Are you unable to work because of lupus? Is chronic lupus preventing you from living a normal and comfortable lifestyle? If you have been considering applying for disability benefits for lupus, you are well aware of the obstacles that you will face along the way.
But, is lupus a disability in Canada? The short answer is yes —all disability benefits providers in Canada recognize lupus as a condition that can qualify a person for benefits.
However, a diagnosis on its own will not qualify you.
Providers pay benefits to people who can prove their condition prevents them from working. When reviewing claims for lupus, providers focus on the seriousness of your symptoms. They will consider the medical treatment you have had and future treatment plans. They look at how your symptoms affect your ability to work and how hard you tried to stay in the workforce.
Are you suffering from another condition along with Lupus? Check out our medical condition series below:
What is lupus?
Lupus is an autoimmune disease where the immune system attacks healthy tissue in the body. It can affect various parts of the body, including the skin, joints, kidneys, brain, and other organs. While there are several types of lupus, systemic lupus erythematosus (SLE) is the most common and serious form of the disease.
Lupus symptoms
Lupus symptoms vary widely and can range from mild to severe, often fluctuating over time with periods of remission and acute flares.
Common symptoms include:
- Fatigue
- Fever
- Joint pain and swelling
- Butterfly-shaped rash on the face
- Skin lesions that worsen with sun exposure
- Raynaud’s phenomenon
In particular, lupus symptoms in women can present certain challenges, as they are disproportionately affected by the disease. Women with lupus may experience symptoms unique to their gender, such as flare-ups during menstruation or pregnancy and an increased risk of complications in pregnancy.
Need a lupus disability lawyer?
Navigating the complex landscape of disability benefits can be overwhelming, especially when dealing with a condition as unpredictable as lupus. That’s where our law firm comes in!
if you need an LTD lawyer, we understand the intricacies of these claims and are dedicated to advocating on your behalf. By partnering with us, you safeguard your rights and significantly increase your chances of a favourable outcome.
If you’re ready to take control of your lupus disability claim or if you’ve been unfairly denied benefits, do not hesitate to reach out!
Get in touch with us by filling out the contact form below or reaching out via phone or email, and our team of experienced disability claim consultants will be more than happy to assist you.
Lupus disability 2023 Canada employment rights
As a general rule, employers can fire anyone if they give proper notice and don’t do it for a discriminatory reason.
However, most employers will not fire employees who take sick leave. Under Canada’s human rights laws, employers have a duty to help employees with medical conditions that affect their work. Allowing sick leave is a reasonable accommodation that employers should give.
If you have lupus and think you may need to take time off for treatment or management of symptoms, it’s important to communicate with your employer and discuss any necessary accommodations. Under human rights laws, employers have a duty to accommodate employees with medical conditions such as lupus.
As part of Lupus Canada guidelines, you need to provide a doctor’s note if you want to go on sick leave. It should confirm that you are unable to work and need the leave. You will need to bring these notes often — every three to six months — to confirm that you still can’t work.
If your application gets denied, you can stay on sick leave while you appeal. Most employers will not give you a hard time — as long as you have a doctor’s note.
If your employer attempts to fire you while you are on sick leave, you may have legal rights to severance pay. You might even be able to get the termination overturned if you are fired because of your condition. However, these situations are complicated. You should always seek out legal advice.
Additional reading: what conditions automatically qualify you for disability in Canada
Lupus disability Canada 2023
At this point, you might be wondering — what benefits can I claim for having lupus? If lupus prevents you from working, you have a few options:
- Disability tax credit
- Long-term disability insurance
- Short-term disability insurance
- CPP disability
- Employment Insurance (EI) sickness benefits
- Workers’ Compensation
- Veterans Affairs Canada
- Provincial disability benefits
Lupus disability tax credit
One of the critical financial supports for individuals suffering from lupus is the disability tax credit, which is a non-refundable tax credit that helps to reduce the amount of income tax that individuals with disabilities or their supporting persons might owe.
Eligibility is determined by the Canada Revenue Agency (CRA), and it hinges on the severity of the impairment, as assessed by a qualified healthcare provider. These impairments should affect the person’s ability to perform basic activities of daily living or require an extended period of therapeutic maintenance. In the case of lupus, the episodic nature of flare-ups and the ongoing treatment may meet these criteria.
It’s important for applicants to understand that approval isn’t automatic, and detailed medical information will be required on the DTC Certificate, a form completed by a physician or qualified practitioner. Therefore, maintaining open communication with healthcare providers is crucial, as their input will be instrumental in accurately conveying the extent of lupus’s impact on the individual’s life to the CRA.
Lupus long term disability (LTD)
LTD payments often cover 50-67% of your monthly salary. A policy will specify that the benefits last a number of years — 2, 5, or 10, for example. Or, they last until you reach a certain age — usually 65. Most LTD benefits come from group plans or privacy policies.
Group long term disability insurance policies are Canada’s most common type of disability insurance. If your employer has insured you as part of a group, you are receiving your disability insurance through your job. These group disability insurance policies provide both long-term and short-term disability benefits.
You can also get LTD through private insurance policies if you are self-employed or underinsured. With private policies, the payment is usually a fixed amount — but sometimes, it’s a percentage of your earnings.
You apply for LTD by filling out forms and sending them to the insurer. There are usually three forms: one for you, your employer, and your doctor. And it’s your job to submit them. You won’t get a decision until the insurer receives all the forms.
If denied, it is possible to appeal the denial. LTD providers usually allow you to do two to three internal appeals. After that, you would need to do an appeal hearing with an outside judge (external appeal).
For denied long term disability help, get in touch with us today for a free consultation.
Lupus short term disability
Short term disability (STD) benefits offer financial support for a limited period, typically ranging from a few weeks to a few months, depending on the specific plan guidelines. For individuals with lupus who may undergo sudden and unpredictable flare-ups, STD can be a critical resource to manage the intermittent periods of illness that impede their ability to work.
So, how to apply for short term disability if you have lupus?
First, you must qualify for STD benefits, and this means providing medical evidence of your lupus diagnosis and clearly demonstrating how your condition inhibits your work performance. This often involves submitting a medical certificate from a healthcare provider detailing the diagnosis, treatment plan, and the expected timeframe for recovery or improvement of symptoms.
The claims process for STD benefits can vary between insurance policies and employers. Generally:
- Report your absence from work due to illness to your employer
- Complete the necessary claim forms
- Submit them to the designated insurance provider for review
It’s important to note that STD benefits may also integrate with other benefits, such as sick leave or workers’ compensation, and understanding the interaction between these resources is vital for effectively managing one’s health and financial well-being.
A short term disability attorney will be familiar with the nuances of these policies and can provide essential guidance and support throughout the claims process. They can help ensure that all necessary documentation is in order, advocate on behalf of their clients during appeal hearings, and work to secure the maximum benefits available.
Similar to the other benefits on this list, if you’re denied short term disability, claims can be appealed internally and externally if necessary. Though the appeals process may seem daunting, it’s important for individuals with lupus to understand their rights and the resources available to them in order to effectively manage their condition and maintain financial stability during periods of illness.
Canada pension plan disability (CPP)
CPP benefits cover permanent disability. If you qualify, then you can get paid until age 65. The payment amount for CPP disability benefits for Lupus in 2024 is at least $583.32 per month. The amount you receive is based on how much you paid into the program. The more you contribute, the more you’ll get back.
But how hard is it to get CPP disability? For one thing, you must have the right amount of credits to quality for the disability benefit. You can get credits by credit splitting with a former spouse or paying into another country’s pension plan. Or, you can qualify for credits if you leave work to raise a child.
You can get LTD and CPP at the same time. However, the LTD insurer usually has the right to offset your payments by the same amount. For example, if you get $900 from CPP disability payments, your insurer can reduce its payment by $900 for the same month.
Even with enough credits, you still need to prove that your disability is “severe and prolonged.” A severe disability prevents you from regularly working a paying job. A prolonged disability has little hope for improvement.
You apply for CPP disability by filling out the forms. Your doctor or nurse practitioner will have to fill out the medical report. Then, you or your CPP disability lawyer can send your application to a designated Service Canada office for your province.
If Service Canada denies your claim, you can appeal on two levels. The first is a reconsideration appeal. You must request this appeal within 90 days of denial. If denied again, then you appeal to the Social Security Tribunal. The deadline is 90 days as well.
At the tribunal, a judge or a three-person panel will decide your claim. You can attend the hearing to give evidence and answer questions.
Employment Insurance (EI) sickness benefits
EI sickness benefits are designed to support individuals who are unable to work due to illness, injury, or quarantine. For those battling lupus, EI sickness benefits can provide short-term financial assistance during flare-ups that disrupt their ability to maintain employment.
Eligible claimants can receive up to 55% of their earnings, to a maximum amount set by the government. As of 2024, the maximum weekly amount is $668. Benefits can be paid for a maximum of 15 weeks, giving individuals with lupus the time they may need to focus on their health without the stress of lost income.
To qualify for EI sickness benefits, applicants must have accumulated a minimum of 600 insured hours of work in the year before the claim or since the last claim. They must also provide medical certificates to prove that they are unable to work due to their medical condition.
If a claim for EI sickness benefits is denied, individuals can request a reconsideration of the decision. This must be done within 30 days of the date the decision was communicated. Should the decision remain unfavourable, further appeals can be directed to the Social Security Tribunal.
Worker’s Compensation
For individuals with lupus who experience complications and are unable to work due to their condition, Worker’s Compensation may be an avenue to explore for financial support. This program is generally aimed at those who have suffered a workplace injury or illness, which does mean that proving a direct correlation between the work environment and lupus flare-ups is crucial.
Understanding workers’ compensation eligibility is a significant step for those affected by lupus. The specific criteria for eligibility can vary by region and are governed by strict regulations that define what constitutes a work-related injury or disease. For lupus patients, this may involve demonstrating that the workplace has directly exacerbated their condition, leading to a need for time off work.
As with other support programs, the application process necessitates detailed medical documentation and oftentimes needs the endorsement of a healthcare professional familiar with the intricacies of your medical history and work situation.
Should a lupus patient face rejection, most workers’ compensation programs allow for an appeals process, providing a structured means to contest the decision and seek a more favourable outcome.
VA disability for lupus
Veterans who have developed lupus as a result of their service may be entitled to disability benefits through the Department of Veterans Affairs (VA). The VA recognizes lupus as eligible for benefits when it can be shown as service-connected, meaning the disease either began during military service or was exacerbated by service activities.
Claiming these benefits requires medical evidence that documents the presence of lupus and its relationship to service.
When preparing a lupus VA claim, veterans should be thorough in gathering their medical records and acquiring statements from treating physicians that detail the nature of their condition and its service-related aspects.
The claim should also include a detailed account of how lupus impacts their daily life and ability to work. VA benefits are rated based on the severity of the disability, and the level of impairment caused by lupus can influence the amount of compensation received.
If a veteran’s initial lupus VA claim is denied, they have the option to file an appeal. It’s crucial for veterans to be aware of timelines and procedures for filing an appeal and consider seeking assistance from veterans’ service organizations which offer resources and guidance in navigating the VA benefits system.
For further guidance and support for any of the above benefits, contact our team today for advice on your next steps and eligibility
Provincial government assistance for lupus Canada
In addition to federal support programs, individuals living with lupus in Canada may also qualify for various provincial assistance initiatives designed to provide additional financial help and resources. These programs include healthcare support, income assistance, and other services that are tailored to those with long-term disabilities or chronic illnesses.
Ontario Disability Support Program (ODSP)
For residents of Ontario wondering, “Can you get ODSP for Lupus?” the answer is often yes. The Ontario Disability Support Program provides financial assistance to individuals with disabilities who are in need of support.
To qualify for ODSP, applicants must provide medical documentation proving that their lupus condition is a substantial physical or mental impairment that is continuous or recurrent and expected to last one year or more. The impairment must also restrict their ability to work, care for themselves, or take part in community life.
Successful applicants receive monthly payments to help cover the costs of basic living expenses, as well as health benefits, including prescription medications and vision care.
Quebec Social Solidarity Program
In Quebec, the Social Solidarity Program provides financial assistance to individuals who have a severely limited capacity for employment due to a disability. Those with lupus may qualify for these benefits if they can demonstrate that their condition significantly limits their ability to perform daily activities or work.
It aims to offer both financial support and access to employment integration services, acknowledging the diverse needs of individuals with long-term health conditions.
British Columbia Disability Assistance
British Columbia offers the Disability Assistance program to provide financial help and health-related services to eligible individuals with a severe physical or mental impairment.
Lupus patients in BC can apply for disability assistance to receive monthly financial aid, along with supplementary health benefits such as medical equipment and supplies, which can greatly aid in managing their condition.
Alberta Assured Income for the Severely Handicapped (AISH)
The Assured Income for the Severely Handicapped (AISH) scheme in Alberta is available to those who have a permanent medical condition that substantially limits their ability to earn a livelihood. Individuals with lupus may qualify for the program if they meet the medical and financial criteria.
AISH provides a monthly income, health benefits, and personal allowances to assist with living and medical expenses.
Through these provincial programs, Canadians living with lupus have a safety net that not only provides financial assistance but also access to crucial health services, helping to ease the burden of managing this chronic condition.
How can I get disability for lupus?
1. Obtaining a specific diagnosis from a qualified physician
The most important part of putting yourself in a position to win disability benefits for lupus is getting a specific diagnosis for it. If you cannot get a doctor to give you a legitimate diagnosis, you will have no case to provide to insurance companies.
The disease is often difficult to diagnose because there isn’t a standalone test that can determine whether you have it or not.
To have the best chance of getting properly diagnosed, you should see a rheumatologist. These doctors specialize in autoimmune disorders like lupus. They use a list of eleven criteria for lupus to assist them in making the diagnosis.
In general, if you have four or more of the criteria, you can be diagnosed with systemic lupus. The different criteria go as follows:
- Butterfly (malar) rash on the nose and cheeks.
- Raised red patches on the skin are called discoid rashes.
- Skin rashes that come from sunlight.
- Ulcers in the mouth or nose.
- Nonerosive arthritis in multiple different joints.
- Inflammation of the lining around the lungs or heart is called cardiopulmonary involvement.
- A neurotic disorder, such as seizures.
- Renal disorder, which is excessive amounts of protein in the urine.
- Low white blood cell or platelet count, known as Hematologic disorder.
- Immunologic disorder which affects antibodies.
- Antinuclear antibodies.
The criteria are quite specific, but each can be tested for, unlike lupus. After going through the many tests required for each of these symptoms, you can find out if you do have lupus. This will allow you to move forward in the process of winning disability benefits.
2. Show that you have gone through every treatment option available
To receive disability benefits for lupus, you must have documented proof that you have done all the possible treatments to alleviate your lupus symptoms. Lupus is a tough illness to treat because the symptoms vary from person to person. Usually, a health professional will create a plan specific to your needs.
The general treatment categories for lupus are prescription drugs, a healthy lifestyle, and regular appointments with your doctor to ensure all of your symptoms are being treated correctly.
Prescription drugs
Prescription drugs have been developed that treat most symptoms of lupus. Anti-inflammatory drugs are used to stop swelling and treat different forms of pain associated with lupus. Antimalarial drugs are another type of drug used to treat a variety of lupus problems.
Since no lupus-specific drugs are available, you have to rely on your doctor’s ability to identify where your problems stem from. Often, lupus patients may not see their symptoms completely subside with drug use. If this is the case, you strengthen your chances of receiving benefits.
While living a healthy lifestyle seems like a weak treatment plan, it is still important if you want to win disability benefits for lupus. You can be rejected for benefits if you have a history of substance abuse or obesity problems. Therefore, you must show that your body is in the best condition possible to handle the disease.
Healthy lifestyle
Additionally, it’s important to make an effort to keep track of your healthy habits to give to insurance companies. You should maintain a healthy diet with documents on what kinds of food you eat throughout a normal week or have regular meetings with a dietitian. You should also keep a journal of your sleep patterns to show you are keeping a consistent and regular sleep schedule.
Try to keep documentation on everything so you can convince insurance companies you are living a healthy lifestyle. Being able to prove you are a healthy individual is crucial to winning your case.
Regular appointments with a doctor
Lastly, you have to make sure you can show you have been seeing your doctor consistently. This proves that you are serious about fixing your problem. If you have been working with your doctor to attempt every possible treatment option to alleviate your symptoms, you will be in a good position to receive disability benefits for lupus.
Doctors can also more accurately tell you if you have gone through every treatment option, which will help with deciding if you should apply for benefits.
Doctors are a reliable and trustworthy source for insurance companies. So, having plenty of documentation from your doctor gives insurance companies convincing information that can really help your case.
3. Keep track of limitations in your daily life associated with lupus
While actively trying to find treatments and being diagnosed are important steps in this process, it is crucial that you are able to prove your daily life is being heavily affected by this disease. The best indication of an inability to do work-related tasks is any difficulties doing activities at home.
You must document the physical limitation you are having at home in great detail. However, you must also be able to discuss why these difficulties at home directly translate to problems in the workplace. In particular, an inability to maintain concentration, pace, or persistence in activities will help build a stronger case.
Be consistent with your documentation and use a ton of detail in describing how lupus affects your activity to give insurance companies the information they need to grant you disability benefits for lupus.
If you need assistance with progressing your claim for lupus disability, call our legal team today for personalized guidance and support
Reasons for insurance claim denial for lupus
The following are the most common reasons an insurance company will deny disability benefits for lupus.
No diagnosis
Many people are denied disability benefits for lupus because they have yet to receive a diagnosis. Benefit providers are very hesitant to give out disability benefits without a diagnosis. If this is the case, see a rheumatologist and start the process of getting diagnosed as soon as possible.
Incorrect treatment
If you got the right treatment, then you would not be disabled, right? This reason for denial shifts the blame to you or your doctor. It supposes either your doctor offered the wrong treatment or you refused the right treatment. This is the most common reason people get denied disability benefits for lupus.
The insurer may argue that your symptoms come from misdiagnosed and untreated depression rather than lupus. By that logic, your treatment would not work for you.
Some insurers may say that you have not received treatment for multidisciplinary pain. Therefore, they argue that your disability is not permanent. Make sure you have ways to shut down this argument.
Insufficient work effort
Another common reason for denial is you can’t do your job, but maybe you could do an easier one. This reason often arises when your job requires medium to heavy duties, and you didn’t try a job with light or sedentary duties.
The best way to fight this is to try easier jobs. Until you do, the disability benefits providers will always doubt you. You might also show that while your job had medium duties on paper, you got accommodations that made your work qualify as light duty.
Lupus treatment in Canada
Options for treating lupus in Canada include:
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarial drugs, corticosteroids, and immunosuppressants are frequently prescribed to manage lupus symptoms and prevent flare-ups.
- Lifestyle Modifications: Patients are advised to minimize sun exposure, adopt a healthy diet, engage in moderate exercise, and implement strategies to reduce stress.
- Regular Monitoring: Due to the potential side effects of long-term medication use and the unpredictable nature of lupus, regular check-ups with healthcare professionals are essential.
The Canadian healthcare system’s support for lupus includes access to specialists, medication coverage under some provincial health plans, and various community support resources. Patients may also benefit from participating in clinical trials for new lupus treatments, which are often available in Canada’s major medical centers.
Medications for lupus in Canada
The range of medications for lupus available in Canada is designed to address the specific symptoms of the disease and includes several categories of drugs:
- Anti-Inflammatory Medications: These are typically the first line of defense against joint pain and swelling. Over-the-counter options like ibuprofen and prescription-strength drugs are used.
- Antimalarial Drugs: Drugs such as hydroxychloroquine (Plaquenil) are often prescribed for skin and joint issues. They can also help prevent flare-ups.
- Corticosteroids: Powerful anti-inflammatory drugs like prednisone can control or prevent inflammation in severe cases of lupus but come with a risk of significant side effects.
- Immunosuppressants: For patients with more severe lupus, medications that suppress the immune system, such as methotrexate, azathioprine, and mycophenolate mofetil, may be necessary.
Each treatment regimen is carefully considered and personalized by healthcare providers to match the needs of the individual with lupus. Due to the possible adverse effects associated with these medications, frequent communication with healthcare professionals is critical to ensure the best possible outcomes.
Disability lawyers specializing in lupus insurance claim denial
If you’ve faced a lupus insurance claim denial, it’s important to act decisively. Consult with a disability lawyer who specializes in lupus-related cases to navigate the complexities of insurance claims and secure the benefits you deserve.
Don’t let a denial discourage you – with the right legal guidance, you can challenge the decision and fight for your rights.
Contact Resolute Legal today for a free consultation and professional guidance tailored to your unique situation.
We represent clients in every province other than Quebec and the Northwest Territories. Click on your province or city of residence to learn more about how we can help you.
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