Life Insurance with Back Problems

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18 Minute read

Originally published: May 22, 2023

Life Insurance for back problems. Two doctors working together to treat a patient's back. The graphic shows a detailed depiction of the patient's large spine, with each disc clearly visible.

Talk to one of our experienced advisors today!

18 Minute read
Originally published: May 22, 2023

Life Insurance for back problems. Two doctors working together to treat a patient's back. The graphic shows a detailed depiction of the patient's large spine, with each disc clearly visible.

In Canada, securing life insurance or disability benefits becomes a unique challenge for individuals with back problems. The impact of back pain extends beyond physical health, affecting our financial security and the well-being of our loved ones. In this article, we delve into the types of disability benefits available, address the challenges you may encounter, and provide actionable strategies to overcome them. Discover how to effectively navigate life insurance and disability benefits with back problems in Canada, ensuring a secure future for you and your family.

Understanding the Scope of the Issue

Back problems are highly common in Canada, affecting a significant number of individuals. According to the Canadian Chiropractic Association (CCA), one in eight Canadians suffers from chronic back problems, with almost a third reporting limitations in work and daily activities. Shockingly, back pain is responsible for 40 percent of work absences. This article aims to assist individuals dealing with chronic back pain in obtaining the disability benefits they deserve, offering valuable insights and strategies. You are not alone, and we are here to help you secure financial security and peace of mind. 

Exploring Eligibility for Disability Benefits with Back Problems

In Canada, back pain is widely recognized by insurers as a valid cause of disability. While some individuals recover from back pain quickly, it can develop into a chronic condition that significantly affects both work and daily life. If you are seeking eligibility for disability benefits, it is crucial to understand which types of back problems may qualify:

  • Degenerative disc disease: Pain originating from a degenerated disc in the spine.
  • Bulging or slipped disc: Expansion of an intervertebral disc, causing pain by pressing on a nearby nerve root.
  • Lumbar radiculopathy: Inflammation of a lower back nerve root due to damaged vertebrae discs. Pain worsens with hip movements, coughing, and sneezing.
  • Sacroiliac joint disease: Inflammation of the joint between the spine and pelvis.
  • Sciatica: Compression of the sciatic nerve resulting in back pain, numbness, weakness, and tingling that radiates down the body.
  • Spinal fractures: Breaks or collapses of vertebrae, which, if untreated, can lead to severe complications.
  • Osteoarthritis of the lower spine: Breakdown of cartilage in back joints and discs.
  • Ankylosing spondylitis: Arthritis affecting the spine.
  • Spinal stenosis: Narrowing of the spinal nerve’s bone channel, potentially causing leg pain or numbness 

It’s important to keep in mind that having a diagnosis alone is insufficient to win disability benefits for back problems. To qualify, you must provide compelling evidence that your pain prevents you from working effectively. Benefit providers closely assess the severity of your symptoms, their impact on your work, the treatment you have undergone, and your efforts to remain employed. 

Employment Rights and Disability Accommodations for Back Pain

Concerns about job loss during sick leave are common, but under Canada’s human rights laws, employers must provide reasonable accommodations for employees with medical conditions affecting their ability to work. Most employers do not terminate employees on sick leave. Provide a doctor’s note to initiate sick leave, confirming your inability to work. If disability benefits are denied, you can stay on sick leave during the appeal process. Termination while on sick leave may entitle you to severance pay, and legal advice is recommended for complex situations.

Types of Disability Benefits for Back Pain

If you find yourself unable to work due to back problems, you may qualify for disability benefits. These benefits can be obtained from various sources, including the government, your employer, or an insurance company.

In Canada, the following disability benefits are available, and you may be eligible to receive them:

  • Employment Insurance (EI) sickness benefits
  • Short-term disability insurance
  • Long-term disability insurance
  • CPP disability (Canada Pension Plan disability)
  • Workers’ compensation
  • Veterans Affairs Canada benefits
  • Provincial disability benefits
  • Disability tax credit

Understanding which disability benefits you may qualify for is essential to ensure you receive the support you need. Explore these options and assess your eligibility to access the appropriate benefits for your back problems in Canada.  

Various types of disability benefits available for back problems in Canada.

Employment Insurance (EI) sickness benefits:

EI sickness benefits are offered through the federal government’s employment insurance (EI) program and they provide temporary disability coverage. These benefits amount to 55% of your salary for a duration of 15 weeks, with a maximum annual payout of $60,300 ($638 per week).

To qualify, recent contributions to the EI program are required (deducted automatically from your paycheque). Applying for EI benefits can be done conveniently online through Service Canada, where you’ll need a doctor’s form confirming your 15-week inability to work. Additionally, your employer must provide a Record of Employment (ROE) as proof of your sick leave. Please note that simultaneous claims for EI benefits and short-term disability benefits are not permissible.

Ensure you understand the eligibility criteria, payment details, and application process for EI sickness benefits to access the support you need during your temporary disability.

Short-term disability insurance:

Short-term disability (STD) benefits offer temporary payments, typically 50-67% of your regular salary, for 15-17 weeks or longer. These benefits are provided by employers through company or group insurance policies. To qualify, your employer must offer STD coverage. If not, you may be eligible for EI sickness benefits. 

You can’t receive both STD and EI benefits simultaneously. To apply, obtain forms from your employer or insurer, including ones for you, your doctor, and your employer. If denied, you can request internal appeals within the company and, if necessary, pursue external appeals through an arbitrator or legal process. Understanding STD coverage and application ensures you access the benefits you deserve.

Long-term disability insurance:

Long-term disability (LTD) benefits provide extended payments that can last for many years, determined by a specified number of years or an age limit (usually 65). Payments typically cover 50-67% of your monthly salary, disbursed once a month.

LTD benefits are commonly offered through group or private plans. Group medical plans offered by employers often include LTD benefits, while unions generally provide them in their medical plans. For self-employed individuals or those without adequate workplace coverage, private insurance policies offer long-term disability coverage, usually as a fixed amount or a percentage of earnings.

To apply for LTD benefits, complete the required forms and submit them to the insurer. Typically, three forms are involved: one for yourself, one for your employer (if applicable), and one for your doctor. It is crucial to ensure all forms are submitted for the insurer to make a decision. If your LTD claim is denied, you have the option to appeal. 

CPP disability benefits:

CPP disability benefits in Canada provide financial support for permanent disabilities until age 65. Payments, ranging from $1,064.80 to $1,457.45 in 2022, are based on CPP contributions.

To qualify, sufficient CPP credits are required, which can be earned through employment or other arrangements. Simultaneous receipt of LTD and CPP benefits is possible, with potential offsetting by the LTD insurer.

A “severe and prolonged” disability must be proven, hindering regular employment and lacking improvement prospects. The application involves filling out forms and submitting a medical report from a healthcare professional to the designated Service Canada office.

In case of claim denial, a two-level appeal process is available. A reconsideration appeal must be made within 90 days, followed by an appeal to the Social Security Tribunal. Attending the tribunal hearing allows presenting evidence and addressing inquiries.

Ensure you meet the criteria and follow the proper application procedure to maximize your chances of receiving CPP disability benefits in Canada.

Workers’ compensation benefits:

Workers’ compensation provides financial support for individuals injured on the job, offering short- and long-term benefits. Each province in Canada has its own workers’ compensation program with specific eligibility criteria.

To qualify, the injury must occur in the workplace, and your job must be covered by the program. It’s important to note that not all workplaces are covered under workers’ compensation. 

Proving that a workplace injury caused or exacerbated back pain can be challenging. Workers’ compensation agencies may try to attribute back pain to pre-existing or non-work-related injuries. Having medical support from a doctor is crucial to succeed in your claim. The doctor should confirm that the workplace injury is responsible for your back pain.

Workers’ compensation benefits may overlap with other programs such as EI, CPP, and short- or long-term disability. Consulting with a legal professional is advisable for any concerns regarding benefit payments. Depending on your province, you may be eligible to retain some or all of your CPP disability and workers’ compensation benefits.

If your workers’ compensation claim is denied, follow the appeal procedures specific to your province. Typically, these programs have two levels of appeal: an internal reconsideration and an external tribunal, such as the Workers’ Compensation Appeals Tribunal (WCAT) in most provinces.

Veterans Affairs Canada:

If you’re a Canadian Forces member or veteran, you may qualify for disability benefits from Veterans Affairs Canada (VAC). These benefits provide support for short- or long-term disabilities. To be eligible, you must demonstrate that your back pain is related to your military service and have a medical confirmation from a doctor.

Applying for these benefits is easy through VAC’s online platform or by submitting a paper form. Your application will undergo a thorough review, considering your service medical records and additional information if needed.

In case of a denial, you can pursue an appeal starting with an internal reconsideration and then seeking review by the Veteran’s Review and Appeal Tribunal.

Provincial income supports benefits:

Provincial income support benefits in Canada provide vital assistance to individuals unable to work due to disability. Discover the eligibility criteria and application process to access these valuable benefits.

Eligibility for provincial benefits extends beyond work history. Even if you’ve never worked, you may qualify, provided your total family income falls below the specific threshold set by your province. Remember, family income does not affect other disability benefit approvals.

To apply for provincial disability benefits, reach out to your local agency or program. Ensure you have a comprehensive medical report or certificate from your doctor confirming your inability to work due to your medical condition.

If your initial application is denied, don’t lose hope. Many provinces offer internal appeal options within the agency or program. Some provinces even provide the opportunity for an external tribunal appeal. Familiarize yourself with the procedures in your province to pursue your case effectively.

Disability tax credit:

The disability tax credit is a valuable benefit in Canada that can significantly reduce your taxable income. Discover how you can qualify and claim this credit to optimize your tax savings.

To be eligible for the disability tax credit, your impairment must meet the program’s specific definition of being severe and prolonged. Keep in mind that this benefit sets a higher standard compared to other disability benefits.

If you meet the eligibility criteria, you may qualify for a refund of a portion of your previous taxes, depending on the duration of your condition. To initiate the application process, simply complete the T2201 form and submit it to Revenue Canada.

In the event of a denial by Revenue Canada, don’t lose hope. You have the right to request an internal appeal, giving you an opportunity to have your claim reconsidered. If the internal appeal proves unsuccessful, you still have the option to escalate your case and appeal to the Tax Court of Canada.

Steps to Obtain Life Insurance for Back Problems

To initiate the application process, it is advised to consult with an independent agent who specializes in life insurance. During the application, be prepared to answer detailed questions pertaining to your overall health, lifestyle, date of diagnosis, underlying issues causing the back pain, condition history, treatment and medication, and preventive care measures.

Working with a life insurance company that asks these specific questions is crucial, as it ensures a comprehensive understanding of chronic back pain and its implications. The more detailed information you provide, the better your chances of securing lower rates based on your current condition.

In most cases, chronic back pain does not significantly impact your eligibility for life insurance coverage. However, if the back pain is related to other medical conditions or complications, it may have more serious repercussions. The specific coverage you receive will depend on the individual circumstances of your condition.

By consistently documenting the history of your chronic back pain through regular doctor’s visits, you can demonstrate its progression and potentially reapply for life insurance in the future to potentially obtain better premium rates. If you believe a cover letter could better represent your situation and provide a fuller explanation, consider including it with your application to the underwriter.

Remember, working with a knowledgeable agent and providing accurate and detailed information about your chronic back pain will help increase your chances of obtaining suitable life insurance coverage.

Note that chronic back pain alone likely won’t affect your chances of receiving life insurance. However, chronic back pain stemming from other medical conditions could have serious repercussions on your premiums and ratings. 

Common results

Chronic back pain typically does not hinder your ability to obtain life insurance coverage. However, it’s important to note that if your back pain is associated with other medical conditions, it may have more significant implications. The specific type of coverage you can expect for chronic back pain can vary considerably based on the unique aspects of your condition.

Fortunately, most individuals with chronic back pain qualify for standard life insurance coverage. Only a small percentage may need to explore alternative options like graded or guaranteed policies. The majority of people with chronic back pain are typically assigned a Standard rating, although some may qualify for a higher Preferred rating. However, individuals with additional medical conditions, complications, or unresolved issues related to their back pain may receive a Substandard rating.

To enhance your chances of securing life insurance coverage, it is advisable to maintain regular visits to your doctor and keep a documented history of your chronic back pain. As your condition improves, you can consider reapplying for life insurance, which may result in more favorable premium rates. Additionally, if you believe that providing a detailed explanation of your situation would benefit your application, you can include a cover letter addressed to the underwriter. 

By following these recommendations, you can navigate the life insurance application process with chronic back pain more effectively. Ensure a smooth experience and obtain the coverage you need.

Securing Disability Benefits for Back Problems

Credibility: The Key to Unlocking the Benefits of Diagnostic Imaging

When applying for long-term disability benefits for back problems, proving the legitimacy of your condition is essential. Diagnostic imaging, including X-rays, CT scans, and MRI scans, provides valuable objective evidence to support your case. However, it’s important to note that there is no direct link between back pain and MRI results.

To strengthen your credibility, be thorough in describing your symptoms to your doctor and explore various treatment options for your back pain. Collaborating with trusted professionals who support your claims can greatly improve your chances of securing disability benefits. 

Remember, credibility plays a significant role in the decision-making process, as it can sway outcomes even with limited documentation. Don’t underestimate the importance of credibility when seeking disability benefits for back problems.

Demonstrating Your Commitment to Getting Better

When applying for disability benefits due to back problems, you must demonstrate that you have pursued all available self-help options. Treatments for chronic back pain include drug therapy, various therapies, surgery, psychological counseling, and physical rehabilitation.

Although drug treatment is a common choice for alleviating back pain, it carries risks such as side effects and addiction, as well as potential affordability issues. Different therapies, including exercise, electrotherapy, and superficial heating/cooling, are available, but their effectiveness varies from patient to patient. It is important to explore these options before being eligible for disability benefits.

Surgery is an alternative for some individuals, but it can be costly and may involve complications, especially if there are other underlying health conditions. Psychological counseling is essential to address the psychological aspects of back pain. Failing to seek this form of therapy may result in denial of disability benefits, making it a crucial step to undertake.

Furthermore, engaging in physical therapy is necessary, recognizing that it requires significant effort and time to achieve results. Demonstrating a genuine commitment to this treatment is vital to avoid denial of disability benefits based on the assessment of your physical therapist.

Documenting Back Pain from Sitting or Standing for Disability Benefits

Experiencing back pain that limits your ability to sit or stand for extended periods can be a strong indicator of work-related disability. Many jobs require long hours of desk work, and if your back pain prevents you from performing these tasks effectively, you have a good chance of being approved for disability benefits.

To support your claim, it’s essential to document your daily movements and provide evidence that sitting or standing for extended periods causes severe pain. This pain should significantly hinder your ability to fulfill your job duties. 

If you can sit coMfortably for more than two hours, it may suggest that your back problem is not as severe. However, if you struggle to do so, it strengthens your case for obtaining disability benefits specifically for back problems.

Overcoming Common Challenges When Applying

Job Suitability Concerns

When seeking disability benefits, it’s common for doubts to arise regarding your ability to perform your current job. The argument often emerges if your job involves medium to heavy duties and you haven’t attempted a job with light or sedentary responsibilities.

The most effective approach to counter this argument is to explore and attempt easier job alternatives. Until you do so, disability benefits providers may continue to question your limitations. It’s essential to demonstrate that although your job may be classified as having medium duties on paper, your employer has made accommodations that qualify your tasks as light in practice.

By trying to work easier jobs and documenting your experiences, you can present compelling evidence to dispel doubts raised about your ability to engage in sedentary or light-duty work. Taking proactive steps to explore alternative employment options will significantly strengthen your disability benefits claim.

Countering Insurer’s Allegations

Insurers may deny disability benefits by shifting blame onto you or your doctor, claiming that the right treatment could have prevented your disability. They might argue that your symptoms stem from untreated depression rather than pain, invalidating the effectiveness of your treatment. Furthermore, some insurers may assert that your lack of multidisciplinary pain treatment implies your disability is not permanent. 

To counter these arguments, gather thorough medical documentation, seek multiple opinions, adhere to prescribed treatments, and work closely with healthcare providers to validate your efforts in managing your condition. By presenting a strong case, you can refute these assertions and enhance your chances of securing disability benefits.

 Insufficient Evidence for Disability

Insurers often deny back pain disability claims citing “insufficient objective evidence of disability.” However, as modern medicine has not established a direct link between pain and objective evidence of disability, this reason holds limited validity.

In your appeal letter, address this denial reason by highlighting that objective evidence is not a requirement in most disability insurance policies and programs. Focus on showcasing how your doctor followed best practices in diagnosis and treatment, and emphasize your adherence to the recommended treatment plan. Additionally, highlight your ongoing efforts to continue working despite the challenges posed by your back condition. By presenting a compelling case, you can effectively challenge the denial reason and bolster your disability claim appeal.

If Your Claim for Disability Benefits is Denied

Facing a denial of disability benefits for back problems can be challenging. Learn how to navigate the appeal process effectively by hiring a lawyer or advocate who specializes in disability claims, increasing your chances of securing the benefits you deserve.

Receiving a denial of disability benefits for back problems can be disheartening, leaving you in a difficult situation. We understand the frustration that comes with this outcome, having witnessed it with numerous clients. In some cases, the denial may stem from a lack of the right type of evidence for your disability claim. Even if the insurance company acknowledges your disability, they may use this technical reason to deny your claim.

If you find yourself in this situation, it is crucial to consider enlisting the assistance of a lawyer or advocate who specializes in disability claims. They can guide you through the appeal process, increasing your chances of a successful outcome and securing the disability benefits you deserve for your back pain.

Frequently Asked Questions (FAQs) about Life Insurance with Back Problems

Yes, it is possible to qualify for life insurance even if you have a pre-existing back problem. However, the availability and terms of coverage may vary between insurance providers, and if there are any other medical conditions to be considered.

Generally, individuals with a history of back problems may face higher premiums due to the increased risk associated with their condition. However, the specific impact on premiums will depend on factors such as the severity of the back problem and overall health.

When applying for life insurance with a back problem, you will typically need to provide details about your medical history, including the nature of your back problem, any treatments received, and any related surgeries or procedures.

In many cases, insurance companies may require a medical examination and access to your medical records, including those pertaining to your back problem. These assessments help insurers evaluate the risk associated with your condition.

The severity of your back problem can impact your life insurance eligibility and premiums. Severe or chronic back problems may be considered higher risk, while milder conditions may have a lesser impact. Insurance providers will assess your specific situation during the underwriting process.

Find a solution for what you’re looking for

Obtaining life insurance coverage for individuals with back problems in Canada is possible, although it may require some extra considerations. By understanding the available options, providing accurate information about your condition, and working with knowledgeable insurance professionals, we can secure the financial protection and peace of mind you and your loved ones deserve.

To schedule a consultation about your income protection goals, or if you have any questions about insurance in Canada, please contact Protect Your Wealth or call us at 1-877-654-6119 to talk to an advisor today! We’re proudly based out of Hamilton, and service clients anywhere in Ontario, British Columbia and Alberta including areas such as Waterloo, Mississauga, Edmonton, and Nanaimo.

Talk to an advisor today.

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