Living with complex regional pain can make daily life and work incredibly challenging. If complex regional pain 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.

Table of Contents

What is Complex Regional Pain?

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that typically affects a limb after an injury, surgery, stroke or heart attack. The pain is out of proportion to the severity of the initial injury and can spread beyond the affected area. CRPS is recognized as a disabling condition that can deeply impact your daily life.

Symptoms of Complex Regional Pain

Complex Regional Pain presents with a variety of symptoms that may worsen over time. Recognizing these can help you seek appropriate medical treatment:

  • Severe Pain: Continuous burning or throbbing pain, usually in your arm, leg, hand, or foot.
  • Swelling: Ongoing swelling in the affected limb, which may change over time.
  • Temperature Changes: The affected area may feel warmer or colder compared to the rest of your body.
  • Skin Sensitivity: Increased sensitivity to touch, cold, or light pressure, leading to intense discomfort (allodynia).
  • Limited Mobility: Stiffness and limited range of motion in the affected limb, making daily activities difficult.
  • Changes in Skin Texture: Skin in the affected area may become thin or shiny.
  • Abnormal Hair and Nail Growth: Rapid hair and nail growth in the affected area.
  • Mood Disorders: CRPS can cause or worsen anxiety, stress, and depression, and lead to post-traumatic stress disorder (PTSD).

Understanding these symptoms can guide your healthcare provider in developing a tailored treatment plan.

Who Does Complex Regional Pain Affect?

Complex Regional Pain Syndrome can affect anyone, but certain groups may be more susceptible. It typically occurs after trauma to a limb, and affects more than 9,000 people annually in the Canada alone. It can impact:

  • Adults: More common in individuals between 40-60 years old, but it can affect people of any age.
  • Women: CRPS is 3 to 4 times more common in women than man.
  • Individuals with Traumatic Injuries: Those who have suffered fractures, sprains, or surgeries are at higher risk.
  • People with Nerve Damage: Nerve-related injuries can increase the likelihood of developing CRPS.

What Causes Complex Regional Pain?

While the exact cause of complex regional pain is not well understood, it is often triggered by an injury or trauma. Here are some common causes:

  • Injuries: Even minor injuries, like sprains or fractures, can lead to CRPS.
  • Nerve Damage: Damage to nerve fibers during an injury can result in long-lasting pain.
  • Surgery: Some individuals develop CRPS following surgical procedures on a limb.
  • Inflammation: Inflammatory processes in the body may contribute to the development of CRPS.
  • Immune Response: Some researchers suggest that CRPS may be linked to an abnormal immune response.

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Types of Complex Regional Pain

Complex Regional Pain Syndrome is generally categorized into two types, depending on whether nerve damage is involved. Understanding these types can help with diagnosis and treatment:

  • Type 1 (Reflex Sympathetic Dystrophy): Occurs without confirmed nerve injury and is the more common form.
  • Type 2 (Causalgia): Occurs after a known nerve injury and often presents with more intense pain.

Identifying the specific type of CRPS is crucial for determining the most effective treatment approach.

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Is Complex Regional Pain Syndrome a Disability in Canada?

Yes, CRPS 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, CRPS 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 complex regional pain, which may include adjustments to work schedules, duties, or environments.

However, eligibility for disability benefits isn’t based solely on having a diagnosis of CRPS. 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.

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Complex Regional Pain Disability Benefits in Canada

If CRPS 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, if you’re unable to work due to complex regional pain. These benefits are available through an employer’s group insurance plan or a private policy.

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

Long-Term Disability (LTD) Benefits

If you have Complex Regional Pain Syndrome, you may qualify for LTD benefits. CRPS can cause severe pain and mobility issues, making it impossible to work. LTD benefits offer financial support that last until age 65 or until you’re able to return to work. To qualify, you must meet the insurer’s definition of “totally disabled,” meaning you’re unable to perform your job or any suitable employment.

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

Canada Pension Plan (CPP) Disability Benefits

Those with severe and prolonged complex regional pain 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)

Complex regional pain 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.

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How to Apply for Complex Regional Pain Disability Benefits

Applying for short-term or long-term disability benefits for Complex Regional Pain Syndrome involves several critical steps:

1. Obtain a Formal Diagnosis

See a psychiatrist, psychologist, or other qualified healthcare provider to get an official complex regional pain 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 complex regional pain 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 complex regional pain 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.


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Common Reasons for Denial of Complex Regional Pain Disability Claims

Disability claims for complex regional pain 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 complex regional pain 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 complex regional pain.

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 complex regional pain 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.


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What to Do If Your Complex Regional Pain 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 complex regional pain disability benefits process. Find more answers in our full LTD FAQ section.

Is Complex Regional Pain Considered a Disability in Canada?

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

Is Complex Regional Pain a Disability in Ontario?

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

Is Complex Regional Pain a Disability in Alberta?

Yes, in Alberta, complex regional pain is recognized as a disability. Individuals who face significant difficulties due to CRPS 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 complex regional pain interferes with your daily activities and ability to work.

Is Complex Regional Pain a Disability in B.C.?

Yes, complex regional pain is considered a disability in British Columbia. Those experiencing substantial challenges because of complex regional pain 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 CRPS impacts your everyday functioning and capacity to maintain employment.

Is Complex Regional Pain a Permanent Disability?

CRPS 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 Complex Regional Pain Grants Available in Canada?

Yes, various grants and funding opportunities exist to support individuals with complex regional pain in Canada, particularly for education, treatment, and daily living expenses. These include the Disability Tax Credit (DTC), Canada Pension Plan (CPP) Disability benefits, and provincial disability assistance programs.

What If My Employer Denies Accommodations for My Complex Regional Pain?

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 complex regional pain 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 complex regional pain 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:

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

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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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Our team of experienced disability lawyers can help individuals in all provinces (excluding Quebec) when their insurance company denies their complex regional pain claim or their CPP Disability benefits are denied.

Whether you’re dealing with major insurers like Manulife, Sun Life, or any other provider, we have the expertise to assist you. See our comprehensive list of long-term disability insurance companies in Canada to learn more about how we can help with your specific insurer.

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