Do I qualify for long-term disability benefits if I have Rheumatoid Arthritis?

Can I Get Long-Term Disability For Rheumatoid Arthritis?

One of the most common questions we get is “Do I qualify for long-term disability benefits if I have rheumatoid arthritis?”

Rheumatoid Arthritis (RA) is a major cause of disability and it can qualify for long-term disability benefits (also called LTD benefits)

Has your claim for disability benefits been denied? Has the insurance company denied your appeal? Were you receiving benefits and the insurance company terminated those benefits?

The experienced team at Ertl Lawyers can help you.

We’ll work with you and your physician to help challenge the insurance company’s denial or discontinuance of your long-term disability benefits.

Where necessary, we will engage other trusted professionals to support your case including specialists, functional capacity evaluators, and vocational evaluators to help credibly explain why your disability symptoms are preventing you from doing your “own occupation” or “any occupation”.

Ertl Lawyers offers:

✓ A free case assessment
✓ Fair, flexible rates, including contingency fees (i.e. only pay if you win)
✓ Service across all of Ontario

If you are looking for long-term disability lawyers that care about your well-being, you’ve found us.

Our help can make all the difference.

Rheumatoid Arthritis: Overview

Rheumatoid arthritis is considered an autoimmune disease, meaning the patient’s immune system is attacking healthy tissues in the body by mistake, such as with lupus or Crohn’s disease.

With rheumatoid arthritis, the immune system attacks the flexible synovial membrane of the joint, causing it to thicken. Consequently, the ligaments and tendons that hold the joint together become weakened and stretched. The joint loses its shape an alignment and can result in deformity and dysfunction and loss of use.

Rheumatoid arthritis usually affects the small joints first:

  • Small joints of the hands and feet
  • Wrists
  • Ankles

As it progresses, the disease can affect larger joints:

  • Elbows
  • Knees
  • Shoulders
  • Jaw
  • Neck

In many patients with rheumatoid arthritis (i.e. about 80%-90%), the cervical spine is involved.  When that happens, the resulting instability can result in pain and other neurological symptoms, including headaches and tingling in the fingers.

While it mainly affects the body’s joints, rheumatoid arthritis is considered a systemic disease, meaning it can affect may parts of the body, including tissues and organs (such as eyes, skin, heart, the nervous system, lungs, blood, and musculoskeletal system.

There is no cure for rheumatoid arthritis. The goal of treatment (namely medication) is to reduce the inflammation and drive the disease into remission to slowing its progression.

See Canadian Rheumatology Association and Canada’s Arthritis Society

Most Common Symptoms of Rheumatoid Arthritis

Joint pain and Stiffness

Joint pain and stiffness commonly occur in the feet, knees, and hands. This can cause permanent joint destruction and deformity. This joint pain can be debilitating, and the damage to your joints can make it difficult to work or do your activities of daily living. 

Swollen and Tender Joints

Swollen joints and painful tenderness limit your ability to do any work activity that requires use of your feet, knees and hands.

Fatigue

Debilitating fatigue that can severely limit work and day-to-day activities.

Note: Some rheumatoid arthritis patients may lose function in their joints as the disease progresses to a later stage

Criteria for a Diagnosis of Rheumatoid Arthritis

There is no “one test” to diagnose rheumatoid arthritis. Rather, a doctor (often a rheumatologist) will examine your complete history and perform a comprehensive examination, including blood tests and x-rays.

Frequently, the symptoms of rheumatoid arthritis can mimic the symptoms of other diseases such as osteoarthritis, psoriatic arthritis, and Sjogren’s syndrome. 

In 1987, the American College of Rheumatology (ACR) developed a list of seven criteria to help diagnose rheumatoid arthritis. According to this classification criteria, if a patient has four of the seven criteria (present for at least six weeks), then a person is said to have rheumatoid arthritis:

  • Morning stiffness in and around joints for at least one hour
  • Swelling and fluid around at least three joints at the same time
  • At least one area in the hand, wrist, or finger joints that is swollen
  • Symmetric arthritis, meaning arthritis occurring in the same joint on both sides of the body
  • Manifestation of rheumatoid nodules (firm lumps in the skin, often occur in the pressure points of the body like the elbow)
  • Abnormal levels of rheumatoid factor in the blood
  • X-rays of the hands and wrists show signs of damage typical with rheumatoid arthritis.[1]

But, the 1987 criteria have come to be recognized as having a poor performance for diagnosing early stage rheumatoid arthritis.[2] So, in 2010, the ACR published new classification criteria in an effort to improve earlier diagnosis of rheumatoid arthritis in patients who may not meet the 1987 ACR criteria.[3]

However, due to the complexity and diverseness of rheumatoid arthritis, medical science does not yet have a comprehensive diagnostic set of criteria for rheumatoid arthritis readily available.

Indeed, this is why long-term disability insurers often deny claims for rheumatoid arthritis – because it can be difficult to diagnose accurately in its early stages.

Treatment for Rheumatoid Arthritis

Medication

Treatment for rheumatoid arthritis often includes nonsteroidal anti-inflammatory drugs, known as NSAIDs, steroids, disease modifying antirheumatic drugs and immunosuppressant drugs. These drugs can have significant side effects, including gastrointestinal problems, anemia and fatigue.

When RA is stable, most people see their rheumatologist every four to six months. Some medications require regular blood tests while they’re being taken or need to be administered in a hospital setting or infusion clinic. 

Therapy

Physiotherapy may help arthritis sufferers cope with chronic pain and disability through the design of programs that address flexibility, endurance, aerobic condition, range of motion (ROM), strength, bone integrity, coordination, balance and risk of falls. 

Massage may help different forms of arthritis in specific ways. For example, if you are living with rheumatoid arthritis, massage can improve healthy circulation throughout the arthritic joints, reducing swelling and improving quality of life. However, the Arthritis Society advises avoiding massages during flare ups. 

Surgery

If medication doesn’t prevent or slow the joint damage, a patient may have to undergo surgery, such as:

  • Joint Replacement: the damaged joint is removed and replaced with a prosthesis made of plastic and metal.
  • Arthrodesis: the damaged joint is removed and neighbouring bones are fused together.
  • Synovectomy: the inflamed synovial tissue around the joint is removed to help reduce or eliminated symptoms.

Important: These surgeries also can be the basis of a disability claim.

Workplace Restrictions and Limitations Caused by Rheumatoid Arthritis

Pain and fatigue are the most often cited challenges that rheumatoid arthritis patients face in maintaining work.

Additional challenges included typing, writing, maintaining a pleasant disposition, physical requirements, overtime, travel, commuting, being on time, and the inability to choose rest periods. 

If your arthritis is severe enough to limit your abilities to perform basic work tasks, such as standing, walking, pulling, carrying, reaching, sitting, lifting, or handling, you may qualify for long-term disability benefits.

See our video: LTD Case Study: Arthritis 

Rheumatoid Arthritis and Workplace Discrimination

It is unlawful to discriminate against someone in the area of employment based on their physical disability: Ontario’s Human Rights Code and the Canadian Human Rights Act.

If you are suffering from rheumatoid arthritis, you might face discrimination in a variety of ways:

  • You are terminated from your job because you have rheumatoid arthritis.
  • You are denied accommodation because of your rheumatoid arthritis. 
  • After returning from a disability leave, your employer places you in a lower, part-time position at a lower rate of pay.
  • Someone makes unwelcome remarks or jokes about your disability.
  • Someone offends or humiliates you physically or verbally threatens or intimidates you because of your disability.
  • Retaliating against you for filing a human rights complaint. 

Ertl Lawyers are experts in Employment and Disability Law. If you have been discriminated against, we can help, including:

  • Having your employer comply with their duty to accommodate you.
  • Having your employer stop all forms of discriminatory conduct.
  • Representing you in wrongful dismissal, constructive dismissal, and human rights matters.
  • Ensuring that your employer complies with its statutory obligations, including its obligations under the Employment Standards Act.
  • Negotiation severance packages (including continuation of benefits).


What Are Some Steps You Should Take Before You Apply for Long-Term Disability Benefits for Rheumatoid Arthritis?

Review Your Policy Carefully

Your entitlement to disability benefits for rheumatoid arthritis depends on the specific wording of your disability policy. 

Therefore, you will need to review your policy and see how it defines things like “totally disabled” and “occupation” – and whether any exclusions apply (particularly for pre-existing conditions).

Gather Medical Evidence

To be entitled to disability benefits for rheumatoid pain, every insurer requires you to provide medical evidence documenting how your illness or injury causes restrictions or lack of ability, such that you are prevented from performing the essential duties of your occupation. 

Therefore, you will need a copy of your medical records to see if there is an objective basis for your diagnosis of rheumatoid arthritis and what your medical records say about your symptoms and your restrictions and limitations 

Gather Evidence of Workplace Limitations

Because your entitlement to long-term disability benefits for rheumatoid arthritis depends on the strength of your evidence, you should get a copy of your employee file from work. It may show that your rheumatoid arthritis has negatively impacted your work performance. Your work performance may have been affected by your limited ability to use your hands, stand, walk, etc.

Create a List of the Physical Duties of Your Job

You should get a copy of your job description. Based on that job description, you should write out a detailed list of the physical (and mental) duties associated with your job description – and explain how your rheumatoid arthritis limits or prevents you from performing you own occupation.

Ask Your Doctor for a Report

It is recommended that you provide your doctor with your occupational description. You should ask your doctor to prepare a report that clearly explains the objective basis for:

  • your diagnosis of rheumatoid arthritis
  • your restrictions and limitations
  • reasons why you are unable to perform some or all of the essential duties of your own occupation.

Follow Your Doctor’s Treatment Plan

Your entitlement to long-term disability benefits also requires you to be receiving regular, ongoing care and treatment for your rheumatoid arthritis. In other words, don’t skip appointments, and always follow your doctor’s treatment plans.

Keep a Pain Diary

On your end, it is important to keep a pain diary. A pain diary is a written record that helps you keep track of when you have pain, how bad it is, and whether your treatment is helping. 

Document Your Disability with Photographs

Also, it is a good idea to take photographs of any affected joints to document the swelling, dysfunction, and disfigurement.

What Other Benefits Might I Be Entitled to for Rheumatoid Arthritis?

Other than short-term and long-term disability benefits through a group or individual insurance plan, people suffering from rheumatoid arthritis might be entitled to one or more of the following benefits:

  • Employment Insurance (EI) Sickness Benefits;
  • Ontario Disability Support Plan (ODSP);
  • Disability Tax Credit (DTC);
  • Disability Creditor Insurance (under your mortgage or credit cards);
  • Trillium (extended health benefits);
  • Canada Pension Plan Disability (CPP-D); and
  • Disability Pension (employer).

Arthritis Organizations / Associations / Colleges

Disclaimer: The content on this web site is provided for general information purposes only and does not constitute legal, medical, or other professional advice or an opinion of any kind. Users of this web site are advised to seek specific legal advice by contacting members of Ertl Lawyers (or their own legal counsel) regarding any specific legal issues. Ertl Lawyers does not warrant or guarantee the quality, accuracy or completeness of any information on this web site

Endnotes:

1. Arnett FC; Edworthy SM; Bloch DA; McShane DJ; Fries JF; Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis and Rheumatism. 1988;31(3):315-324, Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/art.1780310302

2. Takeda A; Sugimoto H. Growing Need for Diagnostic Precision in Rheumatoid Arthritis: Proposal of MR imaging Criteria for Early Diagnosis. IntechOpen [Online], 2020, retrieved from: https://www.intechopen.com/books/connective-tissue-disease-current-state-of-the-art/growing-need-for-diagnostic-precision-in-rheumatoid-arthritis-proposal-of-mr-imaging-criteria-for-ea

3. Aletaha D; Alan T; Silman J; Funovits J; et al. Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis and Rheumatology [Online], 2010, Vol. 62, No. 9, Retrieved from https://onlinelibrary.wiley.com/doi/10.1002/art.27584

4. “Rheumatoid Arthritis,” Physiopedia (website), accessed September 1, 2020, https://www.physio-pedia.com/Rheumatoid_Arthritis

5. Klodzinski, L and Wislowska, M. Comorbidities in Rheumatic Arthritis. Rheumatologia [Online], 2018, Vol. 56(4). Retrieved from the National Centre for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142024/#:~:text=The%20most%20common%20comorbidities%20reported,8%5D%2C%20tumors%20and%20depression

6. “Rheumatoid Arthritis Sends Many Into Early Retirement.” ScienceDaily, 7 February 2008. Retrieved from: www.sciencedaily.com/releases/2008/02/080204102758.htm

Long-Term Disability Benefits Denied?

Ertl Lawyers provides expert representation in long-term disability matters.
The vast majority of disability matters are resolved through negotiation and mediation – and that’s because insurance companies know that we are passionate about our clients’ rights.

How we can help you:

• free disability policy analysis
• free case assessment
• applying for disability benefits
• appealing a denial or termination of your benefits
• disputing a denial through a legal claim
• handling all communications with your employer
• protecting your employment
• prosecuting human rights claims

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