Are you dealing with long-lasting symptoms of long COVID? Does your illness keep you from doing your work duties? Wondering how to get disability benefits for a long COVID disability in Canada? Well, you’re in the right spot!
Navigating the complexities of long COVID and its impact on disability benefits demands dedicated lawyers. At our firm, we understand the unique challenges individuals face in securing the support they rightfully deserve.
We’ve been at the forefront of advocating for clients in this emerging field. From decoding the complex application process to addressing misconceptions surrounding long COVID as a disability, our dedicated team is committed to guiding individuals through every step of coronavirus Canada benefits and long COVID disability payments, ensuring they receive the financial assistance they need.
Long COVID disability Canada guide
In this comprehensive guide on navigating long-term disability claims relating to long COVID, we’ll explore and explain the complexities surrounding long-lasting symptoms and explore the avenues available to ensure you receive the support you need.
From understanding the eligibility criteria to the step-by-step process of claiming disability benefits, this is your go-to resource for valuable insights, empowering you on your journey to securing the assistance you deserve.
Let’s embark on this informative exploration together, providing clarity and guidance every step of the way.
If you’d rather simply talk to one of our team to discuss your situation, contact us today.
Is long COVID a disability in Canada?
Despite potential misunderstandings by disability providers about long COVID, your entitlement to benefits remains unchanged. If you are grappling with the questions, “Is long COVID considered a disability?”, or “Does long haul COVID qualify for disability?”, our guidance can help you take the initial steps towards securing the support you rightfully deserve.
But first, let’s clear up the basics of long COVID to help provide some background and clarity.
If you have more questions about disability benefits and qualifying conditions, please read our article What medical conditions qualify for disability in Canada or explore the articles below:
Long COVID Terminology
If you’ve received a diagnosis of long COVID or are undergoing the diagnostic process, you might observe various terms employed to characterize this condition. The Canadian government and the World Health Organization (WHO) refer to it as Post COVID-19 condition.
Alternative expressions encompass:
- Chronic COVID syndrome
- Late sequelae of COVID-19
- Post-acute sequelae SARS-CoV-2 infection (PASC)
- Long haul COVID
- Long-term COVID
It’s important to mention that, in this article, we will specifically use the term “long COVID.”
The effects of the long COVID disability
As mentioned earlier, our understanding of long COVID remains incomplete.
Nevertheless, it is evident that long COVID manifests in several ways, with over 100 reported long-term symptoms to date. Among these, the most frequently observed and common symptoms include:
- Fatigue
- Shortness of breath
- Anxiety and depression
- Memory problems
- Posttraumatic stress disorder (PTSD)
- Sleep disturbances
- General pain and discomfort
- Difficulty thinking or concentrating
Four major patterns have been found in long COVID sufferers
Despite the multitude of reported symptoms, a recent study published in Nature Medicine on December 1, 2022, has identified four primary subtypes of long COVID.
The research, led by Weill Cornell Medicine scientists, utilized a machine-learning algorithm to discern patterns in the health records of nearly 35,000 U.S. patients who initially tested positive for the initial infection of COVID-19 and later developed long-COVID symptoms.
The four subtypes showed the following patterns:
- 1st subtype: An impact on everyday functioning of the heart, kidney, and circulatory problems, primarily observed in patients infected during the initial months of the pandemic in 2020.
- 2nd subtype: Respiratory issues, anxiety, and sleep disorders.
- 3rd subtype: Musculoskeletal and nervous system problems, such as musculoskeletal pain, cognitive dysfunction, headaches, and sleep-wake disorders.
- 4th subtype: Impacted patients’ respiratory and digestive systems.
The most prevalent long COVID subtype, affecting almost 34% of the studied patients, was characterized by heart and kidney problems. The second most common category involved respiratory, sleep, anxiety, headache, and chest pain symptoms, affecting 33% of patients. The third and fourth categories, addressing musculoskeletal and nervous system issues, and digestive and respiratory problems, were less widespread among patients.
This comprehensive study marks a significant stride in understanding the elusive nature of long COVID and what occurs in individuals following initial recovery from an acute COVID-19 episode or even a mild case. Additionally, it has the potential to guide further research on effective treatments and accurate diagnostic approaches for this condition.
What this does show us is that the symptoms of long COVID clearly have a debilitating impact on an individual’s ability to work.
Diagnostic criteria for long COVID
As of the present moment, there exists no unanimous agreement on the definition of long COVID or a universally accepted methodology for its diagnosis and treatment. Nonetheless, the diagnosis of long COVID typically relies on two key factors:
- A prior infection with COVID-19, and
- The manifestation of post-COVID-19 symptoms persists beyond the initially anticipated acute infection period.
The specific duration considered for the acute infection period may vary depending on the organization or agency in question. For example, the World Health Organization (WHO) defines long-COVID as “symptoms that linger beyond three months of a probable or confirmed SARS-CoV-2 infection, which last at least two months and cannot be explained by an alternative diagnosis.”
In contrast, Public Health Ontario tentatively characterizes long COVID as the presence of “persistent or new sequelae present three or more weeks after severe, mildly symptomatic, or asymptomatic SARS-CoV-2 infection.”
For insights into how your provincial health organization defines and diagnoses long COVID, you can visit the website of Long COVID Resources Canada. Alternatively, consult with your doctor to understand the diagnostic criteria applicable in your province.
You are not alone
Even though an accurate method for diagnosing long COVID is still unavailable, estimates indicate that it has impacted millions of Canadians.
According to the 2022 Canadian COVID-19 Antibody and Health Survey, approximately 1.4 million people in Canada have either experienced or were grappling with long COVID. This accounts for around 4.6 percent of the Canadian population aged 18 years and older.
Furthermore, studies highlight the substantial effect of long COVID on individuals’ work capacity. A nationwide study involving over 1,000 long COVID sufferers revealed that nearly 70 percent of respondents had to take time off work. Additionally, more than half had to reduce their working hours, with 74% decreasing their working hours by 50% or more.
The skepticism of disability benefits providers should not undermine the legitimacy of your symptoms. You are entitled to access disability benefits just like anyone else.
So now let’s turn out attention to the various benefits you may qualify for.
Long haul COVID disability benefits you may qualify for
In the context of pursuing and knowing how to apply for long COVID disability support, workers facing the need for long COVID disability benefits in Canada may qualify for either of two distinct types of disability assistance.
These options encompass CPP disability benefits disability benefits and benefits provided by long-term disability insurance.
Long COVID CPP disability
The Canada Pension Plan (CPP), primarily designed to provide financial support in retirement, also extends coverage to disability benefits that activate upon your disability onset and continue until the age of 65. Subsequently, these disability benefits are transitioned into regular pensions.
To qualify for CPP disability benefits, you must have been employed for at least four of the past six years and have contributed to payroll taxes. The CPP necessitates proof that your disability is both prolonged and severe, rendering you incapable of engaging in employment.
Applying for CPP disability involves completing the requisite forms, with your medical report filled out by your doctor or nurse practitioner. Following this, you submit your application to a designated Service Canada office in your province.
Be sure to check out our tips for applying for CPP disability!
If you’re in a LTD denied situation from Service Canada, you have the option to appeal on two levels. The initial stage is a reconsideration appeal, which must be requested within 90 days of the initial denial. If the reconsideration is also unfavorable, the next step involves appealing to the Social Security Tribunal within another 90-day window.
Upon appealing to the tribunal, your claim will be adjudicated by either a judge or a three-person panel. You have the opportunity to participate in the hearing, providing evidence and responding to inquiries.
Long COVID long term disability
Group disability insurance policies stand out as the most prevalent form of disability insurance in Canada. If your employer has included you in a group insurance plan, your disability coverage is typically facilitated through your workplace.
These group disability insurance policies encompass both short term disability and long term disability insurance benefits. If you are contending with long COVID, you have the option to apply for long-term COVID disability benefits if you meet the eligibility criteria. Upon approval, these benefits offer a monthly income stream during extended work absences.
To apply for LTD, you’ll need to complete and submit forms to the insurer. Generally, there are three forms to contend with — one for yourself, one for your employer (if applicable), and one for your doctor. The responsibility falls on you to ensure the timely submission of all these forms, as the insurer won’t reach a decision until they have all the necessary documentation.
In the event of a denial, many LTD plans afford the opportunity for two to three internal appeals. If these internal appeals prove unsuccessful, the next step involves an appeal hearing, typically conducted with an external arbitrator or judge.
Other long COVID benefits Canada provides
If you don’t qualify for long-term disability insurance or CPP disability, you may be eligible for one of the following disability programs.
EI COVID sickness benefits
Employment Insurance (EI) sickness benefits serve as temporary disability support provided by the federal government through the Employment Insurance program. EI offers 55% of your regular salary for a duration of up to 26 weeks. Effective January 1, 2024, the yearly maximum payout is capped, equating to a weekly maximum of $668.
To qualify for EI sickness benefits, recent contributions to the EI program are essential. These contributions are automatically deducted from your paycheque. If you’ve received an official paycheque, you’ve likely contributed to the EI program.
You can apply for EI benefits online through Service Canada, either from home or at any Service Canada office. Additionally, a crucial step involves your doctor completing a form confirming your incapacity to work for the specified 26-week period. Furthermore, your employer must provide a Record of Employment (ROE) to validate your sick leave.
Long COVID short term disability
Short-term disability (STD) benefits represent an additional form of temporary disability compensation, typically covering 50-67% of your regular salary. The duration of these benefits typically spans 15-17 weeks, although it may extend for a longer period in some cases. Payments are usually disbursed on a weekly basis.
Employers administer these benefits either directly through the company or via a group insurance policy, often outsourcing program management to an external agency.
Qualification for STD benefits is contingent on your employer offering such plans, as not all jobs provide this option. If your employment lacks this coverage, you may be eligible for EI sickness benefits.
To initiate the application process, you can obtain the necessary forms from your employer or the relevant insurance company. The application typically comprises three forms—one for yourself, one for your doctor, and one for your employer. It is your responsibility to ensure that all forms are completed and submitted to the insurer.
In the event of a denial, you have the option to request an appeal. Initially, an internal appeal involves a review by another individual within the company. Multiple internal appeals may be available—up to three or four. If success is not achieved through internal appeals, an external appeal, potentially involving an arbitrator or judge, may become necessary, depending on your specific circumstances.
Workers’ Compensation
Compensation for workers provides both immediate and extended benefits to individuals who sustain injuries while on the job.
Every province maintains its own compensation initiative. To be eligible, one must experience a workplace injury or illness and be employed by a company covered by the program. It’s important to note that not all employers fall under this coverage.
Payments for workers’ compensation benefits may coincide with those from EI, CPP, and short- or long-term disability. Seeking legal counsel is advisable for any uncertainties related to these payments. Depending on the province, individuals may retain some or all of their CPP disability and workers’ compensation.
In the event that your workers’ compensation claim is rejected, it is recommended that you follow the appeal procedures specific to your province. These appeal processes typically involve internal reconsideration and an external tribunal. In many provinces, this external tribunal is referred to as the Workers’ Compensation Appeals Tribunal (WCAT).
Disability tax credit
The disability tax credit is a form of benefit designed to reduce your taxable income.
To be eligible, you must have a severe and prolonged impairment as specified by the program. It’s important to note that this benefit has a more stringent standard compared to other similar programs.
Successfully qualifying for this credit can result in a refund of some of your previous taxes, contingent on the timeline of your medical condition. The application process involves completing a T2201 form and submitting it to Revenue Canada.
In the event that Revenue Canada rejects your claim, you have the option to initiate an internal appeal. Should the internal appeal prove unsuccessful, the next step is to pursue an appeal through the Tax Court of Canada.
Note that, at the time of writing this article, it doesn’t appear that the Canada disability benefit applies to long COVID.
You are entitled to disability support by law. Get in touch with us today for a free consultation!
Provincial long COVID financial support in Canada
Each Canadian province provides income support benefits to individuals unable to work due to a disability. Those who qualify can receive fixed payments for the entirety of their lives.
Eligibility for provincial benefits is not contingent on prior work experience; individuals who have never worked may still qualify. However, these benefits are income-dependent, applying only if the total family income falls below a specified threshold, which varies among provinces. It’s essential to note that family income does not impact the approval process for other forms of disability benefits.
Application for provincial disability benefits is made through the local agency or program responsible. As is customary, a medical report or certificate from your doctor confirming your inability to work due to a medical condition is required.
In case of a denial, there is an internal appeal process within the agency or program. Additionally, some provinces allow appeals to an external tribunal for a final decision. It’s advisable to check with your specific province for the correct procedures in such cases.
Winning long COVID disability benefits in Canada
Historically, chronic fatigue and fibromyalgia faced a lack of acknowledgment as genuine disabilities. However, a shift has occurred over time, with health professionals and insurance companies now recognizing these conditions based on extensive research, clinical evidence, and legal decisions.
A comparable trajectory is anticipated for long COVID. This doesn’t imply that securing disability benefits for long COVID is impossible; rather, it necessitates thorough preparation for the process.
The complexities of diagnosing long COVID stem from the absence of a single test or universally accepted criteria for confirmation. Early in the pandemic, Canadians were advised to stay home and refrain from COVID-19 testing, assuming infection if another family member had it.
Moreover, the reliance on at-home tests, some of which were unreliable and yielded false negatives, poses a significant challenge. This complicates matters for individuals seeking disability benefits for long COVID, as they may lack a positive COVID-19 test to substantiate their claim.
Given these challenges, it’s not surprising that insurance companies and the CPP disability program may approach long COVID claims cautiously. Winning benefits necessitates a meticulously organized application with well-documented medical evidence that systematically eliminates alternative causes for symptoms.
It’s crucial to understand that a mere doctor’s diagnosis may not suffice for approval of CPP disability benefits. The real hurdle lies in proving that your symptoms render you incapable of functioning in any workplace, taking into consideration your age and work experience.
To enhance the likelihood of approval, consider the following strategies:
Get a diagnosis and document it
As previously mentioned, obtaining a diagnosis for long COVID doesn’t ensure automatic approval, but it is a crucial element in the process of securing benefits.
If you haven’t done so already, schedule an appointment with your doctor to initiate the diagnostic process. In cases where your doctor is unable to provide a diagnosis, consider asking for a referral to a specialized long COVID clinic.
Include detailed medical documentation
Although obtaining a diagnosis is crucial, it holds little weight without the necessary accompanying medical records and documentation.
Ensure your submission includes:
- Documentation of a positive COVID-19 test (if available)
- Comprehensive medical reports detailing symptoms
- Information about your past medical history
- The results of any additional tests conducted by your doctors throughout the diagnosis and treatment process
Medical records that rule out other medical conditions
An essential aspect of securing disability benefits for long COVID is furnishing medical documentation that systematically excludes the possibility of other conditions. This is of utmost importance. It is imperative to demonstrate that your symptoms stem specifically from long COVID, ruling out alternative causes.
Therefore, the evidence should emphasize symptoms that emerged subsequent to your initial COVID-19 infection and are distinctively associated with the long-term effects of the virus.
Get the appropriate treatment and document it
When evaluating your claim, disability benefits providers will assess whether you have undergone appropriate treatment for your condition. Failure to receive the correct treatment is a common reason for benefit denials.
Despite the absence of a known cure or official treatment plan for long COVID, it is imperative to diligently adhere to your doctor’s recommendations. This may involve attending specialist appointments, trying prescribed medications, undergoing diagnostic tests like x-rays, blood tests, and MRIs, participating in recommended therapies, and more.
Additionally, discuss the possibility of a referral to a long COVID treatment center with your doctor, as these specialized centers operate throughout Canada. You can check this page to identify a center in proximity to your location.
Given that medical professionals are continuously learning about long COVID, it is crucial to advocate for yourself. New information and studies emerge regularly, so do not hesitate to engage in conversations with your doctor about any recent treatments or potential referrals you come across.
Evidence of work-related limitations
Given the absence of a definitive method to confirm the presence of long COVID, your application must strongly emphasize your functional limitations or lack thereof. It’s crucial to present evidence detailing tasks you are unable to perform, along with documentation highlighting the challenges you are encountering in your workplace.
Furthermore, document any adjustments you have made to your work habits to sustain employment while coping with long COVID. Before submitting your application, consider trying less demanding roles within your workplace.
Until you do so, there may be skepticism from disability benefits providers. Demonstrate any accommodations made by your employer, indicating that despite your job being categorized as having medium duties on paper, adjustments were implemented to qualify your duties as light.
If long COVID compelled you to switch jobs, make a clear note of that as well. The overarching objective is to establish that you are incapable of performing your regular work, tasks from past employment, and any other form of gainful employment.
Credibility is key
Maintaining absolute honesty is crucial for individuals pursuing disability benefits for long COVID. Credibility holds significant weight in the legal process of claiming disability benefits related to long COVID.
Any exaggerations or inconsistencies in describing symptoms can undermine credibility, even if such inconsistencies are unintentional and arise from honest mistakes.
Credibility killers
- Contradicting medical records or earlier statements
- Making excuses or blaming others for problems
- Criticizing other parties in the claim (even if they deserve it)
- Filing complaints against professionals you see as negative, biased, or unprofessional
- Using aggressive, sarcastic, or confrontational tones in your claim or testimony
- Blocking or stalling reasonable requests for information
- Fighting with doctors over your diagnosis instead of focusing on the disability
- Acting like a medical expert
Credibility boosters
- Making sure what you say matches the medical records
- Taking responsibility for errors or problems with your claim (not blaming others)
- Being cooperative and respectful of everyone in the claim
- Accepting expert advice and opinions
- Making good faith efforts to try all reasonable advice, even if you disagree with it
- Obvious efforts to keep working
Returning to work for individuals living with Long COVID
Returning to work after experiencing Long COVID presents unique challenges due to the condition’s unpredictable and episodic nature. For those affected, the journey back to the workplace may require a flexible and individualized approach. According to a 2022 report from Realize, a successful return-to-work plan for individuals with Long COVID should include:
- Flexible Work Hours: Allowing for variable work schedules can help accommodate the fluctuating symptoms and energy levels experienced by those with Long COVID.
- Prolonged Phased Return: A gradual return to work, with the possibility of extended timelines, ensures that individuals are not overwhelmed as they reintegrate into their professional roles.
- Workplace Accommodations: Modifications to the work environment, such as ergonomic adjustments or changes in workload, can support the physical and cognitive needs of employees.
- Remote Work Options: Offering the ability to work from home can reduce the strain of commuting and provide a more manageable work setting for those dealing with fatigue or other symptoms.
- Reduced Workload: Limiting both physical and cognitive tasks can help individuals maintain productivity without exacerbating their symptoms.
- Rest-time Accommodations: Allowing for regular breaks and periods of rest is crucial in managing the fatigue and post-exertional symptom exacerbation (PESE) commonly associated with Long COVID.
It is important to recognize that some individuals may not fully recover or be able to return to their pre-illness employment. Employers, insurers, and rehabilitation professionals should be prepared to support various outcomes, including the possibility that some individuals may not be able to return to work at all.
When to contact a long-haul COVID claim lawyer
In our experience, a significant number of initial long COVID claims, despite being valid, often encounter denials due to the lack of an established diagnostic method, leading disability providers to reject benefits based on insufficient medical evidence.
This challenge is compounded for those dealing with respiratory issues, as disability insurance claim denials related to such conditions are unfortunately common.
However, there is a silver lining. You are not compelled to accept the denial of your rightful claims. Instead, you have the option to appeal the insurance company’s decision with the support of our legal team, dedicated in long haul COVID-19 and respiratory issue disability insurance claim denial cases.
Our lawyers have accumulated several cases of experience in handling disability benefits claims, including those related to long COVID and respiratory issues. Notably, Resolute Legal was among the first firms in Canada to litigate against an LTD insurance company for overlooking long COVID as a disability.
There is no question that a long haul COVID-19 claim denial lawyer from Resolute Legal will do the best to work on your disability claim.
Understanding the challenges you face, we are confident in our ability to assist you. You have the power to challenge insurance companies that deny you the legal support you are entitled to. Call us at (888) 480-9050 to schedule your complimentary consultation today.
Our offices are located in Toronto, Ottawa, Moncton, and Halifax, and we serve clients across all provinces except Quebec. We provide 90% of our services online and will visit you in person as needed. Learn more from the pages below:
Service areas:
Office locations:
Next Step – Get Your Free Books
Start making better decisions today. Subscribe to our email newsletter to get free downloads of our books on winning disability benefits.
