Which medical conditions qualify for disability benefits in Ontario?

Medical Conditions Disability Ontario

The answer may not be as straightforward as you would think

Statistics show that nearly one-third of people who suffer a severe disability continue to work. If you’re one of those people, you may be wondering, ‘what qualifies for disability benefits in Ontario’?

This is both a common and complicated question. It’s common because 22 per cent of Canadians, 15 years and older report having at least one disability. And it’s complicated because the eligibility qualifications are not clear.

So, what conditions qualify for disability benefits?

Many medical conditions can potentially qualify for disability benefits but it depends on the degree of disability and whether the disability meets the requirements of your benefits plan and program. The determining factor is the level of impairment, rather than the name of your diagnosis.

What are the challenges?

Each medical condition comes with its own challenges. Mental illness, for example, is an invisible ailment that can’t be seen in a diagnostic test. In many cases, an insurance company will often reject a physician’s assessment as not being persuasive enough. “Insurance companies do not tell you that they look for any and every way to not pay benefits,” said Samantha Share, Assistant Managing Director at Share Lawyers. “They often will refer to the fact they have had their medical consultant review the claim and base their decision to deny benefits on the document review opinion of that unnamed medical consultant.”

With one in three workplace disability claims in Canada related to mental illness, this is alarming. 

Disability insurance policies are not all the same

To qualify for long-term disability benefits, you must establish that your medical condition prevents you from being able to do your job or any job for which you are qualified. However, different insurance companies, such as RBC Life Insurance, Manulife and Sun Life (to name a few) use different (but similar) language in defining what constitutes total disability under their respective long term disability policies, and it is important to review and understand the specific definition of total disability that would apply to your claim. Use this free online tool to determine how an experienced lawyer can help you navigate your claim.

What medical conditions qualify for long-term disability?

Assuming you don’t have an excluded condition, you can qualify for long-term disability benefits if your medical condition prevents you from doing your regular job. Some common injuries and medical conditions are:

  • Fibromyalgia and Chronic Pain
  • Mental health problems
  • Back and Neck injuries
  • Cancer
  • Mood disorders
  • PTSD
  • Migraines, Chronic Headaches

Medical conditions that may qualify for long term disability benefits and are often overlooked include, scar tissue, spinal cord injuries and nerve damage, bowel disease and gender dysphoria.

While some conditions may not appear to be disabilities, they can still adversely affect a person’s life. They may need care, support, and expert legal assistance to ensure their claim is approved.

Have your disability benefits been denied in Ontario? What is your next step?

Claimants with denied disability benefits should use one of the free online tools available to find out if they have a valid disability case and should not wait to call a disability lawyer. The longer they wait, the longer they will be without income. Samantha Share said, “A disability lawyer can get the appeal or lawsuit process started right away. They also can make suggestions as to alternate forms of income that may be available to the claimant during the waiting period.”

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