Disability benefits may be available if Complex Regional Pain Syndrome is causing severe, ongoing pain and other symptoms that prevent you from working. CRPS is a chronic, progressive neurological condition that can cause continuous burning or throbbing pain, weakness, swelling, muscle spasms and other debilitating symptoms. While some people are able to work when their symptoms are well managed, a flare-up or worsening of the condition can make working difficult or impossible.
If you have been diagnosed with CRPS and are trying to understand whether you qualify for long-term disability benefits, this guide explains how CRPS may be treated as a disability, what insurers look for when assessing eligibility, why these claims can be hard to prove, what treatment and medical evidence can support an application, and what to do if your claim is denied. Because CRPS symptoms can fluctuate and may be difficult to objectively measure, proper medical documentation is particularly important. If your condition is preventing you from working, understanding your rights, your coverage, and the disability claims process can help you protect your entitlement to benefits and secure financial support while you focus on treatment.
Quick overview (TL;DR:)
CRPS disability benefits may be available when Complex Regional Pain Syndrome causes symptoms that prevent you from working. Although people with CRPS may be able to work when their symptoms are well managed, severe pain, weakness, tremors, swelling, muscle spasms and other symptoms can make working difficult or impossible.
A CRPS disability claim should clearly explain not only the diagnosis, but how the condition affects your ability to perform your job. If your disability claim has been denied, a disability lawyer can review your insurance policy, medical evidence and the insurer’s reasons for denial and advise you about your options.
What is complex regional pain syndrome (CRPS)
Complex Regional Pain Syndrome (“CRPS”) is a chronic, progressive neurological condition that typically develops after an injury, surgery or other trauma like a broken bone, and causes pain that is often more severe and prolonged than would normally be expected for the injury/surgery.
CRPS most often affects an arm, leg, hand, or foot.
CRPS symptoms include:
- severe, continuous burning or throbbing pain
- muscle spams
- weakness
- tremors
- persistent swelling
- changes in skin temperature of colour
- reduced movement
There is no cure for the condition and treatment is aimed to relieve pain, manage symptoms and improve or restore function.
What are the two types of CRPS?
There are two recognized types of CRPS:
CRPS Type 1 occurs without a clear nerve injury (it was previously known as reflex sympathetic dystrophy)
CRPS Type 2 occurs where there is a confirmed nerve injury.
Both types can cause significant pain and functional limitations. For the purposes of a disability claim, the important issue is generally how the condition affects your ability to function and work.
Is CRPS a disability?
Yes, CRPS can qualify as a disability in Canada if you are experiencing debilitating symptoms impacting your ability to perform the essential duties of your job or otherwise meet the definition of disability in your insurance policy. It can be a debilitating condition that significantly limits work capacity.
CRPS affects people differently. Some individuals may be able to continue working when their symptoms are controlled, while others may experience severe pain and physical limitations that make working impossible.
The severity of your symptoms can also change over time.
For a CRPS disability claim, the focus should therefore be on your current symptoms and functional limitations, rather than the diagnosis alone. No specific pain level automatically guarantees disability benefits; the key issue is how your symptoms affect your ability to function.
How does CRPS affect eligibility for long term disability benefits?
CRPS is a complicated diagnosis. If your CRPS symptoms have changed and you are no longer able to work, you may qualify for long-term disability benefits. When the symptoms prevent you from performing the duties of your occupation, subject to the terms and definition of disability in your insurance policy.
Why can CRPS disability claims be difficult to prove?
CRPS disability claims can be challenging because pain and other symptoms may be difficult to objectively measure, even when they have a significant impact on a person’s ability to work.
Due to the complexity of the condition, insurer representatives may struggle to understand the debilitating effects associated with your symptomology. They may have difficulty understanding the extent to which CRPS affects a claimant’s functional capacity, particularly when the claimant’s symptoms fluctuate or when there is limited objective evidence that demonstrates the severity of the pain. This gap in understanding unfortunately can cause legitimate claims to be denied.
This makes detailed medical documentation especially important.
Your medical records should explain:
- Your symptoms
- The severity and frequency of your pain
- How your symptoms have changed
- Your treatment history
- Your response to treatment
- Your physical limitations
- Your cognitive or psychological symptoms, where applicable
- How your symptoms affect your ability to perform your specific job duties
A diagnosis of CRPS is important, but the insurance company also wants objective evidence explaining why the condition prevents you from working. Doctors may also use tests to rule out other conditions with symptoms similar to CRPS.
What treatment is available for CRPS?
Treatment for CRPS is generally focused on reducing pain, improving movement and function, and helping the individual manage the condition. There are multiple levels of treatment for CRPS. The type of treatment intervention depends on the recommendations of your medical provider.
Treatment may include:
- Medications (like steroids or anti-inflammatory prescriptions)
- Physical or occupational therapy
- Procedures
- Surgery
- Movement and rehabilitation
- Emotional or psychological support (pain psychology)
Some people also receive nerve blocks, including a sympathetic nerve block, as part of pain management to reduce pain and improve movement.
For selected patients, advanced options may include spinal cord stimulation, which uses electrical signals and may involve minor surgery, as well as dorsal root ganglion stimulation.
Rehabilitation supports can also include graded motor imagery and, where swelling is significant, compression stockings for the affected limb.
The fact that someone is receiving treatment does not necessarily mean that they can work. In some cases, treatment may be ongoing precisely because symptoms remain severe or disabling.
How do you apply for disability benefits for CRPS?
People diagnosed with CRPS have managed to work if the symptoms are properly medically managed. However, if the condition has a prolonged flare up or a negative development to the symptoms, working can become difficult and feel impossible. This is when it is important to have the appropriate disability coverage to ensure you’re financially covered so you can focus on treatment and improving the symptoms. Early treatment and following your doctor’s advice can also matter not only for symptom management, but for creating a clear medical record from the outset.
If you have disability coverage through your employer’s group benefits plan, you can submit a claim. You’re required to fill out three forms to get the process started:
- Plan Member Statement:
A form filled out by you, that provides information on your condition, employment and disability.
- Attending Physician Statement:
A form filled out by your doctor, providing medical information about your diagnosis, symptoms, treatment and functional limitations.
- Plan Sponsor Statement:
A form filled out by your employer, that provides information about your employment and benefits coverage.
Once you’ve submitted the completed forms, the ball is in the insurer’s court to approve or deny your claim.
Why your CRPS disability claim may be denied?
CRPS is a complicated condition to understand. Most case managers or the insurance company may not have the knowledge or experience to evaluate or assess your condition appropriately resulting in the denial of a legitimate claim.
The insurer concludes that the medical evidence does not establish that your symptoms prevent you from working or that you do not meet the definition of disability in the policy.
Because CRPS can be complex and symptoms such as pain can be difficult to measure objectively, insurers may question the severity or functional impact of the condition.
A denial does not mean that your claim is not legitimate.
The insurer’s decision should be reviewed alongside:
- The wording of your disability policy
- Your physician’s reports
- Your treatment history
- Your occupational duties
- Any independent medical or vocational assessments
- The specific reasons given for the denial
Key takeaways
- CRPS is a chronic pain condition that can cause severe and persistent symptoms.
- CRPS can qualify as a disability when the symptoms prevent you from performing your job.
- The severity of CRPS symptoms can fluctuate and may change over time.
- Medical evidence should explain how CRPS affects your functional abilities, not simply confirm the diagnosis.
- People with CRPS may be able to work during periods when their symptoms are well managed but become unable to work during a severe flare-up or deterioration.
- Disability claims involving CRPS may be challenging because pain and other symptoms can be difficult to objectively measure.
- If your CRPS disability claim is denied, you should carefully review the reasons for the denial and consider obtaining legal advice.
What should I do if my CRPS disability claim is denied?
If your CRPS disability claim is denied, consider speaking with a disability lawyer before deciding how to proceed.
A disability lawyer can review your insurance policy, medical evidence and the insurer’s reasons for denying the claim. They can also advise you about your options for challenging the denial and, where appropriate, pursuing your entitlement to disability benefits, including challenging the denial in court if necessary.
Ensure you get the right advice early on to protect your rights.
The disability legal team at Whitten & Lublin offers free consultations for denied short and long term disability claims. If your legitimate disability claim has been denied, contact us online or call 416 640 2667.
Frequently Asked Questions
Can CRPS qualify for long-term disability benefits?
Yes. CRPS can qualify for long-term disability benefits when its symptoms prevent you from performing the duties of your occupation or otherwise satisfy the definition of disability in your insurance policy.
Is CRPS considered a disability?
CRPS can be considered disabling when its symptoms significantly limit a person’s ability to function or work. Whether you are entitled to disability benefits depends on the severity of your symptoms, your functional limitations and the terms of your disability policy.
Can I get LTD benefits if I have CRPS?
Yes. You may be entitled to LTD benefits if your CRPS symptoms prevent you from working and you meet the definition of disability under your insurance policy.
What symptoms of CRPS can prevent someone from working?
Depending on the individual, CRPS symptoms such as severe pain, swelling, weakness, muscle spasms, tremors, reduced mobility and sensitivity can interfere with physical tasks, concentration, attendance, productivity and other essential job duties.
Does CRPS have to be permanent to qualify for disability benefits?
Not necessarily. Eligibility depends on the definition of disability in your insurance policy and the medical evidence supporting your claim. A condition does not necessarily have to be permanent to qualify for disability benefits.
Why was my CRPS disability claim denied?
A CRPS disability claim may be denied if the insurer believes the medical evidence does not establish sufficient functional impairment, questions the severity of your symptoms or concludes that you do not meet the policy’s definition of disability. The specific reason should be reviewed carefully.
What medical evidence is needed for a CRPS disability claim?
Medical evidence should establish your diagnosis, symptoms, treatment and functional limitations. It is particularly important for your healthcare providers to explain how your CRPS affects your ability to perform your specific job duties.
Can I work with CRPS and still qualify for disability benefits?
Potentially. Some people with CRPS are able to work when their symptoms are controlled but become unable to work when their condition worsens. Whether you qualify for benefits depends on your current functional abilities and the definition of disability in your insurance policy.
