Long-term disability claims for pain conditions have always been at high risk of being denied or terminated by insurance companies. Pain conditions are the classic invisible disability. They are difficult to diagnose; difficult to determine their severity because symptoms are subjective; difficult to treat, assuming there is even treatment for the condition; and the prognosis for recovery from many pain conditions is often unknown or poor.

It’s impossible for anyone to know the pain you are experiencing.

At Mulqueen Disability Law, Courtney Mulqueen has over 20 years of experience litigating pain-related LTD claims, with nearly all of those having a related mental illness (such as depression, anxiety, panic, and PTSD) which adds a layer of complexity to the claims.

Common pain conditions & LTD denials

Some of the pain conditions that are commonly denied LTD benefits include:

• Fibromyalgia
• Chronic fatigue syndrome
• Chronic back pain
• Chronic headaches/migraines
• Arthritis
• Complex regional pain syndrome
• Neuropathic pain
• Endometriosis
• Inflammatory bowel disease
• Multiple sclerosis
• HIV/AIDS-related pain
• Sickle cell anemia
• Cancer pain
• Carpal tunnel syndrome
• Trigeminal neuralgia

Insurance companies often apply a “one-size-fits-all” approach to assessing disability. Requiring “objective” evidence to prove LTD claims for pain conditions is like forcing a round peg into a square hole. The insurance company may tell you that they require “medical evidence” to approve claims and when it is provided in the form of doctor and specialist reports diagnosing very real pain conditions, they will deny these claims based on “non-medical evidence” (like a person’s daily activities on a “good day”). This leaves our clients and their doctors shocked by how the insurance company could have reached its decision to deny the claim.

Insurance companies will support their denial on the basis that they do not have sufficient evidence to support a severe condition. They may go so far as to say that our client is not disabled because it is not severe based on factors such as they are not seeing a rheumatologist (long waitlist); not taking medication (for various valid reasons); not seeing a psychotherapist or a physiotherapist (too expensive/not recommended); not hospitalized (not necessary for LTD benefits); or because they are able to go grocery shopping; take care of their children or parents; do their taxes; spend time with family and friends; or workout (not considering the variable nature of these conditions – good days and bad days).

The complex relationship between pain, fatigue & mental illness

LTD claims for pain conditions are often complicated by other conditions like chronic fatigue and mental illness. Fatigue and mental illness are also invisible disabilities and equally difficult to prove to LTD insurance companies. When clients with pain conditions have fatigue and mental illness (which is often the case), the interplay between pain, fatigue, and psychological conditions is often ignored or not considered by the insurance company.

Mulqueen Disability Law understands that the longer you go without an income, the worse your mental health conditions will become. We will sue the insurance company for emotional and financial distress damages. We will also discuss how you will support yourself and your family through the litigation process and provide you with options for other disability benefits and help apply for those. Our guides provide additional information about other benefits you may be entitled to.

Insurance companies won’t give you the “benefit of the doubt”.

We know that no one chooses not to work and instead, spend their time going to medical appointments, live with a reduced income or without an income, and fight with an insurance company for benefits to which they are entitled. Unfortunately, insurance companies do not tend to give people the benefit of the doubt. Even our most credible clients, with the most supportive doctors, specialists and treatment providers, are left wondering how it is possible that the insurance company could deny their LTD claim.

Insurance companies will go so far as to deny our clients’ LTD claims on the basis that our clients are “self-limiting”; suggesting that the pain is all in their heads or that they are choosing not to be active or work and that there is no “objective” reason that they are not able to work. They will also say that working is not “contraindicated” (meaning work would not cause our client’s condition to worsen) and that activity is the appropriate treatment and therefore, our client can and should work. This totally ignores the reality of being limited by pain, fatigue, depression and anxiety–which, taken together, make it impossible for our clients to work.

Mulqueen Disability Law holds insurance companies accountable for chronic pain-based LTD denials.

Proving a pain condition LTD claim to an insurance company is not only challenging, but it can also cause our clients serious harm and set them back in their recovery. Clients with pain also typically suffer fatigue and mental illness as well – often due to living with constant pain. They will tell us that, had the insurance company paid their LTD benefits, they might have been able to return to work. Instead, the way the insurance company has treated them and by denying them benefits, their mental health condition has worsened and caused a worsening in their pain and fatigue conditions, to the extent that returning to work is now not even on their radar.

When they mismanage our clients’ LTD claims, insurance companies cause our clients harm and set them back in their recovery.

We will argue that our clients’ insurance companies have not fulfilled their duty of good faith to our clients. That they have mischaracterized (cherry-picked) medical evidence and self-reported evidence; ignored relevant evidence; and relied on irrelevant evidence to construct a basis for denying our clients’ claims. In the process, they have caused our clients serious emotional and financial distress.

Providing compassionate, trauma-informed LTD legal services in Ontario

We provide trauma-informed legal services and our team is certified in Psychological First Aid. We are not mental health treatment providers, but we do know how to provide legal services to our clients who have mental illnesses to ensure that we will not cause them more harm.

We’ve learned that insurance companies are required to accommodate their clients for disabilities pursuant to Canadian laws, but they are not required to provide trauma-informed services. In many case for pain, fatigue and mental illness disabilities, our clients tell us that their LTD case manager was rude, bullied them, ignored what they said, or mischaracterized what they said to later use against them to deny their claims. Sometimes our clients say that they are not able to reach their case managers and that the delays in assessing their claims are extreme and result in long periods of no communication and no income, causing increased anxiety and panic and aggravating their pain conditions.

It’s lonely living in constant pain. We can help.

The entire process of applying, appealing and having to continually prove a mental illness LTD claim can cause serious emotional distress. Then when an LTD claim for pain and mental illness is denied, the financial stressors will further aggravate our clients’ conditions. It becomes too much to bear. Some of our clients have become suicidal as a result. We take these claims extremely seriously.

At Mulqueen Disability Law, we are protective of our clients throughout the litigation. We aggressively pursue damages claims against these insurance companies. We fight for our clients because they can’t fight for themselves. We protect them because no one else has.

You should never be made to feel like you are lying, exaggerating or malingering.

Never.

Contact Mulqueen Disability Law in Markham & Toronto for trusted, skilled advice on chronic pain LTD conditions

Courtney Mulqueen, the founding partner of Mulqueen Disability Law, has resolved thousands of LTD claims for pain. She knows the law and legal strategy and uses her skills and experience to successfully argue these cases. She also knows how to ensure that her clients are protected in the process so as not to aggravate her clients’ conditions. Further, all members of the Mulqueen Disability Law team are required to be certified in Trauma-Informed Practice and Mental Health First Aid, to ensure that we do not accidentally cause further harm to our clients.

With locations in Markham and Toronto, Mulqueen Disability Law advocates for disabled clients throughout Ontario, particularly those struggling with invisible disabilities such as mental illness and chronic pain. For clients who have difficulty meeting us in person, we are able to provide our services virtually. To discuss your LTD matter with a member of our attentive team, please contact us online or by phone at 416-900-0368 (or toll-free at 833-363-3LAW [3529]).