Fibromyalgia Disability Benefits Canada | Comprehensive 2024 Guide

Living with fibromyalgia can make daily life and work incredibly challenging. If fibromyalgia symptoms are preventing you from maintaining your job, know that you’re not alone—and there is help available.

At Samfiru Tumarkin LLP, we specialize in navigating the complex disability benefits system in Canada. Our dedicated team is here to ensure you receive the support and benefits you’re entitled to, helping you regain stability in your personal and professional life.

1. What is Fibromyalgia?
2. Types of Fibromyalgia
3. Is Fibromyalgia a Disability in Canada?
4. Fibromyalgia Disability Benefits in Canada
7. How to Apply for Fibromyalgia Disability Benefits
8. Common Reasons for Denial of Fibromyalgia Disability Claims
9. What to Do If Your Fibromyalgia Disability Claim is Denied
10. FAQs
11. Expert Support for Your Fibromyalgia Claim

What is Fibromyalgia?

Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. The exact cause of fibromyalgia is unknown, but it is believed to involve a combination of genetic and environmental factors that lead to changes in the way the brain processes pain signals.

Symptoms of Fibromyalgia

Fibromyalgia affects each person differently, but there are several common symptoms that many individuals experience. Understanding these symptoms can help in managing the condition more effectively. Here are some of the most common symptoms:

Widespread Muscle Pain: Aching or burning sensations in muscles all over the body.
Fatigue: Persistent tiredness that doesn’t improve with rest or sleep.
Sleep Disturbances: Trouble falling asleep or staying asleep, leading to unrefreshing sleep.
Cognitive Difficulties: Problems with focus, memory, and concentration, often referred to as “fibro fog.”
Mood Disorders: Depression and anxiety are common among people with fibromyalgia, possibly due to chronic pain and fatigue.
Hyperalgesia: Increased sensitivity to pain, where mild pain feels more severe.
Allodynia: Feeling pain from things that don’t usually hurt, like a light touch or mild temperature change.
Neuropathic Pain: Sharp, shooting, or burning pain caused by nerve issues.
Temporomandibular Joint (TMJ) Disorders: Pain and problems with the jaw joint and muscles controlling jaw movement.
Headaches: Including tension headaches and migraines, which are common among people with fibromyalgia.
Abdominal Pain: Digestive issues like irritable bowel syndrome (IBS), leading to stomach cramps, bloating, and discomfort.

Recognizing these symptoms helps healthcare providers develop treatment plans that work best for you.

Who Does Fibromyalgia Affect?

Fibromyalgia can affect anyone, however it’s more common in middle-aged women. According to the Arthritis Society of Canada, fibromyalgia affects approximately 2% of Canadians.

Women: Women are more likely to develop fibromyalgia than men, with some estimates suggesting up to 80-90% of those diagnosed are female.
Men: While less common, men can also develop fibromyalgia and may be underdiagnosed due to misconceptions about the condition.
Children and Adolescents: Juvenile fibromyalgia can occur, leading to chronic pain and fatigue that affects schooling and social activities.
Older Adults: Symptoms may become more severe with age, affecting the elderly population’s quality of life.

What Causes Fibromyalgia?

The exact cause of fibromyalgia is unknown, but it likely involves a variety of factors working together:

Genetics: Fibromyalgia tends to run in families, suggesting a genetic predisposition.
Infections: Some illnesses appear to trigger or aggravate fibromyalgia.
Physical or Emotional Trauma: Post-traumatic stress disorder (PTSD) has been linked to fibromyalgia.
Stress: Prolonged stress may contribute to the development of fibromyalgia.

Types of Fibromyalgia

Fibromyalgia is generally recognized as a single condition, but symptoms and severity can vary widely among individuals. Some healthcare professionals discuss fibromyalgia in terms of different patterns or triggers to better tailor treatment plans. Understanding these variations can help you manage the condition more effectively. Here are some ways fibromyalgia may be described:

Primary Fibromyalgia: Occurs on its own without any underlying medical condition. It’s the most common form, characterized by widespread pain and typical fibromyalgia symptoms.
Secondary Fibromyalgia: Develops alongside another medical condition like lupus or rheumatoid arthritis. The underlying condition may influence symptoms and treatment approaches.
Localized Fibromyalgia: Symptoms are concentrated in specific areas of the body rather than being widespread. Even so, this form can significantly impact daily life.
Generalized Fibromyalgia: Involves widespread pain affecting multiple areas of the body, often accompanied by fatigue and cognitive difficulties.
Post-Traumatic Fibromyalgia: Symptoms develop after a physical injury or psychological trauma, suggesting that the event may have triggered the onset of fibromyalgia.

Understanding these different patterns can help you and your doctor create a treatment plan that works best for your specific situation.

Is Fibromyalgia a Disability in Canada?

Yes, fibromyalgia is recognized as a disability in Canada, particularly when it significantly impacts a person’s ability to function in daily life or perform their job.

Legal Recognition

Under the Canadian Human Rights Act, fibromyalgia is recognized as a disability, entitling individuals to protection from discrimination and access to reasonable workplace accommodations.

Employment Rights

Employers are required to accommodate workers with fibromyalgia, which may include adjustments to work schedules, duties, or environments.

However, eligibility for disability benefits isn’t based solely on having a diagnosis of fibromyalgia. To qualify for specific disability benefits, you must demonstrate that your condition severely impacts your ability to work and meets the criteria outlined in the benefit plan or program.

Fibromyalgia Disability Benefits in Canada

If fibromyalgia symptoms are preventing you from working, you may be eligible for various disability benefits:

Employment Insurance (EI) Sickness Benefits

EI sickness benefits provide up to 15 weeks of financial assistance if you’re unable to work for medical reasons. You must have worked the required number of insurable hours and provide a medical certificate confirming your inability to work.

Application: Submit an application online or at a Service Canada office as soon as you stop working.

Short-Term Disability (STD) Benefits

STD benefits provide financial support for a temporary period, typically up to 17 weeks, through an employer’s insurance plan.

Application: Obtain forms from your employer or insurer, and submit all required documentation promptly.

Long-Term Disability (LTD) Benefits

LTD benefits offer extended financial support if you’re unable to return to work after STD or EI benefits run out. It can last for several years, often until age 65 or until you’re able to return to work. You must meet your insurer’s definition of “totally disabled,” meaning you can’t perform your own job or any suitable employment based on your education, training, and experience.

Application: Requires detailed medical evidence and may involve assessments by the insurer.

Canada Pension Plan (CPP) Disability Benefits

Those with severe and prolonged fibromyalgia symptoms who are unable to work may qualify for Canada Pension Plan (CPP) disability benefits. Provided by the federal government, it offers long-term financial support to Canadians who have contributed to the CPP and are under the age of 65.

Application: Involves a detailed application and medical report submitted to Service Canada.

Disability Tax Credit (DTC)

Fibromyalgia can qualify for the Disability Tax Credit (DTC) in Canada if it severely impacts daily functioning. The DTC is a non-refundable tax credit that reduces the income tax you owe.

Application: Requires Form T2201 to be completed by you and your medical practitioner and submitted to the Canada Revenue Agency.

Provincial Disability Benefits

Each province offers its own disability assistance programs, which are generally based on financial need and the severity of your disability. They can include income support, health benefits, and employment support services.

Application: Process varies by province, typically involving an application form and medical assessment.

How to Apply for Fibromyalgia Disability Benefits

Applying for short-term or long-term disability benefits for fibromyalgia involves several critical steps:

1. Obtain a Formal Diagnosis

See a psychiatrist, psychologist, or other qualified healthcare provider to get an official fibromyalgia diagnosis. Ensure the assessment covers your medical history, symptom severity, and how symptoms affect your daily life.

2. Document Your Symptoms and Impact on Work

Record how fibromyalgia symptoms affect your ability to perform your job duties, through a journal or diary. Gather all relevant medical documents, including test results, treatment plans, and doctor’s notes.

3. Follow Prescribed Treatment Plans

Engage in all recommended therapies, whether medication, counseling, or behavioral strategies. Keep records of appointments, medications taken, and any side effects experienced.

4. Communicate with Your Employer

Discuss possible workplace accommodations that could help you perform your job. Keep a record of all communications with your employer regarding your condition and any accommodations provided.

5. Complete Application Forms Thoroughly

Provide comprehensive answers to all questions on the application forms. Double-check all information for accuracy before submission.

6. Submit Supporting Documentation

Attach medical records, letters from healthcare providers, and any other evidence that supports your claim. Make it easy for the reviewer to find and understand your documentation.

7. Meet All Deadlines

Be aware of all application deadlines for the specific benefits you’re applying for. Submit your application as soon as possible to avoid delays.

8. Follow Up on Your Application

Check the status of your application periodically. Provide any additional information requested by the benefit provider promptly.

9. Get Legal Advice

If you’re unsure about the process or face challenges, get invaluable professional guidance from our team.

Contact the fibromyalgia disability lawyers at Samfiru Tumarkin LLP for a FREE consultation if your STD or LTD claim is denied by the insurance company.

Our experienced legal team specializes in disability benefits. We can help you navigate the process and improve the chances of your claim for benefits being approved.

Further enhance your long-term disability claim. Watch this short video where we share three effective ways to make your application stronger:

Applying for disability benefits can be overwhelming, but taking it step by step can make the process more manageable. Remember, it’s okay to ask for help along the way.

Common Reasons for Denial of Fibromyalgia Disability Claims

Disability claims for fibromyalgia are often denied for the following reasons:

Insufficient Medical Evidence

Claims are frequently denied due to a lack of comprehensive medical documentation.

Solution: Provide detailed medical records, including diagnosis, treatment plans, and letters from healthcare providers explaining how fibromyalgia affects your ability to work.

Not Meeting the Definition of Disability

Each benefit program has specific criteria for what constitutes a “total disability.” This is a misleading term created by insurance companies. It simply means that your insurer believes you don’t meet the criteria for disability benefits, and that you are still capable of performing your job despite the impact of fibromyalgia.

Solution: Ensure you understand the criteria and clearly demonstrate how your condition meets these requirements in your application.

Non-Compliance with Treatment

Failing to follow prescribed treatments without a valid reason can lead to denial.

Solution: Follow and document all recommended treatments. If you can’t follow a treatment due to side effects or other issues, have your doctor note this in your records.

Pre-Existing Condition Exclusions

Some insurance policies exclude coverage for conditions that existed before the policy started.

Solution: Review your policy to understand any exclusions.

Incomplete or Inaccurate Applications

Errors or omissions in your application can result in denial.

Solution: Double-check all sections of your application for completeness and accuracy. Consider having someone else review it before submission.

Missed Deadlines

Failing to submit your application or required documents on time can automatically disqualify you.

Solution: Keep track of all deadlines and submit materials promptly.

These are some of the common reasons your insurer may give for denying your fibromyalgia disability claim. If your claim is denied for any reason, get a free consultation with a disability lawyer to learn how to get your benefits.

What to Do If Your Fibromyalgia Disability Claim is Denied

Receiving a denial for short-term or long-term disability can be discouraging, but it’s important to remember that you have options.

1. Review the Denial Letter Carefully

The letter should outline why your claim was denied. Knowing the specific reasons can help you address them effectively.

2. Gather Additional Evidence

Obtain recent evaluations or additional statements from your healthcare providers that address the denial reasons. If there were misunderstandings or missing information, provide explanations or additional documentation.

3. Consult a Disability Lawyer

Before filing an appeal, consult with an experienced disability lawyer at our firm who specializes in disability claims. Samfiru Tumarkin LLP can help you decide whether to appeal internally, file a lawsuit, or take other actions.

Watch this video to learn why hiring a disability lawyer can make a difference in your case:

4. Avoid Immediate Appeals Without Legal Guidance

Internal appeals are often handled by the same company that denied your short-term or long-term disability claim and may not be in your best interest. In fact, they are rarely successful. Insurers profit by denying you access to your disability benefits and keeping your money.

There are strict time limits for taking legal action, so it’s important to act promptly.

5. Continue Following Medical Advice

Keep attending appointments and following treatment plans. This shows ongoing commitment to managing your condition. Maintain records of all medical visits, treatments, and any correspondence related to your claim.

6. File a Legal Claim

If appropriate, your Samfiru Tumarkin LLP disability lawyer may advise taking legal action against the insurer to secure the benefits you’re entitled to. Legal processes are often the most effective way to achieve a positive outcome.

Facing a denial can be stressful, but with the right support and information, you can navigate this challenge more effectively. That is why it’s crucial to get the right legal advice before appealing your insurer’s decision. An experienced disability lawyer at Samfiru Tumarkin LLP can help you determine the best course of action.

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Frequently Asked Questions

Below are some frequently asked questions to help you understand more about the fibromyalgia disability benefits process. Find more answers in our full LTD FAQ section.

Is Fibromyalgia Considered a Disability in Canada?

Yes, fibromyalgia is recognized as a disability in Canada. Individuals with fibromyalgia may qualify for various disability benefits if the condition significantly impairs their ability to work or perform daily activities.

Is Fibromyalgia a Disability in Ontario?

Yes, fibromyalgia is recognized as a disability in Ontario. Individuals experiencing significant challenges due to fibromyalgia may be eligible for short-term and long-term disability benefits through private insurance or the Ontario Disability Support Program (ODSP). Both evaluate how fibromyalgia affects your daily functioning and ability to work to determine eligibility for assistance.

Is Fibromyalgia a Disability in Alberta?

Yes, in Alberta, fibromyalgia is recognized as a disability. Individuals who face significant difficulties due to fibromyalgia may qualify for short-term or long-term disability benefits through private insurance or the Assured Income for the Severely Handicapped (AISH) program. Eligibility is based on how much fibromyalgia interferes with your daily activities and ability to work.

Is Fibromyalgia a Disability in B.C.?

Yes, fibromyalgia is considered a disability in British Columbia. Those experiencing substantial challenges because of fibromyalgia might be eligible for short-term and long-term disability benefits via private insurance or the provincial Disability Assistance Program. Eligibility is determined by assessing how fibromyalgia impacts your everyday functioning and capacity to maintain employment.

Is Fibromyalgia a Permanent Disability?

Fibromyalgia is often considered a chronic condition that can persist throughout a person’s life. If it significantly impairs your ability to work or perform daily activities, it can be recognized as a permanent disability for the purposes of disability benefits in Canada. This designation depends on the severity of the condition and how it affects daily functioning.

How Long Does the Disability Benefits Application Process Take?

The timeline varies depending on the type of benefit and the completeness of your application. It can range from several weeks to a few months. Prompt submission of all required documents can help speed up the process.

Do I Need a Lawyer to Apply for Disability Benefits?

Yes. While you can apply on your own, consulting a disability lawyer at Samfiru Tumarkin LLP can significantly improve your chances of approval, especially if your case is complex or has been previously denied.

Are There Fibromyalgia Grants Available in Canada?

Yes, various grants and funding opportunities exist to support individuals with fibromyalgia, particularly for education and treatment. This includes the DTC, CPP Disability, the federal Home Buyers’ Plan, and provincial disability assistance programs.

What If My Employer Denies Accommodations for My Fibromyalgia?

Employers are legally required to provide reasonable accommodations, even if it is difficult or costly to do so. If they fail to accommodate, you may have grounds for wrongful dismissal and a human rights complaint. Contact us to explore your options in Ontario, Alberta or B.C.

Resources and Support

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You’re not alone in this journey.

Living with fibromyalgia can be challenging, and obtaining the disability benefits you’re entitled to shouldn’t add to your stress. At Samfiru Tumarkin LLP, we’re here to listen, support you, and advocate for your rights—ensuring you receive the compensation you’re entitled to.

Our compassionate team of experienced disability lawyers understands the complexities of fibromyalgia disability claims in Canada. Some of our lawyers have previously worked for insurers; we know how they think, why they deny certain disability claims, and how to successfully navigate the system on your behalf.

Samfiru Tumarkin LLP is a nationally recognized leader in insurance and disability law, dedicated to informing Canadians of their rights through:

The Disability Law Show on TV and radio
Insightful livestreams
Over 1,000 media interviews
Comprehensive resources, such as FAQs on long-term disability and guides on how to apply for different medical conditions.

We’re proud to have helped clients like you overcome these obstacles and obtain the benefits they needed. Here are some of their stories:

Sandra Bullock’s Triumph After $5.3M Legal Claim

Her long-term disability coverage was reinstated after we took legal action against Sun Life. Learn more.

Teacher Secures Six Figures in Disability Benefits

We successfully won compensation for Julie after she suffered a brain injury in a student assault. Follow her saga.

Nova Scotia Man Challenges Paralysis Claim Denial

Mitch’s insurer, SSQ, said he wasn’t “totally disabled” despite his spinal fracture. We took on his case.

Mother Battles Insurer While Daughter in Palliative Care

We helped Amanda after her insurer denied her mental health benefits. Discover her story.

Whether you’re struggling to get approved for benefits, appealing a denial, or dealing with a claim cut-off after two years, we’re here to assist you. Contact us today for a free consultation and find out how we can support you through the process and protect your rights. Our services extend across all Canadian provinces, excluding Quebec.

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