Medical Evidence necessary to Prove your Disability Claim

Posted by Stevenson Whelton MacDonald & Swan
August 01, 2019

Your doctor needs to support you in the understanding that you cannot work due to the seriousness of your symptoms

To make a successful claim for disability benefits, you must first have sought medical treatment for your injury or illness.  And, your doctor must support you and be willing to provide opinion evidence stating that they believe that your medical condition prevents you from being able to do your job.  If your current physician initially does not take your symptoms seriously, you need to convince them that your symptoms are real and disabling, because your disability insurer is unlikely to find your disability claim credible if your own doctor doesn’t provide compelling evidence of your disability.  However, if you have an unempathetic doctor who refuses to understand or believe the disabling effects of your condition, you need to get a second opinion from a doctor who is better informed.

When to seek medical treatment from a specialist

Your family doctor can diagnose and treat some medical problems, but cannot properly assess or treat all types of injury and illness.  Consequently, for many medical conditions, your disability insurance provider will expect that if you are genuinely suffering from a particular condition, you will have taken steps to get proper and informed treatment from a doctor or medical profession who specializes in your condition.  Seeing a specialist indicates that you are genuinely suffering and want to get well.  Also, the medical opinion of a specialist carries more weight with your disability insurance provider.

For some conditions, your insurer will only approve a disability claim if you are being treated by a medical specialist who is trained to accurately diagnose and treat your condition, such as a neurologist, rheumatologist or psychiatrist.  This is particularly true if you are suffering from a mental or psychological condition that prevents you from working effectively.  Mental health disorders, such as depression, anxiety and PTSD are ‘invisible conditions’ which cannot be proven through an objective medical test such as a CT scan or blood test.  And, although there is undeniable evidence showing that mental illness effects many Canadians, insurance companies are in the business of making money and are motivated to deny disability claims that are not backed up by knowledgeable medical opinion from a mental health professional, such as a psychiatrist or psychologist.

Chronic pain is another condition that can be hugely disabling and is difficult to measure in an objective medical test.  If you cannot work due to chronic pain or another condition that has invisible symptoms, it’s important to keep a diary or journal of your symptoms and how they effected you and/or prevented you from functioning in a particular task.  You may also consider asking a close family member who is able to observe you regularly to also keep a journal and record when they observe an adverse effect due to your condition. Finally, you need to schedule regular visits with your doctor and be forthcoming about your symptoms and how they effect you, and let your doctor know if your condition is worsening over time.

Medical Evidence is Essential

Medical evidence is crucial in proving your disability and making a successful claim. One of the most common reasons for rejecting an application for disability benefits is that the applicant did not provide sufficient medical evidence.

If you have a condition that can be established in an objective medical test, such as X-rays or an MRI, your doctor needs to include the results of these tests.  Clinicians have also developed tests, based on common or defining symptoms, that help identify whether someone is suffering from a brain injury, PTSD, depression and other conditions that are not necessarily measurable in a standard medical test.  Although these tests may not be conclusive proof that your condition prevents you from working, they are very important evidence to support your claim.

Also, ensure that you and your doctors have fully answered all of the questions on your application.  You not only need to provide a description of your symptoms, your doctor also needs to supply details showing how your symptoms prevent you from performing the essential tasks of your job.  For example, if you are suffering from chronic pain and cannot sit or stand for more than half an hour at a time, you are unlikely going to be able to perform any type of work that requires you to stand or sit for a long time.    Also, make sure that the information you provide is honest and consistent.

To summarize, your medical information must include the following:

  • Your specific symptoms, their severity and duration
  • Specific activities that are negatively affected by your symptoms
  • How are these activities affected:  does your impairment limit how long you can perform an activity, or are you entirely prevented from performing the activity?
  • Include how both home and work activities are affected by your disability
  • Medical tests and assessments to substantiate that you are disabled
  • Your doctor’s treatment plan for controlling or improving your condition

Be careful what you post on Social Media

Insurance companies often check Facebook, Instagram and other social media sites to determine whether an applicant for disability benefits has posted information that conflicts with their claim.   If you are claiming that you are too sick to work but, at the same time, are posting photos of yourself partaking in physical activities or posting comments about what a good time you’re having, you are providing your disability insurer with grounds to deny your claim on the basis that your social media posts indicate you’re in good health.

If your disability claim was denied or you wish to get help with your disability claim application, talk to an experienced disability claim lawyer at  Stevenson Whelton MacDonald & Swan.

Disclaimer: Our blog is intended to inform our existing and prospective clients about topics pertinent to their lives. While our goal is to provide accurate and factual information, this in no way should be taken as legal advice or applied to specific cases. It is in your best interest to contact a licenced and practising lawyer for legal representation, as matters of the law are often complicated and cannot be fully assessed without knowing all of the details of a case.