Is Fibromyalgia a Disability in Ontario?
Fibromyalgia is a chronic condition that is quite common. It is characterized by a group of symptoms that exist simultaneously and need to be managed. Warning signs include fatigue, chronic pain, changes in mood, and problems with memory. While painful, it is not life-threatening nor does it lead to joint impairment.
At the early onset of a fibromyalgia disability, the condition often affects a certain area subtly. As time progresses, multiple areas of the joints, organs, and skin are affected. Although any part of the body can be distressed, the sites most affected by the condition are the legs, back, arms, shoulders, and neck.
Fibromyalgia is considered a rheumatic condition, meaning it is marked by pain and inflammation in the muscles, joints, and fibrous tissue in the body though it causes no damage.
Approximately 900,000 Canadians are affected by the condition.
The Challenge of Receiving Long-Term Benefits for a Fibromyalgia Disability
Acquiring long-term benefits for a fibromyalgia disability is difficult, but it is not impossible. An experienced disability lawyer can carefully read your policy with you and determine how you can receive long-term benefits for your fibromyalgia disability.
Companies that provide long-term disability insurance often limit or deny claims for benefits if an individual has fibromyalgia. This is because, currently, an objective test to diagnose the disease does not exist. Fibromyalgia identification is largely based on symptoms that are self-reported. Frequently, fibromyalgia is specifically excluded from coverage for long-term benefits.
Some insurance companies limit long-term disability benefit payments to one or two years because they consider a fibromyalgia disability to be mainly a mental disorder.
Keep in mind that even if your insurance policy does not specifically limit or exclude coverage for fibromyalgia, you can anticipate significant resistance when applying for long-term benefits on the basis of being disabled by fibromyalgia.
Eligibility for Disability Benefits in Ontario
While fibromyalgia is recognized as a disability, the eligibility for disability benefits depends on demonstrating how the condition significantly affects your ability to perform normal work activities. In Ontario, individuals may qualify for:
- Ontario Disability Support Program (ODSP): If fibromyalgia causes long-term impairments that prevent you from working, you may be eligible for financial assistance through ODSP.
- Canada Pension Plan Disability (CPP-D): If fibromyalgia leads to severe limitations in your ability to work, you may be eligible for CPP-D benefits, provided that the condition is long-term and prevents you from earning a living.
Key Factors in Proving Eligibility
Proving eligibility for disability benefits involves demonstrating that fibromyalgia significantly impairs your ability to work. To support your claim, it is essential to provide:
- Medical Documentation: Reports from your healthcare provider that outline your diagnosis, symptoms, and how the condition limits your ability to work.
- Functional Limitations: Evidence that demonstrates how fibromyalgia affects your daily activities and work-related tasks.
- Treatment History: Documentation of the treatments you’ve tried, such as medications, physical therapy, or alternative therapies, and their effects on your condition.
Why Documentation is Crucial
In Ontario, applying for disability benefits with fibromyalgia can be complex, as the symptoms are often invisible. Therefore, comprehensive and well-documented evidence is crucial to showing that the condition meets the disability criteria. Working with healthcare professionals and legal experts can help you build a strong case for eligibility.
What Fibromyalgia Disability Benefits Are Available in Canada?
About three percent of all Canadians suffer from Fibromyalgia in varying levels of severity. Compared to many other diseases, this is a high number and means that nearly one-million Canadian citizens suffer from the disorder, which can sometimes reach debilitating levels of pain. One thing we are often asked is, is there a fibromyalgia disability living allowance in Canada? It is possible to receive benefits for Fibromyalgia disability in Canada under specific conditions. Fibromyalgia does qualify for a disability tax credit and other benefits that can provide financial support ranging from $1,600 to $50,000. But what exactly is the condition and how does it appear in sufferers?
What Is Fibromyalgia?
One of the medically baffling aspects of Fibromyalgia is that it typically appears as a group of unrelated symptoms and is often misdiagnosed. In general, sufferers experience mood changes, memory difficulty, chronic pain and fatigue. The only upside is that the malady does not cause permanent joint disability, nor does it cause death. That’s small comfort, however, for anyone who is unfortunate enough to face the disease.
In its most common form, Fibromyalgia means chronic pain in muscles and bones, physical exhaustion and generalized fatigue. Organs anywhere in the body can become targets, with tissues and muscles near joints being the most common locations for the worst pain. And while almost any sector of the body can experience symptoms, common locations include the legs, neck, arms, back, and shoulders.
Fibromyalgia After A Car Accident
Individuals who have suffered injury in a motor vehicle accident or slip and fall accident often do not have a family physician. Often the injured do not receive the medical monitoring that they need because it may take a very long time to be assessed by a medical specialist. Wait lists for specialists of one to two years is common, and causes a great deal of frustration for the patient. It’s especially important to speak with a lawyer right away to secure a strong claim for benefits and care.
Fibromyalgia is a common condition for those suffering injury, and previously required referral to a Rheumatologist for diagnosis and treatment. The Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome recently has been revamped and addresses the issue of readily available diagnosis and treatment.
The new Guideline acknowledges that a diagnosis can be made by a family physician. Laboratory tests and unnecessary investigations which may be detrimental to the patient should be avoided.
This new philosophy is designed to lead to an early diagnosis which will avoid lengthy, costly, and unnecessary investigations. This philosophy is geared toward primary care management (family physician) of the disease without the need for the long wait for treatment.
The Guideline recommends non-pharmacologic strategies with patients encouraged to pursue as normal a life pattern as possible, using pacing and/or graded incremental activity to maintain or improve function.
What does this mean for the pain-ridden accident victim suffering as a result suffering from Fibromyalgia? It means that the current medical opinion is not to encourage total reliance on prescription medications. Many motor vehicle accident lawyers representing the insurer of the at-fault driver would like to suggest that because you do not consume daily prescription medications then clearly you must not be suffering. The medical opinion clearly does not agree with this proposition. The insurer would like to also suggest that if you are able to lead some semblance of a normal life you must not be suffering. The medical opinion clearly does not agree with this proposition. Consulting with your family physician on a regular basis so that a diagnosis can be made with treatment appropriate to your condition is necessary for your health and litigation.
If you are suffering from Fibromyalgia due to an accident, contact our experts to get the assistance, benefits, and care you deserve at 1-855-446-7765. For more information, visit our accident lawyer section.
What About Chronic Pain Syndrome?
Similar to fibromyalgia, chronic pain syndrome is a recognized disorder of pain that persists beyond the usual healing time following an injury. This is a condition that must be diagnosed by a medical doctor after extensive investigation and treatment to rule out an organic cause for the pain.
When diagnosing chronic pain syndrome (CPS), physicians often typically on the following six criteria for chronic pain as described by the American Medical Association Guidelines:
- Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances.
- Excessive dependence on health care providers, spouse, or family.
- Secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain.
- Withdrawal from the social milieu, including work, recreation, or other social contracts.
- Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family, or recreational needs.
- Development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or nonorganic illness behaviors.
How To Apply For Fibromyalgia Disability Benefits In Ontario
If you suffer from Fibromyalgia, you face a few unique hurdles pertaining to benefits, both in the application process and afterward. Here are the primary facts you need to keep in mind if you are a Fibromyalgia sufferer, a resident of Ontario, and seek to obtain Fibromyalgia disability benefits:
Document Everything
You’ll need documentation of four distinct facts: that you suffer from Fibromyalgia, that the disease prevents you from working, that you are getting treatment for the condition, and that you have tried your best to keep working even after the diagnosis. That’s a lot and is just one of the reasons people usually hire competent lawyers to help with claims.
Know the Status of Fibromyalgia Disability in Canada
The first question, “Is Fibromyalgia considered a disability in Ontario,” is an easy one. Fibromyalgia is listed as a disorder that qualifies for disability benefits in Ontario and throughout Canada. To be successful with a fibromyalgia disability claim, however, it’s wise to hire a lawyer and assemble all the documentation noted above. Next, it’s important to understand that getting CPP (Canada Pension Plan) disability benefits represent one of eight types of payments you can get if you can show that Fibromyalgia keeps you from working and are hoping to collect a fibromyalgia disability living allowance. Other categories of benefits you might be able to get include employment insurance, short-term disability, a tax credit, provincial benefits, workers comp, veterans affairs benefits, and long-term disability insurance.
Qualifying for Fibromyalgia Disability In Canada
Fibromyalgia and disability qualifications are complex. The basic rule for CPP benefits is that sufferers must prove a “prolonged and severe” condition. These two words have precise legal definitions that are sometimes at odds with the way they’re used in everyday speech. Taken together, they refer to a condition that is long-term and of indefinite duration that keeps a person from doing financially gainful work.
Successful Chronic Pain Syndrome and Fibromyalgia Disability Claims
To have a successful long-term disability claim for CPS and fibromyalgia you have to seek treatment and undergo medical investigations to rule out causes other than chronic pain syndrome or fibromyalgia for your pain. You will need extensive medical records and treatment records supporting your CPS and fibromyalgia long term disability claim.
If your insurance company denies your claim for disability from chronic pain syndrome or fibromyalgia, our experienced disability lawyers will help you obtain the necessary expert medical opinion to confirm that you cannot work because of chronic pain or fibromyalgia chronic pain.
If your case goes to trial, we would also need to get evidence from you about the impact of chronic pain and fibromyalgia on your day-to-day functioning, such as taking care of your self, your family and your home, your ability to participate in leisure and social activities, and your inability to work. Corroborative evidence from friends, family, your treating medical professionals, and your employers or co-workers is also important for winning fibromyalgia or chronic pain disability case.
Finally, and most importantly, because there is no objective cause for your persistent and debilitating pain, we have to trust what you say; therefore, credibility is really important in chronic pain and fibromyalgia disability claims.
A Case-By-Case Review Process
It is essential for applicants to use expert legal help because the misfiling of a single document or a routine clerical typographical error can result in a rejected application. Getting it right the first time is of paramount importance and speed up the receipt of benefits substantially.
Keep in mind that even though fibromyalgia is often called an invisible disease, the symptoms can be quite severe, and disability claims for fibromyalgia will be approved when all the necessary paperwork is in order. It’s also common for claimants who have been denied to reapply with the assistance of a lawyer and get a successful result on a second attempt.
