Can I Get Long-Term Disability Benefits for Fibromyalgia in Canada?

Fibromyalgia presents a major health obstacle for millions across Canada.

For those experiencing severe fibromyalgia, holding down a job might seem unattainable, leading them to question, “Am I entitled to long-term disability for fibromyalgia in Canada?”

This in-depth guide will discuss fibromyalgia, the challenges it creates in the workplace, whether it can qualify for long-term disability benefits, the steps you might consider if you plan to apply for benefits, and how insurance companies might stand in your way.

Additionally, we’ll highlight the value of consulting experts like Ertl Lawyers, which can significantly enhance your experience during this process.

Fibromyalgia: Overview

a) What is Fibromyalgia?

Fibromyalgia is a neurologic chronic health condition that causes pain all over the body and other symptoms, especially fatigue and cognitive impairment.

Fibromyalgia is not an autoimmune or inflammation-based illness, but research suggests the nervous system is involved.

In some people, the disease appears after a traumatic experience like an accident, overwork, emotional trauma, hormonal changes, sexual or physical abuse during childhood, or a viral disease. In some people, fibromyalgia presents with no apparent cause.

The intensity of the symptoms is extremely variable from person to person. Some individuals are almost completely disabled, while others are only mildly so. 

Though there is no cure, medications can reduce symptoms in some patients.

Fibromyalgia often co-exists with other painful conditions, such as:

• irritable bowel syndrome
• migraines and other types of headaches
• interstitial cystitis or painful bladder syndrome
• temporomandibular joint disorders/jaw pain
• rheumatoid arthritis

See: Arthritis Society and Canadian Rheumatology Association

b) Most Common Symptoms of Fibromyalgia

Fibromyalgia is mainly associated with:

• Pain: the pain generally consists of burning, aching and soreness that is typically more severe in parts of the body that are used the most (such as the feet, causing difficulty walking or standing). 
• Fatigue: the fatigue is usually strong, often to the point of exhaustion, resulting in decreased endurance and a limited ability to function physically and mentally. 
• Cognitive difficulties: Memory, concentration, and attention are impaired, particularly when exhaustion is most intense.

Other symptoms can include:

• muscle stiffness, especially in the morning
• unrefreshing sleep (waking up tired even after a full night’s sleep)
• headaches / migraines 
• jaw pain
• dizziness or lightheadedness
• nausea, diarrhea, constipation, gas, or bloating
• bladder spasms
• difficulty controlling body temperature
• sensitivity to bright lights or sounds
• weight gain or loss
• feeling anxious or emotionally numb
• painful menstrual periods (women only)

Important: Many people with fibromyalgia become discouraged, which can lead to depression and anxiety. 

c) Criteria for a Diagnosis of Fibromyalgia

There is no single test to confirm if you have fibromyalgia. Doctors (usually rheumatologists) have to rule out other conditions to make a diagnosis, but there are now Canadian guidelines – endorsed by the Canadian Pain Society and the Canadian Rheumatology Association – to identify and manage the condition.[1]

The main diagnostic criteria using the Canadian guidelines are:

• history of widespread pain in all four body quadrants for a minimum of three months
• pain in 11 of 18 specified tender points when they are pressed
• other clinical symptoms including fatigue, sleep disturbance, neurocognitive manifestations and/or neurological manifestations.

Because a fibromyalgia diagnosis is based, to a large extent, on self-reported symptoms, long-term disability insurers often deny these claims.

Workplace Challenges for Individuals with Fibromyalgia

Physical Limitations

Employees suffering from fibromyalgia often deal with pain, stiffness, and fatigue, making it challenging to carry out physically demanding tasks. Activities such as lifting, prolonged standing, or sitting at a desk for long stretches can trigger painful flare-ups.

Cognitive and Emotional Challenges

Fibromyalgia can also cause issues with memory, concentration, and decision-making, commonly known as “fibro fog.” This can greatly impair job performance, especially for those in positions that require critical thinking or multitasking.

Absenteeism and Presenteeism

Absenteeism refers to the necessity for employees with fibromyalgia to take time off due to their health or flare-ups, while presenteeism describes employees who work despite being unwell, often resulting in reduced productivity, errors, and prolonged fatigue.

Social Stigma and Misunderstanding

Fibromyalgia is an invisible illness, and many individuals with the condition face skepticism or misunderstanding from colleagues and supervisors. This stigma can lead to feelings of isolation, frustration, or anxiety, further exacerbating symptoms.

Fibromyalgia 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 fibromyalgia, you might face discrimination in a variety of ways:

• You experience employment termination because you have fibromyalgia
• You are denied accommodation because of your fibromyalgia. 
• 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. 

See our video: “Disability Discrimination”

Ertl Lawyers are experts in Employment and Disability Law. If you have been discriminated against, our disability and employment lawyers in Toronto 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 in Ontario, 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).

Apply for Long-Term Disability Benefits for Fibromyalgia

Review Your Policy Carefully

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

As noted, some policies outright exclude fibromyalgia coverage or else consider it a “mental disorder” (and seek to limit the amount of benefits).

It is important that you understand how the insurance company defines things like “totally disabled,” “occupation,” “mental disorder, “self-reported condition” – and whether any exclusions apply (particularly for pre-existing conditions).

Bottom line: You need to know what your policy says before you apply for benefits.

Gather Medical Evidence

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

It is recommended that you get treated by a medical professional (particularly a rheumatologist) who will diagnose your condition using established criteria.

It is also recommended that you provide to the insurer results of any Functional Capacity Evaluation or cognitive testing that objectively documents your physical and (if applicable) mental limitations.

Gather Evidence of Workplace Limitations

Because your entitlement to long-term disability benefits for fibromyalgia depends on the strength of your evidence, you should get a copy of your employee file from work. It may show that your fibromyalgia has negatively impacted your work performance. Your work performance may have been affected by your pain, fatigue, cognitive impairment, or other symptoms.

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 fibromyalgia limits or prevents you from performing you 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 fibromyalgia. 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. 

What Other Benefits Might I Be Entitled to for Fibromyalgia?

Other than short-term and long-term disability benefits through a group or individual insurance plan, people suffering from fibromyalgia 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).

Fibromyalgia Resources

• Arthritis Society
• Canadian Rheumatology Association
• Canadian Pain Society
• American College of Rheumatology
• National Fibromyalgia and Chronic Pain Association 
• Arthritis Foundation

How a Long-Term Disability Lawyer Can Help You

Navigating the disability claims process can be challenging, especially when dealing with fibromyalgia. This is where working with an expert, like a long-term disability lawyer in Ontario, can make a significant difference.

Here’s how legal professionals can support you:

Understanding Your Policy: Lawyers can help interpret the complex details of your insurance documents, clarifying the benefits you are entitled to.

Creating a Strong Appeal: If your initial claim is denied, an experienced long-term disability lawyer can gather supporting evidence, consult with medical professionals, and file a persuasive appeal on your behalf.

Initiating a Legal Action: Instead of relying on the insurance appeal process, it might be better for you to commence a legal claim to get your benefits.

Dealing with Insurance Companies: Since insurance companies focus on profits rather than payouts, a knowledgeable lawyer can navigate their tactics and negotiate effectively for you.

Saving You Time and Effort: Juggling a disability claim while managing the symptoms of fibromyalgia can be overwhelming. Having legal representation allows you to concentrate on your health, knowing that your case is being handled by professionals.

Dealing With Your Employer: Ertl Lawyers will help you with employment issues arising from your disability, including wrongful dismissal, constructive dismissal, accommodation, discrimination, and return to work.  We are experts in both disability and employment law.

Pursuing Disability Benefits with Confidence

Fibromyalgia is a significant medical condition that warrants acknowledgment and support. If you’re facing difficulties in your job, finding it hard to meet work expectations, or looking for disability benefits related to fibromyalgia, remember that there are resources available to assist you.

If you’re uncertain about what to do next, consider reaching out to knowledgeable legal experts like Ertl Lawyers, who can help you navigate your claim and protect your rights. Seeking the assistance you need may feel overwhelming right now, but it could be the key to improving your future.

Contact Ertl Lawyers today for a free case assessment.