Whether you have already started applying for long-term disability benefits or are considering beginning the process, you probably already know that winning disability benefits for knee disorders can be an uphill battle. Although knee disorders are visible, you will still need to prepare very diligently to win the benefits you deserve. Winning won’t cure your knee disorder — but removing the financial burden from your shoulders will be worth it.
As a former occupational therapist and current disability benefits lawyer, I can help you avoid the extra pain of preparing your application. If you are suffering from knee disorders in Canada, I can help you take your first steps toward securing the support that you are entitled to.
This article will highlight things to keep in mind during your diagnosis and treatment, types of disability benefits you might qualify for, specific challenges in preparing your claim for knee disorders, and final thoughts on approaching the overall process.
Is Knee Pain a Disability?
Yes. Knee disorders and knee pain are considered disabilities in Canada, and those who suffer from them can qualify for disability benefits.
However, a diagnosis on its own will not qualify you.
Benefit providers pay benefits to people who can prove their condition prevents them from working. When reviewing claims for knee disorders, 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 work and how hard you try to keep working.
Should you have any other inquiries about disability benefits and eligibility criteria, please read our article on medical conditions and disability benefits or review the articles below:
Documenting Your Diagnosis is Key
A comprehensive strategy to win payment of disability benefits must take into account three key things: your occupation, the specific disability benefits provider, and your medical condition.
In the case of your medical condition, gaining a firm diagnosis is step one. You could be suffering from a wide variety of knee related-pain. Your pain could be dull and achy or sharp and severe. It could be gradually worsening, sudden, or persistent. The location may vary, too. Your pain might be along one or both sides of the knee, behind the knee, around the kneecap, or in the knee joint itself.
The pain could be triggered in various ways. You might be encountering pain in everyday activities, by overuse, or by an actual injury. You’ll have noticed if the pain is worsened by moment, rest or inactivity, or by prolonged sitting and standing.
Many symptoms may accompany your knee pain. Bruising and discolouring, locking and catching, a decreased range of motion, popping and snapping, or a feeling of instability could go hand in hand with the pain. Other accompanying symptoms might be skin redness, a grating sensation, swelling, the inability to bear weight, warmth to touch, and joint weakness.
If you haven’t received a diagnosis, now is the time to start working toward that. When you go to your doctor, understanding your pain will help your doctor make the diagnosis. He or she will ultimately diagnose one of many knee disorders.
Types of knee disorders:
- knee bursitis,
- a torn meniscus,
- osteoarthritis,
- patellar tendinitis,
- Patellofemoral pain syndrome,
- sprains and strains,
- an ACL injury,
- Baker’s cyst, fractures,
- or Osteochondritis dissecans.
As you get this diagnosis, begin to record what potential recovery periods and the likelihood of full recovery might be.
The knee is a complicated area, so be aware this is only a short list of possible diagnoses. If you haven’t already, you should see a doctor as soon as possible to help confirm a diagnosis. A knee disorder that prevents you from working is good enough to start the process of applying for disability benefits.
A successful doctor’s diagnosis of a knee disorder is no guarantee your disability claims will also be successful, but it is an important starting point. Be steady and diligent in gaining your diagnosis. The clinical signs of your knee disorder must be well documented in your medical records as you approach the disability benefits claims process.
It can be very difficult to secure a diagnosis and get acknowledgment from your employer. But once you are properly diagnosed with a knee disorder, you’ve taken a critical step toward winning your disability benefits. The next step is preparing a successful disability insurance claim. You may have spent a long time fighting chronic knee pain and meeting with perhaps multiple doctors to gain the diagnosis— now it’s time to get the financial help you deserve.
You could be up against insurance companies willing to confuse your illness to avoid paying the benefits you paid for. Before I share details about insurance claims specifically related to knee disorders, you should be aware of which disability benefits you qualify for in general.
Types of disability benefits for Knee Disorders
As a worker, you might be eligible for one of two types of disability benefits in Canada. These are the Canada Pension Plan (CPP) disability benefits and long-term disability insurance benefits.
CPP disability benefits for knee disorders
The CPP program, designed to support you after retirement, also covers disability benefits that start once you become disabled and last until you are 65. After that, these disability benefits are converted into regular pensions. In order to be eligible for the CPP disability benefits, you have to have worked for four out of the past six years and paid payroll taxes. The CPP requires you to prove that your disability is both prolonged and severe, leaving you unable to work.
Long-term disability insurance benefits for knee disorders
Group 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. If you are suffering from a knee disorder, you can apply for long-term disability benefits if eligible. If successful, these will provide you with monthly income payments during long absences from work to ease the financial pressure.
How to Win Disability Benefits for Knee Disorders
There are specific challenges in preparing your long-term disability benefits to claim for knee disorders.
I’ve already described the steps you should take to gain a firm diagnosis for knee disorders. Remember, an insurance company or the CPP disability administration will not approve your long-term disability benefits for a knee condition just because a doctor diagnosed you with the condition.
If only it were that easy.
To win disability benefits for a knee disorder, the true challenge is to prove that your symptoms render you unable to function in any workplace while taking into account your age and work experience.
You will have to present a well-organized application with well-documented medical evidence. In addition to the comments and descriptions made above, here are the main points to consider for knee disorders.
Get a diagnosis
As discussed earlier, securing a diagnosis can be challenging. However, having a diagnosis will vastly improve your chances of winning disability benefits. Without one, you are significantly less likely to get approved. If you haven’t already, book an appointment with your doctor to start your journey to getting diagnosed.
Get the appropriate treatment and document it
When evaluating your claim, disability benefits providers will assess whether you’ve undergone appropriate treatment for your condition. Failure to receive adequate treatment is a leading cause for denial.
This requirement applies across all medical conditions. For instance, if you have both a psychological disorder and a knee issue, treatment must be sought for each ailment. This may involve medications, consultations with psychiatrists, or psychological therapies.
It’s crucial for your doctor to accurately document all treatments. Ultimately, benefit providers rely on the medical records they receive to make decisions. Even if you’ve received top-notch treatment for knee problems, lacking proper documentation means no treatment in the eyes of the insurer.
Monitoring and recording your difficulties
Knee disorders can limit you from sitting or standing for prolonged periods of time. This is some of the best evidence of disability from work. Many jobs require you to sit at a desk for an extended time. If your pain seriously prevents you from doing this type of work, you have a good chance of getting approved for disability benefits for knee disorders.
You must document movements throughout the day to present as evidence. You have to prove that you cannot sit or stand for a long time without experiencing severe pain. The pain must prevent you from performing your job duties. If you can sit for more than two hours, your pain might not be as severe as it seems. However, if you are unable to do that, you have a strong case for winning disability benefits for chronic pain.
Evidence of work-related limitations
You will also want to record all the ways in which you have modified your work habits in order to maintain employment while dealing with a knee disorder.
You should also try easier jobs within your workplace before you apply. Until you do, the disability benefits providers will always doubt you. You might show that while your job had medium duties on paper, your employer made accommodations to qualify your duties as light.
If you were forced to change jobs as a result of chronic pain, make a note of that, too.
Credibility is key
Maintaining absolute honesty is crucial for individuals seeking disability benefits due to knee disorders. Credibility holds immense significance when pursuing legal claims for such benefits.
Even unintentional exaggerations or inconsistencies in portraying pain or disability can significantly undermine credibility.
Credibility killers
- Contradicting medical records or previous statements
- Offering excuses or shifting blame onto others for issues
- Criticizing involved parties in the claim, regardless of their culpability
- Submitting complaints against professionals perceived as negative, biased, or unprofessional
- Employing aggressive, sarcastic, or confrontational language in your claim or testimony
- Resisting or delaying reasonable requests for information
- Engaging in disputes with doctors regarding your diagnosis instead of concentrating on the disability
- Attempting to portray yourself as a medical authority
Credibility boosters
- Ensuring alignment between your statements and the medical records
- Assuming accountability for any mistakes or issues with your claim without attributing blame to others
- Maintaining cooperation and respect towards all involved parties in the claim
- Embracing expert advice and viewpoints
- Making sincere attempts to follow all reasonable advice, even when in disagreement
- Demonstrating clear efforts to remain employed
Have You Been Denied Disability Benefits for a Knee Disorder?
You’ve completed the necessary paperwork and gathered evidence diligently. However, the letter you receive politely denies your eligibility for disability benefits, leaving you feeling compelled to return to work.
This is undoubtedly a challenging moment, one I’ve witnessed numerous times with my clients. Receiving a rejection can leave you feeling confused and unfairly treated.
Being informed that your condition doesn’t meet the criteria for financial assistance to provide you with the breathing room necessary for recovery adds insult to injury, especially when grappling with knee pain. Returning to work with unhealthy knees can have severe repercussions on both your physical and mental well-being.
The silver lining is that you don’t have to accept this denial of your rightful claims. Instead, you have the option to appeal the insurance company’s decision. With years of experience handling disability benefits claims, including those related to knee disorders, I understand the challenges you’re facing. Unfortunately, insurance companies often lack understanding regarding knee disorders or have unrealistic expectations about recovery from knee injuries. But we can work together to help them comprehend.
I empathize with your situation, and I’m confident that I can assist you. You have the power to challenge the insurance company’s refusal to provide the support you are legally entitled to.
To turn that denial into approval, book a free consultation today. You can reach us at (888) 480-9050.
Our offices are in Toronto, Ottawa, Moncton, and Halifax, and we provide services to clients in every province except Quebec. Most of our services, about 90%, are online, and we will come to you for any in-person requirements. Check out the pages below to learn more:
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