Chronic Pain and Alberta Long-Term Disability Claims: What You Need to Know

Chronic pain can change your life. Whether it’s from an accident, an illness, or a long-standing condition that worsens over time, living with ongoing pain can make everyday tasks feel impossible. For many people in Alberta, chronic pain also means being unable to work, which can create serious financial stress.

Long-term disability (LTD) insurance benefits replace a portion of your income if you cannot work, usually ranging from 40% to 70% of earnings from your current or most recent employment. This coverage is often part of a group insurance plan paid for by your employer, although individual policies can also provide such benefits. This replacement income may be the key to keeping up with the bills you already had before stopping work, along with the extra costs that may arise from your chronic pain treatment and recovery.

If you’re dealing with chronic pain and considering a long-term disability claim, it’s important to understand how the process works and what challenges you might face. Here is what you need to know about making an LTD claim for chronic pain.

Understanding Chronic Pain and Long-Term Disability

Chronic pain isn’t just a physical issue—it can affect your mental health, relationships, and ability to earn a living. Some common examples of conditions that lead to chronic pain include (but are not limited to):

Arthritis
Fibromyalgia
Carpal tunnel syndrome or cubital tunnel syndrome
Irritable bowel syndrome (IBS) or another gastrointestinal disorder
A neurological or spinal disorder
A back or neck injury
Other injuries that resulted from physical trauma
And more

What makes chronic pain tricky in LTD claims is that it’s often “invisible.” Unlike a broken bone or a visible injury, chronic pain doesn’t always show up on medical tests like X-rays or MRIs. This can make proving your condition a challenge, even if your pain is very real and disabling.

Does Chronic Pain Qualify for Long-Term Disability?

Yes, chronic pain can qualify for long-term disability benefits, but it depends on your specific situation and your insurance policy. To qualify, you’ll likely need to prove that:

Your pain is severe enough to prevent you from performing the duties of your job (or any job, depending on your policy);
You’ve been receiving consistent treatment for your condition, and;
Your condition is expected to last for an extended period.

Each LTD policy is different, so it’s important to understand how your insurance company defines “disability.” Some policies focus on whether you can do your own job (“own occupation”), while others look at whether you can do any job (“any occupation”). If you require LTD benefits long enough, most insurance policies using the “own occupation” definition of disability will eventually switch to the “any occupation” definition of disability, commonly referred to as the “change of definition.”

Some medical conditions and illnesses may be excluded from coverage based on your individual medical history, for example if you already had a health problem (or “pre-existing condition”) before signing up for insurance. Our Calgary long-term disability claim lawyers can check whether your chronic pain is covered under your insurance policy and pursue benefits that you are eligible for on your behalf.

The Importance of Medical Evidence

Medical evidence is one of the most important parts of an LTD claim caused by chronic pain. Because chronic pain is subjective (meaning you can feel it, but others can’t see it), having strong medical documentation can make or break your case. Here’s what you’ll need:

Doctor’s Reports: Detailed records from your doctor describing your condition, symptoms, and how they affect your ability to work.
Specialist Evaluations: Reports from specialists like rheumatologists (experts in inflammatory diseases and their effects on bones, muscles, and joints), neurologists (experts in brain function), or pain management doctors can add credibility to your claim.
Treatment History: Proof that you’ve tried different treatments, such as physiotherapy, medication, or counselling, to manage your pain.

Even if your condition doesn’t show up on diagnostic tests, consistent medical records that document your pain and limitations can help validate your claim. Long-term disability insurance policies, in general, do not require a diagnosis of a specific illness or other health issue to qualify. As noted earlier, your eligibility for benefits depends on whether your pain symptoms stop you from working.

While medical-based statements and reports are typically a major part of the evidence backing your claim application, you may also wish to gather statements from your employer, co-workers, friends, and family. Their accounts could help make clear how your pain has affected your quality of life, ability to work, and mood.

Although your insurance company may initially deny your LTD claim application and ignore your evidence, the information you collect may later form the basis of your case in an internal appeal, lawsuit, settlement negotiations between your lawyer and insurer, or trial.

Keep a Pain/Symptom Journal

Your own observations could add to the evidence for your long-term disability claim as well.

Since chronic pain can vary day to day, keeping a journal of your pain and symptoms can be an effective way to show how your condition impacts your life. In your journal, note:

The intensity of your pain (e.g. mild, moderate, severe)
Activities you’re unable to do or struggle with because of your pain
Side effects from medication or treatments
How your condition affects your mental health (e.g. depression, anxiety, difficulty concentrating)

A pain/symptom journal that contains information like the above fills in the gaps between medical appointments and provides a more complete picture of your daily struggles. Again, pain affects every individual differently, but your journal helps to illustrate its specific impact on you.

Common Challenges with Chronic Pain LTD Claims

Insurance companies don’t always make it easy to get LTD benefits, especially for conditions like chronic pain. Some common challenges include:

Lack of Objective Evidence: Insurers may argue that your claim lacks proof because chronic pain doesn’t always show up on tests.
Claims Denials: Many chronic pain claims are denied on the grounds that the insurer believes you’re still capable of working.
Surveillance Tactics: Insurance companies sometimes use surveillance to check if your activities match your claimed limitations. For example, if you say you can’t lift heavy objects but are seen carrying groceries, they might use this against you.

Knowing these challenges in advance can help you prepare a stronger case and avoid common pitfalls. A lawyer experienced with long-term disability claims and dealing with insurance companies can advise how these challenges apply to your specific situation.

Steps to Strengthen Your Claim

If you’re making a long-term disability claim for chronic pain, here are some steps to improve your chances of success:

Work Closely with Your Doctor: Make sure your doctor understands how your pain affects your ability to work and includes this information in their reports.
Follow Your Treatment Plan: Sticking to your prescribed treatments shows the insurance company that you’re making an effort to manage your condition.
Be Honest and Consistent: Be truthful about your symptoms and limitations, both in your claim forms and during any interviews or assessments.
Get Legal Help If Needed: If your claim is denied or you’re feeling overwhelmed, a disability lawyer can help guide you through the process.

Final Thoughts

Living with chronic pain is hard enough without having to worry about financial stability. Long-term disability benefits can provide much-needed relief, but getting approved for chronic pain claims often requires extra effort and preparation.

By understanding your policy, gathering strong medical evidence, and being prepared for challenges, you can increase your chances of a successful claim. And if you’re feeling stuck or unsure where to start, don’t hesitate to reach out to one of our long-term disability lawyers for help. With the right support, you can focus on managing your pain and moving forward with your life.

How a Long-Term Disability Lawyer Can Help

Dealing with an LTD claim while managing chronic pain can be stressful and time-consuming. Our Alberta long-term disability lawyers may be able to help you understand the options in your long-term disability case. Chronic pain may qualify you for long-term disability, but if your insurance company denied your application for benefits, we may be able to help you file an internal appeal or build a case to challenge the insurance company in a lawsuit. Our firm is not afraid to take insurance companies to court if they are not willing to give you a fair offer based on the facts of your case.

Call Us to See How We Can Assist Your LTD Claim

Initial consultations are free, and our firm operates on a contingency-fee basis with no upfront costs to our clients. Please contact us today at 1-888-494-7191 to arrange a meeting with our Alberta long-term disability lawyers if you are dealing with chronic pain and may need to apply for LTD.