverage for pre-existing conditions if symptoms began or treatment was sought before the policy started.
Definition of disability varies
Many private insurance policies include different definitions of disability. For instance, one policy may consider someone disabled if they are no longer able to perform their previous job, while others state someone is disabled if they are unable to perform any work. These differences in definitions may cause claims to be denied if the insurer believes you can work, either in a similar role or in any other capacity.
Addressing these reasons in your appeal is critical.
Can My Doctor Help Me Get Disability?
Doctors play an important role in helping patients obtain disability benefits. Their medical insight and detailed documentation concerning your medical condition will influence insurers’ decisions regarding your claim. Medical documents from doctors include a thorough record of a diagnosis, treatment, and progression history. Other factors such as appointment attendance and adherence to treatment plans will also be included. Conveying these minor yet important details can strengthen your appeal significantly, so long as records show you’ve consistently done everything possible to follow medical advice to manage your condition. Additionally, doctors describe how symptoms like pain, fatigue, or cognitive challenges affect your ability to perform physical and mental tasks. Their expertise indicates what level of functional limitations you have and how these constraints prevent you from working or completing daily activities.
Medical Evidence For Disability Claims
Depending on your disability, your claim should include medical evidence detailing diagnostic test results, functional assessments, and other notes from a primary care physician or specialist.
- Diagnostic test results include blood tests, X-rays, MRIs, and other objective data.
- Functional assessments include detailed notes on symptoms, physical or mental restrictions, and how these factors impact your ability to perform daily tasks.
- Specialist reports include letters or evaluations from specialised doctors who provide additional support to corroborate your primary doctor’s findings.
This evidence helps demonstrate the severity and prolonged nature of your disability, addressing insurers’ requirements.
How to Get Medical Records for Disability
You can request medical records from the doctor or clinic you visited to receive a diagnosis. Once you receive these documents, review them for completeness and relevance. Make sure the records your doctor provided address the specific requirements of the benefits program you applied for. It’s a good idea to consult with a lawyer who can help organize and present evidence in a way that aligns with the disability claims or appeal process.
If you’ve been denied disability benefits, remember that your doctor is one of your most important allies. Working closely with them and gathering the right medical evidence may improve your chances of obtaining the support you deserve. For additional guidance, work with Stephens & Holman to ensure your appeal is comprehensive and compelling.