Whether you have already started to apply or are considering beginning the process, you probably already know that winning disability benefits for schizophrenia is no easy task. Although schizophrenia is a severe mental disorder, it is still an invisible illness. So, it presents additional challenges when proving your claim to disability providers.
You will need to prepare very diligently to win the benefits you deserve. Winning won’t cure your condition, but removing the financial burden will certainly help. We wrote this article to teach you exactly how to win disability benefits for schizophrenia. Along with that, we also discuss the types of disability benefits you might qualify for, specific challenges you may face, and what to do after a denial.
Is schizophrenia a disability in Canada?
Yes. All disability benefits providers in Canada recognize schizophrenia as a disability. And it is a condition that can qualify for benefits. However, a diagnosis on its own won’t win you benefits. Providers pay benefits to people who can prove their conditions prevent them from working.
When reviewing claims for schizophrenia, disability providers focus on the seriousness of your symptoms. They consider the medical treatment you’ve had and future treatment plans. They look at how your symptoms affect your employment and how hard you tried to keep working. And you must have this documented in medical records or other paperwork with your claim.
If you are interested in learning about other conditions that qualify as a disability in Canada, check out our article: Medical Conditions that Qualify for Disability Benefits or click on any of the links below:
Interested in working with a long term disability lawyer? If you answered yes, click on the button below to schedule a FREE consultation. Our team has years of experience handling disability claims, including many clients with schizophrenia. We know what it takes to win mental health claims, and we are confident we can help you.
Employment rights and schizophrenia
As an employee on long-term disability (LTD) due to schizophrenia, you are protected by various laws and regulations governing the employer-employee relationship in Canada. Employers cannot terminate your employment on discriminatory grounds, and disability is considered a protected category under both common law and human rights legislation.
Before terminating an employee on LTD, employers must fulfill their duty to accommodate the disability, taking into account factors such as the company’s size and financial resources. As the employee, you have a responsibility to provide the necessary information, including medical documentation, to assist the employer in meeting their duty to accommodate your condition.
The relationship between employer and employee is governed by both express and implied obligations, encompassing duties such as arriving to work on time and performing tasks competently. However, individuals with disabilities are afforded special protections, including the right to take sick leave and the duty of employers to accommodate their condition. Thus, while on LTD for schizophrenia, you retain your rights as an employee, including protection from discriminatory termination and the expectation of reasonable accommodation from your employer.
Disability Benefits for schizophrenia
There are several mental illness disability benefits in Canada available for people with schizophrenia in Canada. You might be eligible for disability benefits from the government, your employer, or your insurer.
This list covers the possible options for schizophrenia disability benefits in Canada:
- Employment Insurance (EI) sickness benefits
- Short-term disability insurance
- Long-term disability insurance
- CPP disability
- Workers Compensation
- Veterans Affairs Canada
- Provincial disability benefits
- Disability tax credit
Employment Insurance (EI) sickness benefits
EI Sickness Benefits offer temporary financial support to individuals who are unable to work due to illness, injury, or quarantine. Administered through the federal government’s employment insurance (EI) program, eligible recipients receive payments equivalent to 55% of their regular salary for a period of 15 weeks.
To be eligible, individuals must have made recent contributions to the EI program through automatic deductions from their paychecks. This contribution is typically mandatory for anyone receiving an official paycheck.
Applying for EI benefits can be done online via Service Canada’s website or in person at any Service Canada office. A medical professional must complete a form confirming the individual’s inability to work for the duration covered by EI benefits. Additionally, employers are required to provide a Record of Employment (ROE) to verify the employee’s sick leave.
It’s important to note that individuals who qualify for short-term disability benefits are not permitted to concurrently claim EI benefits.
For further information on EI, please refer to our comprehensive article on the EI sickness benefits program.
CPP disability benefits for schizophrenia
The Canadian Pension Plan (CPP) is renowned for its support post-retirement, yet it also extends disability benefits, beginning upon disability onset and continuing until age 65, after which they transition into regular pensions. How hard is it to get CPP disability? Eligibility for CPP disability benefits mandates a work history of four out of the past six years and payroll tax contributions. Demonstrating a prolonged and severe disability rendering you incapable of working is essential for approval.
Currently, CPP disability payments range from $583.32 to $1,606.78 monthly in 2024, contingent on your contributions to the program. Those who earned a salary paid into CPP potentially yield higher benefits. Simultaneous receipt of long-term disability insurance benefits and CPP disability is feasible, albeit insurers often exercise the right to offset payments by an equivalent amount. For instance, if CPP disburses $900, your insurer may reduce its payment by an equivalent sum.
The process for applying for CPP disability entails completing requisite forms, with your medical practitioner completing the medical report. Submission occurs at a designated Service Canada office in your province. Should Service Canada reject your claim, you possess the right to appeal on two tiers: initially via a reconsideration appeal, which must be lodged within 90 days of denial, followed by an appeal to the Social Security Tribunal if denial persists. The tribunal, comprising either a judge or a three-person panel, adjudicates your claim, affording you the opportunity to provide evidence and respond to inquiries at the hearing.
Considering the complexities and challenges inherent in securing CPP disability benefits, engaging the expertise of CPP lawyers at Resolute Legal, a distinguished disability law firm, can be instrumental in navigating the process effectively and maximizing your chances of success.
Long-term disability insurance benefits for schizophrenia
Applying for long-term disability (LTD) in Canada involves a process of filling out forms and submitting them to the insurer. These forms typically include paperwork for yourself, your employer, and your doctor. It’s crucial to ensure all forms are submitted promptly, as the insurer won’t make a decision until they have received all the necessary documentation. See how to apply for long-term disability in Canada for more information on this process.
Long-term disability denied? If your claim is denied, you have the option to appeal the decision. Many LTD plans permit two to three internal appeals. If these internal appeals are unsuccessful, you may proceed to an appeal hearing with an external judge or consider taking legal action.
How much does disability pay for schizophrenia? Long-term disability benefits are designed to provide financial support over an extended period, often spanning many years. These benefits usually cover a percentage of your monthly salary, typically ranging from 50 to 67%. Whether you’re covered through a group medical plan provided by your employer or through a private insurance policy, the benefits are typically paid monthly.
It’s essential to explore the details of your coverage, as policies may vary regarding the duration of benefits and the percentage of salary covered. Additionally, individuals with conditions such as schizophrenia may wonder about the specific amount of disability pay they can expect. This can vary based on individual policies and circumstances, so it’s advisable to review the terms of your policy or consult with an insurance representative for clarity.
LTD for schizophrenia denied? Click on the button below to schedule a free consultation. Our team can assess your situation and offer advice on the next steps.
Short-term disability (STD) benefits
Short-term disability (STD) benefits provide temporary financial support for individuals unable to work due to illness or injury. These benefits typically cover 50-67% of your regular salary, and payments are typically disbursed every two weeks. How long is short term disability in Canada? STD benefits are usually available for a period of 15-17 weeks, although extensions may be possible in certain cases.
Employers commonly offer STD benefits either directly through the company or via a group insurance policy, with administration often outsourced to an external agency.
Eligibility for STD benefits is contingent upon having coverage through your employer, as not all employers provide this benefit. If your employer does not offer STD coverage, you may be eligible to receive benefits through Employment Insurance (EI) sickness benefits.
It’s important to note that if you qualify for STD benefits, you cannot concurrently receive EI benefits. Therefore, if eligible for STD payments, you must apply for those instead of EI.
The application process involves obtaining the necessary forms from either your employer or the insurance company. These forms typically include documentation from yourself, your doctor, and your employer. It is your responsibility to ensure all forms are completed and returned to the insurer.
In the event that your STD application is denied, you have the right to request a review, known as an internal appeal. See reasons short-term disability can be denied for more information on appeals. During this process, a different individual within the company will review your claim. Typically, you are allowed three or four internal appeals. If unsuccessful, further recourse may involve appealing to an external judge or pursuing legal action, depending on the specifics of your situation. At this point, we highly recommend contacting a short term disability lawyer.
Workers’ compensation benefits
Workers’ compensation pays short- and long-term benefits to people who miss time from work due to a work-related injury or illness.
Each province has its own program. To qualify, you must have suffered an injury at work or a work-related illness. Also, your employer must be covered by the program. Yes, you read that right; not all employers have coverage.
It’s extremely difficult — but possible — to prove a workplace injury worsened your schizophrenia.
Historically, worker’s compensation programs only considered mental health claims caused by a single workplace incident. They wouldn’t recognize situations of chronic workplace stress caused over time.
But this is changing. In January 2018, WSIB in Ontario implemented a new policy to allow claims for “chronic mental stress” caused by a worker’s employment. However, not all workers’ compensation programs in Canada have adopted this policy. Check with the program in your province to see if it includes chronic mental stress.
To succeed in this claim, you need a doctor to support your belief that a substantial work-related stressor, incident, or injury triggered the schizophrenia or permanently made it worse. You will also need to have a diagnosis of schizophrenia. And finally, you must prove that specific workplace conditions or events are to blame. Research has shown that extreme stress for long periods can play a role in developing schizophrenia. So, you would need to prove that your job and the stress you endured are what caused or contributed to your condition.
Workplace harassment and bullying are two common reasons for extreme workplace stress. The workers’ compensation program will also independently verify these events with your employer or coworkers.
This kind of claim is extremely difficult to prove. We highly recommend talking to a lawyer or advocate before you do anything.
If workers’ compensation denies your claim, you must follow the appeal procedures for your province. There are two levels of appeal: the internal reconsideration and the outside tribunal. In most provinces, the tribunal is called the Workers Compensation Appeals Tribunal (WCAT).
To learn more about WCB, check out our ultimate guide to workers’ compensation benefits in Canada.
Veterans Affairs Canada
If you are a current or former member of the Canadian Forces, you may be eligible for disability benefits, both short and long-term, through Veterans Affairs Canada (VAC).
To qualify, you must demonstrate that your schizophrenia has been exacerbated by a “service-related injury,” with confirmation from a medical professional.
The application process for VAC disability benefits can be completed either online or by filling out a paper form. VAC will evaluate your service medical records and may request additional information if needed.
In the event of a denial, the appeals process with VAC typically involves internal reconsideration followed by review by the Veteran’s Review and Appeal Tribunal.
Provincial income support benefits for schizophrenia
In Canada, each province offers income support benefits to individuals unable to work due to a disability, providing fixed payments for life to those who qualify.
Eligibility for provincial benefits is not contingent upon previous employment history; however, it is subject to income thresholds, varying across provinces. Importantly, the approval process for other forms of disability benefits is not influenced by family income.
To apply for provincial disability benefits, you must engage with your provincial agency or program. Typically, your doctor will need to furnish a report or certificate confirming your inability to work due to your condition.
In the event of a denial, internal appeals within the agency or program are usually an option. Additionally, in some provinces, there exists the possibility to appeal to an external tribunal for a final decision. It’s advisable to consult the income support program specific to your province for guidance on the appropriate procedures.
Disability tax credit for schizophrenia
The disability tax credit is a beneficial program designed to reduce your taxable income, yet it maintains stricter eligibility criteria compared to other benefits. To qualify, individuals must demonstrate a sustained impairment, significant limitations, two or more notable restrictions, or reliance on “life-sustaining” therapy.
Eligibility for this credit may result in refunds for previously paid taxes, contingent upon the duration and impact of the individual’s condition.
To apply, one must complete a T2201 form and submit it to Revenue Canada. In cases where Revenue Canada denies the claim, an internal appeal can be requested. Should this internal appeal prove unsuccessful, further recourse involves appealing to the Tax Court of Canada for reconsideration.
How to win disability benefits for schizophrenia
To win disability benefits for schizophrenia, you need a comprehensive strategy that accounts for three key factors: your medical condition, your job, and your disability benefits provider.
In the case of your medical condition, gaining a firm diagnosis is step one.
Appropriate medical diagnosis
There is not a single test that can be used to diagnose schizophrenia. In order to diagnose the condition, medical professionals must rule out multiple conditions, such as brain tumours and other psychiatric conditions. They also have to identify several kinds of symptoms that occur in particular ways over specific periods of time. To compound that, medical professionals also have to get answers from a person who is often distressed and has trouble explaining their symptoms. Due to all these challenges, it often takes nearly a decade for a person to receive a proper schizophrenia diagnosis.
In order to receive a schizophrenia diagnosis, you must speak to your family doctor or a psychiatrist about your symptoms.
If your doctor suspects you have schizophrenia, the first thing they will do is complete a psychological evaluation and a medical exam. They will also ask about your family history to see if anyone you are related to has these symptoms or has been diagnosed with schizophrenia.
However, in order to receive a proper diagnosis, you must meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for diagnosing schizophrenia.
DSM-5 diagnosis of schizophrenia
To receive a diagnosis of schizophrenia, you must have experienced the following:
- Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be delusions, hallucinations or disorganized speech:
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or incoherence)
- Grossly disorganized or catatonic behaviour
- Negative symptoms (i.e., diminished emotional expression or avolition)
- Continuous signs of the disturbance persist for at least six months. This 6-month period must include at least one month of symptoms (or less if successfully treated) that meet the above criteria (i.e., active phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested only by negative symptoms or by two or more symptoms listed above present in an attenuated form.
- For a significant portion of time since the onset of the disturbance, the level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is a failure to achieve the expected level of interpersonal, academic, or occupational functioning).
- Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out.
- The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
- If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least one month (or less if successfully treated).
If you haven’t received a diagnosis, now is the time to start working towards that. A diagnosis alone will not automatically win you benefits, but it is an important starting point. Be steady and diligent in gaining a diagnosis. The clinical signs of your schizophrenia must be well documented in your medical records as you approach the claims process.
It can be very difficult to secure a diagnosis. But once you are diagnosed with schizophrenia, you’ve taken a critical step toward winning your disability benefits.
The next priority is to start preparing a successful disability claim. You may have spent a long time fighting and living with schizophrenia. You’ve met with doctors and psychiatrists and taken many medications—but now it’s time to get the financial help you deserve.
You could be up against insurance companies who will do anything in their power to avoid giving you benefits. Before I share details about insurance claims related to schizophrenia, you should be aware of which disability benefits you may qualify for.
As mentioned earlier, an official diagnosis alone is not enough, but you still need to have one. You must meet the Diagnosis and Statistical Manual for Mental Disorders (DSM) criteria for schizophrenia.
Your doctor must show a detailed medical history, as well as all the measures that were taken to rule out other possible conditions.
Following recommended treatments
In evaluating your claim, providers scrutinize whether you’ve undergone appropriate treatment for schizophrenia. Non-compliance with recommended treatment regimens stands as a prevalent cause for denial. This non-adherence typically manifests in two ways: either your physician deviates from established treatment standards, or you consciously reject treatment options.
Despite potential belief in the efficacy of alternative methods, adherence to standard treatments is imperative to qualify for disability benefits. Failure to do so opens the possibility for others to argue that you could work if provided with appropriate treatment, undermining your claim.
Medication and therapy are the most common and effective treatments for schizophrenia, according to the Canadian Mental Health Association. If you want to win disability benefits, you should follow a plan that incorporates both medication and therapy.
Documented treatment plan
An extensively documented treatment strategy significantly enhances your likelihood of attaining benefits. While your doctor may devise a treatment plan, its efficacy hinges on documentation and communication with the insurance provider.
Without proper documentation, even the most exemplary treatment plan holds little sway with insurers. Occasionally, access to suitable treatment may be delayed due to pending appointments with psychiatrists or psychologists. Nonetheless, approval for disability benefits remains feasible if your doctor has meticulously documented the treatment plan.
This documentation should acknowledge the wait for specialist consultations and affirm your commitment to adhering to all other recommended treatments in the interim. By ensuring thorough documentation, you bolster your case for benefits, even amidst treatment delays.
Medications and side effects
As you probably already know, medication is one of the most effective treatments for schizophrenia. The most common medication used to treat the disorder is antipsychotics. However, they may be used in combination with medications for other mental health symptoms, such as mood stabilizers, sedatives, antidepressants, and other medications that help with the side effects of antipsychotics.
With that said, there is no single medication or dose that will work for everyone. So, you will have to work closely with a specialist to find what drug or combination of medications works best for you. This means you must try all the recommended medications — even if you fear the side effects.
If you’re not taking the appropriate medication for your condition, insurance companies will think your symptoms aren’t serious enough to qualify for disability benefits. It’s common for doctors to prescribe multiple medications and different dosages to find the right treatment. So, if you have a bad reaction to one medication, you can’t refuse the troubleshooting that follows. You have to try all other options or try changing your dosage.
If you have a bad reaction to your medications, your medical records must report that in detail. And, if your doctor recommends against a medication, you need to have it documented that the side effects were worse than the condition. Again, you run the risk of denial if you stray too far from standard treatments without a good reason.
Evidence of work-related limitations
In cases of invisible illnesses like schizophrenia, securing disability benefits hinges significantly on demonstrating earnest efforts to remain employed. Simply stating your inability to perform current job duties isn’t sufficient; you must also exhibit proactive steps taken to seek assistance from your employer in sustaining employment.
This could entail requesting modifications such as reduced hours, lighter tasks, or transitioning to different roles within the company. Particularly if your job entails medium or heavy work, exploring less demanding positions with light or sedentary duties is advisable. Substantiating these efforts with concrete evidence is crucial.
This may involve providing medical documentation detailing your attempts to work, employment records outlining places of employment and accommodations sought, a personal statement delineating your endeavours, or signed attestations from employers or colleagues attesting to your struggles. Strong evidence indicating diligent attempts to maintain employment significantly enhances the likelihood of securing benefits, whereas insufficient evidence diminishes approval prospects substantially.
Credibility
Solid evidence from both medical and employment sources is crucial to bolstering your claim, yet it’s equally imperative that decision-makers perceive you as credible. In legal contexts, credibility hinges on your trustworthiness and believability. Even if your evidence is lacking, a decision-maker inclined to trust you may still rule in your favour, while a lack of trust can undermine even strong evidence. Often overlooked, credibility provides an intangible advantage.
However, certain behaviours can diminish credibilities, such as discrepancies in medical records or statements, making excuses, criticizing other parties involved, or engaging in confrontational language. Conversely, credibility can be enhanced by aligning your statements with medical records, taking ownership of any shortcomings in your claim, cooperating with all parties involved, and demonstrating a willingness to heed expert advice. Additionally, showing genuine efforts to remain employed despite your disability can further bolster credibility.
What to do after a denial of schizophrenia disability?
Even after diligently filling out forms and gathering all possible evidence, it can be disheartening to receive a denial letter for your disability benefits application. I’ve witnessed this scenario countless times with my clients, and I understand how deeply frustrating it can feel.
However, there’s hope amidst the disappointment. You’re not bound to accept the decision as final. Instead, you have the option to appeal it. The appeal process will differ depending on what program you applied for. However, most programs allow for an initial “internal” appeal or review. Then, you move to a more formal appeal stage — the Social Security Tribunal for CPP disability and lawsuits for long-term disability.
While some can successfully appeal on their own, others won’t stand a chance without a lawyer. If you are part of the latter group, click on the button below to schedule a free consultation.
How Resolute Legal can help with your schizophrenia disability claim
Resolute Legal specializes in handling disability benefits claims, including those related to schizophrenia. We recognize that insurance companies often lack understanding of conditions like schizophrenia and may hold unrealistic expectations about recovery. Our firm is dedicated to bridging this gap in understanding and advocating for your rights.
You’re not alone in this journey. We empathize with your situation, and we’re confident in our ability to assist you. You have the power to challenge the denial and fight for the support you rightfully deserve.
We service clients across Canada. Click on the service area or office location to learn more about how we can assist you:
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Don’t hesitate to take action. If you need assistance with your claim, simply click the button below to schedule a complimentary consultation with us. Let’s work together to navigate this process and secure the benefits you deserve.
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