Have your Long Term Disability Benefits been denied for Epilepsy?
Epilepsy can be a debilitating, disabling condition that impairs your ability to work; if your epilepsy has made it difficult or impossible to continue working, you may be eligible to file a claim for long-term disability benefits for epilepsy.
While epilepsy can be treated with anti-seizure medication, treatment does not always work, and many individuals find themselves suffering life-long consequences and constant fear about their next seizure. According to the Canadian Epilepsy Alliance, approximately 260,000 Canadians are living with epilepsy, with a prevalence of 7 in 1,000 people across the country. Many of those Canadians are unable to work due to their condition.
Matt Lalande is a Hamilton disability lawyer who has been practicing law in Ontario since 2003. He has litigated against every major disability insurance carrier in Canada and has helped claimants across the province who have been totally disabled for a variety of injuries, illnesses, and conditions. If you suffer form serious symptoms of epilepsy, you may in fact have a valid claim for long-term disability benefits. If you have been denied or cut off your long-term disability benefits – you should get the help of an experienced Hamilton epilepsy disability lawyer without delay to help you recover the benefits that you are rightfully owed.
Epilepsy is an umbrella term for a spectrum disorder that covers a variety of conditions that range from moderate and manageable to severe and disabling. It is an episodic condition, sometimes associated with other chronic illnesses or conditions, wherein the individual experiences unprovoked recurring seizures.
Anyone could experience a seizure for a variety of reasons, but if you experience seizures more than once, or on a regular basis, you may be diagnosed with epilepsy. Usually it takes a minimum of two seizures for a diagnosis of epilepsy to be considered.
As an episodic condition, the effects and symptoms of epilepsy may come and go within an individual’s day to day life. Someone with epilepsy may have a seizure as little as once a year or as frequently as multiple seizures per day. Further, some people have epileptic “triggers” that may induce a seizure, such as flashing lights, alcohol use, lack of sleep, or low blood pressure.
The primary treatment for epilepsy is anti-seizure medication, but in some cases surgery may also be recommended or required. Some forms of epilepsy are drug resistant, a classification that is typically reached if the individual goes through two trials of anti-seizure medications without any reduction in seizure frequency. Surgery, nerve stimulation, and diet management are therapies that are often used as an alternative to medication. Epilepsy surgery usually involves removing the part of the brain that is causing the seizures, or where damage has occurred.
Epileptic seizures are caused by disruptive brain activity or sudden abnormal bursts of energy in the brain, and the most common cause is brain damage or neurological damage. Other causes of epilepsy that have been identified include:
While these are some of the potential causes of epilepsy, many individuals may be diagnosed with epilepsy in their lifetime without any indication of a specific cause. In fact, the majority of people with epilepsy in Canada do not know the cause – according to Statistics Canada, 64% of epileptic Canadians report epilepsy as their only neurological condition, and there are 20,000 people in Ontario alone living with “medically untraceable” epilepsy.
A seizure occurs when the brain experiences a sudden burst of energy or a disturbance in communication within the brain cells. People with epilepsy can experience different types of seizures depending on the type of epilepsy they have and the area of the brain where the condition occurs, but each individual person experiences the same type of seizure each time.
Seizures are broken down into multiple categories based on the symptoms associated with each episode. The types of seizures and their associated symptoms include:
Most epileptic seizures last anywhere from a few seconds to a few minutes at a time. If a seizure lasts for longer than a few minutes, or multiple seizures occur in a row, this is known as status epilepticus and requires immediate medical attention.
Another significant risk for those with epilepsy is sudden unexpected death in epilepsy (SUDEP). This may occur during a seizure, for example if the individual has a seizure while alone and comes into contact with something dangerous, or as a result of the condition that caused the epilepsy (such as brain damage or stroke). In very rare cases, an individual may die during a seizure with no apparent cause.
In addition to functional impairment during an episode, epilepsy and seizure disorders can leave an individual with long-lasting symptoms that can dismantle or limit their ability to work. These long-term symptoms can be caused either by epilepsy itself, or by the anti-epileptic medication that is often prescribed to control seizure frequency.
Some long-term symptoms of epilepsy include:
Aside from physical and functional long-term symptoms, epileptic individuals often experience higher rates of psychological conditions, such as severe anxiety, due to the fact that a seizure may occur at any moment. Living in constant fear that you may suffer a seizure at any moment, especially during a moment where you may be in a compromised position such as operating machinery, can prevent you from obtaining any peace of mind. Without peace of mind, it’s difficult to concentrate on tasks, perform daily functions safely or efficiently, or even feel satisfied in day-to-day relationships or social interactions.
A national survey titled The Impact of Epilepsy on Canadians was conducted in 2012 to offer an in-depth look at the daily struggles and challenges epileptic Canadians face. Respondents identified the following as the largest obstacles and challenges they face that limit their lives:
People who suffer from epilepsy may no doubt face a number of complex and interacting issues in maintaining employment. Stigma, seizure occurrence and severity, as well as psychosocial variables such as low self-esteem, inadequate coping style, and low self-efficacy have been implicated as factors that play an important role in maintaining employment.
Also, even though the risk of seizures at work may be considered quite low, when they do happen, the risk of accidental injury can be severe. For example, particular trades, such as HVAC, plumbing and electrical, with employees who work at consistent heights may no doubt be at risk for severe injury due to seizures at work. There are certain types of jobs that can be considered high risk and suffering severe seizure symptoms can no doubt interfere with a person’s ability to work.
Also, if you work in a service field such as police or paramedic, or in field where you are required to operate machinery, having a seizure at the wrong time could have potentially fatal consequences. Likewise, memory and cognitive impairment can make any type of task in any field much more complicated, leading to lost production and crucial errors.
Also, what happens to individuals who need to be on the road – but lose their driver’s licence? Ontario is governed by the Ontario Highway Traffic Act, which requires physicians to report medical conditions that could impair driving to the Ministry of Transportation. If you are diagnosed with severe epilepsy, you may have your license suspended unless you can meet certain conditions (such as being free from seizures for at least six months). Not being able to drive can be very limiting when it comes to employment opportunities or job functions, especially for those who are required to drive for work or who live in areas without access to reliable public transportation or ride-sharing services.
The answer is, that it depends on the extent of your disability and the language of your disability policy. In short, the essence of a policy of disability insurance is for a disability insurance company to pay a monthly benefit to an insured person that is hurt or suffers a chronic condition, assuming that the person meets their applicable policy definition of a total disability.
Most, if not all disability policies are very carefully constructed. Total disability, in the context of disability insurance, normally has two meanings. Within the first 24 months of benefit payments, an claimant must be unable to complete the important or substantial duties of his or her own job, even though he or she may be capable of performing another occupation. This is commonly referred to as the “own occupation” provision. After 24 months, there is a change of definition. At this point, a total disability will usually be defined as a disability that prevents a person from engaging in any occupation for which he or she is reasonably suited by way of education, training or experience. The availability of jobs do not matter – is whether or not you can complete the duties of any job in relation to your education, training or experience.
If your symptoms are so severe and you often have seizures, and your policy definition is fairly standard, then you would be entitled to apply for long-term disability benefits if your seizures prevent you from working.
As there are many other conditions or factors that may cause an individual to experience one or more seizures, epilepsy can sometimes be misdiagnosed or incorrectly diagnosed. Additionally, as there is not always a direct identifiable cause of epilepsy, it’s difficult to obtain the right diagnosis without extensive scanning and testing. If the epilepsy is associated with brain damage, injury, or illness, imaging such as EEGs and MRIs can sometimes detect the issue. A clear, proper diagnosis by your doctor or medical specialist is an essential component of your long-term disability application or claim as it is the most important piece of evidence you’ll need to prove you’re totally disabled and cannot work.
If you have an epilepsy specialist team, or are being treated by a neurologist, make sure you are attending regular appointments as part of your treatment plan. Attending regular treatment sessions and following your plan is an important factor your insurance carrier will analyze. If you are not undergoing treatment, your insurance carrier may make the claim that you are not working out of choice and may go as far as sending surveillance teams to “catch” you contradicting your medical claims.
Insurance carriers also attempt to claim you are not totally disabled by sending their own team of doctors or specialists to examine you, who will more often than not argue that they found you in good health and that you are not disabled. These are often doctors who have never met you before, and who will attempt to dismiss the conclusions made by your own specialist or health care practitioner that has actually been working with you since your initial diagnosis.
These are just some of the many reasons why it is imperative that you work with a Hamilton disability lawyer to structure a claim that will prove beyond a doubt that you are, indeed, totally disabled. Our strategy includes a multidimensional approach based on years of experience in litigation and trial, with our own defense of specialists, professionals, and doctors to strengthen your defence.
Fortunately, if your long-term disability benefits for epilepsy are denied or cut off, you still have options.
In some cases, an insurance carrier may offer you the option to appeal internally when you receive a denial letter in the mail. This is usually not the best option to take, as you will still be required to go up against the same corporate team your insurance carrier used to deny your application in the first place. Instead, you have the right to hire your own disability lawyer and pursue your disability insurance company for wrongfully denied disability benefits.
Appealing a disability claim decision is a complex, tedious, and exhausting process. It should not be attempted alone. Often, a denial letter will include a series of complex legal terms and jargon that anyone who is not a legal professional would likely not understand. This may seem intimidating and discouraging when you are already facing the frustration of your own insurance carrier working against you.
The best decision you can make is hiring a disability lawyer who has significant experience recovering lost benefits or denied benefits claims against all of the major insurance carriers in Canada. Book a free consultation with us and we will give you more information about your rights, and advise you on the best course of action for your situation.
Our disability lawyer firm’s main office is located in Hamilton, but we serve claimants across Ontario. We have offices in Burlington and Sudbury, but have worked with disabled claimants throughout many cities, towns, and districts throughout the province.
If you are not comfortable coming to one of our offices, we are more than happy to offer your consultation virtually over Zoom or Google Meet, or over the phone. With our longstanding experience in disability law, we are usually able to make a determination as to whether or not you have a case after one conversation. If you don’t have a case, or decide you do not want to pursue your claim, you will not be charged.
After we determine that you do have a case, we will need to meet with you in person. However, we can do so at your convenience. If you are unable to travel to meet with us, we can come to meet you where you are comfortable.
Calling a Hamilton disability lawyer and discussing your situation can be intimidating, and we understand why it would be – most people do not typically need to speak to a lawyer unless they are undergoing serious circumstances. However, we strive to be as approachable, helpful, and transparent as possible and are dedicated to supporting you in every step of your claim.
We welcome you to contact us with any questions or concerns you may have about your situation and the possibility of an appeal. Matt Lalande has recovered millions of dollars in lost disability benefits payments for claimants across the province, and is a victim-focused disability lawyer. We never represent insurance companies, and we operate on a contingency basis, which means we don’t get paid until you win your case. Consultations are always free, with no obligation to work with us if you change your mind.
Call us today no matter where you are in Ontario at 1-844-LALANDE or local in the Hamilton/GTA/Niaragra area at 905-333-8888 to tell us about your case and determine your options. You can also request a call back through our online contact form if you prefer. The longer you wait to get in touch with us, the longer you will need to go without necessary financial support, so don’t delay in getting your benefits back on track.