Do you need to win long-term disability benefits for Lyme Disease in Canada? Does your illness leave you struggling in everyday life and unable to fulfil your duties at work?
If you started to apply for long-term disability benefits or are considering it to lift the financial weight off your shoulders, you might already know that you are in for a bumpy ride.
Insurance companies consider Lyme disease an invisible medical condition; diagnosis is difficult and often inaccurate.
Additionally, many employers are unfamiliar with the disease and the profound effect it has on those suffering from it. What should be a simple and straightforward application process can turn into a lengthy and frustrating ordeal.
A bureaucratic nightmare is the last thing you need when you are trying to cope with a difficult long-term illness. This article discusses the unique challenges Lyme disease victims will face when applying for long-term disability benefits. We can help you take the first steps toward securing the support that you are entitled to.
This article is part of our series looking at what conditions qualify for disability in Canada.
Can you get disability for Lyme disease in Canada?
Yes, Lyme disease qualifies for disability benefits in Canada. However, to win, you must prove that your symptoms prevent you from working. This isn’t as easy as it sounds. You need strong medical evidence and the right strategy to give you the best chance at success.
A long term disability lawyer can help you put your best foot forward. Click on the button below to hear how our team can help you win back the benefits you are entitled to.
Are you suffering from another condition along with Lyme disease? If so, check out some of our other medical condition articles:
Disability from Lyme disease: You’re not alone
If you are struggling with headaches, fevers, fatigue, heart palpitations or pain in your joints due to a Lyme disease infection, you are experiencing some of the many symptoms of an illness that is as complex as it is elusive. Lyme disease, a systemic disease, can affect your entire body if left untreated.
The serious long-term effects of Lyme disease can make you feel isolated from the rest of the world. However, it is crucial to remind yourself that you are not the only one battling this illness.
Lyme disease disability on the rise in Canada
In fact, the risk of contracting Lyme disease — once limited to parts of Ontario — is on the rise in Canada. Lyme-carrying ticks can now be found in all Canadian provinces along the U.S. border. Along with that, Lyme disease cases are increasing too. From 2009 to 2021, provincial health units reported 14,616 cases of Lyme disease across the nation, with the majority of reports taking place in the last couple of years. The preliminary data for 2021 recorded 2,851 cases, which is the highest year yet.
The disease is spreading slowly but steadily across the country. And, with more and more reported cases and numerous unreported or misdiagnosed ones, Lyme disease can no longer be brushed off as a dangerous exception. The numbers will continue to rise.
These are shocking numbers, and they show that you are not alone in this battle. Unfortunately, the support available to those suffering from Lyme disease has yet to catch up with these worrying developments. Canada’s health and insurance systems are lagging way behind the disease.
One thing I have learned both as a health professional and a disability benefits lawyer is you need to figure out how to play the system to get the support you need. Getting financial and medical support should be given in a country like Canada. I am hoping that the situation will change in time. But for now, you have to work within certain restraints – and we will do our best to help you.
Lyme disease diagnosis
Lyme disease is an inflammatory infection caused by tick bites. If caught early, you can treat Lyme disease with several weeks of antibiotics. Infected patients usually make a quick recovery. However, if left untreated for longer periods of time, the disease can progress into a chronic one. Treatment becomes more difficult, and diagnosis becomes unlikely as time passes.
Devastatingly, diagnosis often doesn’t happen in time for the simple antibiotics course to be effective anymore. If you are looking to claim long-term disability benefits for Lyme disease, then you must be all too familiar with the difficulties of diagnosing it.
The symptoms of Lyme disease vary. They also mimic the symptoms of other illnesses. So, misdiagnoses are extremely common. If you had a bull’s-eye rash after the tick bite – supposedly the most reliable indicator of Lyme disease – then, bizarrely, you might be one of the lucky ones. Many infected people never develop the rash and are not aware a tick has bitten them either. Arthritis, Fibromyalgia and Multiple Sclerosis are only a few of many illnesses that Lyme disease victims are regularly misdiagnosed with. Symptoms are often not connected to their real cause until it’s too late.
False negative tests for Lyme disease
Did you falsely test negative for Lyme disease at some point during this exhausting journey? A lot of controversy surrounds the diagnosis, especially when it comes to the tests that ought to reliably detect Lyme disease and give you peace of mind.
Canadian tests are notorious for misdiagnosing the illness, and a great proportion of those affected falsely test negative. For this reason, many patients turn to laboratories in the U.S., especially in California. This is because U.S. tests are capable of detecting more strains of bacteria than their Canadian counterparts.
If you have been struggling to support yourself financially and are turning to disability benefits, you are probably one of the many people who went undiagnosed for years – and maybe still are. Left unrecognized and thus untreated, Lyme disease turns into a chronic disease with long-term implications for your health and well-being.
If you are struggling with Lyme disease, you never know what the next day will bring. Will you be able to make it out of bed, or is the pain going to be too much? So, you shouldn’t have to worry about how to make it work on top of that.
Employment rights relating to Lyme disease
Employers cannot legally terminate an employee due to disability under Canadian law, as it’s considered a protected ground of discrimination. Before termination, employers must fulfill their duty to accommodate the employee’s disability, unless doing so would cause undue hardship. Accommodation may involve adjustments to the work environment or duties to enable the employee to continue working effectively.
Termination can still occur under certain circumstances. Firstly, employers can terminate with reasonable notice or pay in lieu thereof, as stipulated by provincial employment standards legislation or common law. The length of notice or severance pay depends on factors such as length of employment and contractual agreements.
Secondly, termination for “just cause” is possible, typically due to employee misconduct such as theft or insubordination. However, this must be clearly demonstrated by the employer.
Additionally, termination may occur if the employment contract is frustrated by unforeseen events, such as the employee becoming unable to perform essential job duties due to illness or disability. In such cases, the doctrine of frustration relieves both parties of their obligations under the contract. However, the foreseeability of the event, such as the inclusion of long-term disability benefits in the contract, may affect whether frustration applies.
Ultimately, while termination is possible under specific circumstances, employers must ensure compliance with both employment standards legislation and human rights laws, including providing reasonable notice or severance pay and not discriminating against employees with disabilities.
Lyme disease disability benefits you may be entitled to
When it comes to claiming long-term disability benefits for Lyme disease in Canada, you might be eligible for one of two types of disability benefits if you are a worker. These are the Canada Pension Plan (CPP) disability benefits and the long-term disability insurance benefits.
CPP disability benefits for Lyme Disease
The CPP, designed to support you after retirement, also covers disability benefits that start once you become disabled. CPP disability payments last until you are 65. After that, these disability benefits are converted into regular pensions.
To qualify for the CPP disability benefits, you have to have worked for four out of the past six years and paid payroll taxes. To get CPP benefits, you have to prove that your disability is both prolonged and severe, leaving you unable to work. See How hard is it to get CPP disability, for more information on teh application process.
If your claim is denied by Service Canada, you have the option to appeal on two levels: first, through a reconsideration appeal, which must be filed within 90 days of the initial denial, and then through an appeal to the Social Security Tribunal if the denial persists. The tribunal, presided over by either a judge or a three-person panel, reviews your claim, allowing you the chance to present evidence and address questions during the hearing.
Given the intricate nature and hurdles involved in obtaining CPP disability benefits, enlisting the assistance of CPP lawyers at Resolute Legal, a renowned disability law firm, can greatly help you skillfully navigate the process and optimize your likelihood of a favourable outcome.
Long-term Disability Insurance Benefits for Lyme Disease
Group disability insurance policies are the most common type of disability insurance in Canada. 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.
If you are suffering from a chronic form of Lyme disease, you can apply for long-term disability benefits. If successful, you will be provided with monthly income payments during long absences from work. See how to apply for long-term disability in Canada for more information on the application process.
Other Lyme disease disability benefits
As discussed, CPP disability and long-term disability benefits are the most common disability benefits for workers. However, the following are some other benefits you may be eligible for.
Employment Insurance (EI) sickness benefits for Lyme disease
EI sickness benefits function as a form of temporary disability compensation administered through the federal government’s employment insurance (EI) program. These benefits cover 55% of your regular salary for a duration of 15 weeks. To be eligible, you must have made recent contributions to the EI program, which are typically deducted automatically from your paycheck. This means that if you’ve received an official paycheck, you’ve likely contributed to EI.
The application process for EI benefits is conducted online through Service Canada, allowing applicants to apply from the comfort of their home or at any Service Canada office. A crucial requirement is the completion of a form by your doctor confirming your inability to work for the duration covered by EI. Additionally, your employer must issue a Record of Employment (ROE) to verify your sick leave.
It’s important to note that individuals who qualify for short-term disability benefits cannot simultaneously claim EI benefits. For more detailed information on EI, you can refer to our article on the EI sickness benefits program.
Short-term disability (STD) benefits for Lyme disease
Short-term disability (STD) benefits serve as another form of temporary disability compensation. Employers typically provide STD benefits either directly through the company or via a group insurance policy managed by an external agency. Eligibility for STD benefits is contingent upon having a plan through your employer, as not all employers offer this benefit. If your employer does not provide STD benefits, you may be eligible for EI sickness benefits instead.
How long is short term disability in Canada? STD benefits can last for as little as 17 weeks to 52 weeks or more. The duration will depend on the wording of your policy.
As previously mentioned, individuals qualifying for STD benefits are ineligible for EI benefits. If eligible for STD payments, you must apply for these instead of EI. The application process involves obtaining forms from either your employer or the insurance company, which include forms for yourself, your doctor, and your employer. It is your responsibility to ensure all forms are submitted to the insurer.
In the event of a denied application, you have the option to request an internal appeal within the company, with the possibility of up to three or four appeals. Beyond this, further recourse may involve appealing to an external judge or filing with the courts, depending on your individual circumstances. See reasons short-term disability can be denied for more information on the appeal process.
If your claim is denied, you should contact a short term disability lawyer. They can help develop a strategy that will give you your best chance at success. Our lawyers at Resolute Legal have years of experience handling disability claims, including those involving Lyme disease. Click on the button below to learn more about how our team can help you.
Workers’ compensation benefits for Lyme disease
Workers’ compensation programs provide both short- and long-term benefits to individuals injured on the job, with each province in Canada having its own specific program. To qualify for these benefits, the injury or illness must have occurred in the workplace, and the employer must be covered by the program, which isn’t the case for all jobs.
In order to win benefits, you must prove that a Lyme-carrying tick bit you while you were working. This can be difficult, but it is certainly possible to succeed in this kind of claim.
Workers’ compensation benefits in Canada may intersect with other forms of support like Employment Insurance (EI), Canada Pension Plan (CPP), and short- or long-term disability, leading to potential complexity. Seeking legal advice regarding benefit concerns is advisable. Depending on your province, you may retain some or all of your CPP disability benefits alongside workers’ compensation.
If your workers’ compensation claim is denied, following the appeal procedures for your province is essential. These typically involve internal reconsideration and, if necessary, external tribunals like the Workers Compensation Appeals Tribunal (WCAT) in most provinces.
This information should give you a better understanding of the various avenues available for seeking support related to Lyme disease, including workers’ compensation benefits, Veterans Affairs Canada benefits, provincial income support benefits, and the disability tax credit. Each option has its own eligibility criteria and application process, so it’s crucial to explore all avenues that may apply to your situation.
Disability tax credit for Lyme disease
The disability tax credit is designed to reduce your taxable income and can provide significant financial relief. To be eligible, you must have a severe and prolonged impairment, as defined by the program. However, it’s important to note that the criteria for this program are more stringent compared to others.
If you qualify for the disability tax credit, you may be entitled to a refund of some of your previous taxes paid, depending on the duration and severity of your Lyme disease. Applying for this credit involves completing a T2201 form and submitting it to Revenue Canada for review.
In the event that Revenue Canada denies your claim, you have the option to request an internal appeal. If the appeal is unsuccessful, you may need to escalate the matter to the Tax Court of Canada for further review and consideration.
Provincial income support benefits for Lyme disease
Every province in Canada offers income support benefits to individuals unable to work due to disability. If you meet the eligibility criteria, you may receive fixed payments for the duration of your life.
These provincial benefits are available regardless of whether you have a previous work history. However, they are means-tested, meaning they are only provided if your total family income falls below a specific threshold, which varies by province. Importantly, your family’s income does not impact the approval process for other types of disability benefits.
To apply for provincial disability benefits, you must submit an application through your provincial agency or program. As part of the application process, your doctor will need to provide a report or certificate confirming your inability to work due to Lyme disease.
If your application is denied, you have the right to appeal internally within the agency or program. Some provinces also offer the option to appeal to an external tribunal for a final decision. It’s essential to consult your province’s guidelines for the correct appeal procedures.
Veterans Affairs Canada
If you’ve served or are a former member of the Canadian Forces, you may be eligible for short- or long-term disability benefits through Veterans Affairs Canada (VAC).
To qualify, you must demonstrate that a “service-related injury” (i.e., tick bite) caused your Lyme disease. A medical confirmation from your doctor is also required.
You can apply for VAC disability benefits online or by submitting a paper form directly to VAC. Your service medical records will be reviewed, and additional information may be requested if needed.
In case of a denial, the appeals process follows a standard procedure: internal reconsideration, followed by the Veteran’s Review and Appeal Tribunal.
Resolute Legal is a distinguished law firm specializing in advocating for individuals in disability claims with insurance companies, government entities, and employers. With offices strategically located in Toronto, Ottawa, Halifax, and Moncton, we extend our services to clients across Canada.
Our adept lawyers handle a wide spectrum of claims, including those related to short-term disability, long-term disability, CPP disability, workers’ compensation, employment disputes, and the disability tax credit. Ready to collaborate with a skilled disability claim lawyer? Begin your journey today by clicking the button below.
How to win disability benefits for Lyme disease
I’ve already touched on the difficulties of getting a firm diagnosis. Unsurprisingly, this translates directly into how insurance companies and the CPP will handle your disability claim. You’ve probably already guessed — or even experienced yourself — that benefit providers aren’t exactly eager to give out disability benefits for an illness like Lyme disease, which is often treated as if it was “all in the patient’s head.”
Another point to consider is the different stages of Lyme disease. You will have to prove that your illness has progressed into a chronic disease. Meaning it doesn’t allow you to lead a normal life anymore. In short, you need to prove that you are legitimately disabled from work.
The nature of the illness and the inadequate testing system make this difficult, however. The most difficult challenge is to get an official diagnosis of Lyme disease. As mentioned previously, Canada has yet to improve the screening test to detect more than one strain of bacteria.
So, insurance companies will have no qualms about debating you on this. And they will crush your hopes of receiving disability benefits if they can find a hole in your application. Insurance companies have to make a profit, and your disability claim reduces that profit. Therefore, every single claim will be scrutinized and eventually denied if it’s not 100 percent bulletproof.
There is a crucial difference between being disabled and being able to prove your disability. Your benefits provider may still deny your claim even if your doctor is on your side and will testify for you. Citing that, they need more proof. Insurance companies are notorious for only believing what you can prove, even if your doctor supports you. They will work to undermine your claim to avoid the payment, acting in their own rational best interest.
Obtaining a diagnosis of Lyme disease can pose challenges, but having one significantly increases your chances of being approved for disability benefits. Without a diagnosis, your approval odds decrease substantially.
If you haven’t already, schedule an appointment with your doctor to begin the diagnostic process.
Lyme disease disability insurance claim denial: what to do next
You’ve filled out the forms, and you’ve compiled as much evidence as you could get. And yet, the letter you receive in the post a few weeks later denies your claim for disability benefits.
This is a tough time, and I know that – I’ve seen it over and over again with my clients. You don’t know what you’ve done wrong, and a rejection can feel like a slap in the face. Getting told your condition doesn’t warrant financial support adds humiliation and frustration to the chronic pain.
The good news is that you don’t have to simply accept that your rightful claims have been denied. You can appeal the insurance company’s decision instead. I have years of experience with disability benefits claims, including many cases of Lyme disease. I know what you are going through, and I’m confident that I can help you. You have a choice. You don’t have to let insurance companies get away with denying you the support you are entitled to by law.
Was your long-term disability denied? For more information on how to navigate disability benefits denial, download a copy of my books. These books are free and will help you consider all your options. You can also book a free consultation below to learn more about your options.
How Resolute Legal can help with your Lyme disease disability claim
Resolute Legal specializes in handling disability benefits claims, including those related to Lyme disease. We understand that insurance companies often lack understanding of conditions like Lyme disease and may hold unrealistic expectations about recovery. Our firm is committed to bridging this knowledge gap and advocating for your rights.
With a success rate of 94.48 percent across all disability claim types, we bring proven experience to your case. However, it’s important to recognize that past success does not guarantee future results, and the outcome of litigation can vary based on the specific circumstances of each case.
We represent clients across Canada. Click on the service areas and office locations to learn more.
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You’re not alone in this journey. Our compassionate team is here to offer unwavering support and knowledgeable guidance throughout the entire process. If you’re in need of assistance with your claim, don’t hesitate to take the first step. Schedule a complimentary consultation with us by clicking the button below. Together, let’s navigate this path and secure the benefits you rightfully deserve.
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FAQs
Why is Lyme disease not recognized in Canada?
Lyme disease is recognized in Canada. In fact, a national case definition was developed in 2009. However, due to poor testing, the condition is often misdiagnosed and undertreated. To get a diagnosis, many Canadians are forced to go to clinics in the U.S. and Europe, where testing is more robust.
Can you work with Lyme disease?
Yes, many people with Lyme disease are able to continue working with the condition. These individuals usually have milder symptoms or respond better to treatment. With that said, many people cannot work with the condition. We have represented several clients who are completely unable to work due to Lyme disease.
Is Lyme disease covered by insurance?
Yes, most disability insurance plans cover Lyme disease unless it is explicitly listed as an “excluded condition.” However, this is rare. Most policies will cover any medical condition so long as it renders the claimant unable to work and all other qualifying criteria are met.
Is it hard to get disability for Lyme disease?
Yes, winning disability benefits for Lyme disease in Canada can be challenging. The process is complicated by several factors, including the difficulty of diagnosis, delays in obtaining medical evidence, and the lack of understanding and stigma surrounding Lyme disease. Insurance companies may dispute claims, particularly without a clear diagnosis.
This makes it harder for individuals to secure the benefits they need. Seeking legal assistance from a disability lawyer experienced in handling Lyme disease cases can significantly improve one’s chances of success in navigating this complex process.
