Long-term disability for CRPS can provide critical financial support when chronic pain prevents you from working. Complex Regional Pain Syndrome (“CRPS”) is a chronic, progressive neurological condition causing severe, continuous burning or throbbing pain and can significantly affect mobility, strength, and daily functioning. There is no cure for the condition and treatment is aimed to relieve pain and restore function. Although many people with CRPS qualify for disability benefits, insurance companies frequently deny these claims because the condition can be difficult to understand and evaluate.
If you suffer from CRPS you should know what your disability insurance coverage is and how it works. Understanding how CRPS affects your ability to work, what medical evidence insurers look for, and what to do if your claim is denied can help protect your rights and strengthen your disability claim.
TL;DR:
Complex Regional Pain Syndrome (CRPS) can qualify for long-term disability benefits if your symptoms prevent you from performing the essential duties of your job. Because CRPS is often misunderstood, insurers may wrongfully deny legitimate claims. Strong medical evidence and detailed documentation can significantly improve your chances of approval.
Can you receive long-term disability benefits for CRPS?
Yes. People with Complex Regional Pain Syndrome (CRPS) may qualify for long-term disability benefits if their symptoms prevent them from performing the essential duties of their occupation. Medical evidence demonstrating how CRPS affects your functional abilities is often critical to a successful claim.
What is Complex Regional Pain Syndrome (CRPS)?
Complex Regional Pain Syndrome (CRPS) is a chronic neurological pain condition which usually starts after an injury, like a broken bone, surgery, other trauma. The pain lasts longer and is much stronger than what you’d expect from the original injury.
CRPS most often affects an arm, leg, hand, or foot and can significantly interfere with a person’s ability to work and perform everyday activities.
There are two types of CRPS:
- Type 1: Occurs without a clear nerve injury
- Type 2: Develops where there is a confirmed nerve injury
Although there is currently no cure, treatment focuses on reducing pain, improving mobility, and restoring function.
Is CRPS a Disability?
It can be if you are experiencing debilitating symptoms impacting your ability to function.
Pain levels can vary with a CRPS diagnosis. Symptoms can be different for each person, but can include muscle spasms, weakness, tremor or persistent swelling where the injury occurred.
Can CRPS qualify for long term disability benefits?
Yes. If your CRPS symptoms have changed and you are no longer able to perform the essential duties of your occupation, you can apply for disability benefits.
Symptoms vary from person to person and may include:
- Severe burning or throbbing pain
- Persistent swelling
- Muscle weakness
- Tremors
- Changes in skin temperature or colour
- Limited range of motion
- Extreme sensitivity to touch
Some individuals are able to continue working when symptoms are well managed. However, prolonged flare-ups or worsening symptoms can make it impossible to work safely or consistently.
Why are long term disability claims for CRPS often denied?
CRPS is a complicated diagnosis. Due to the complexity of the condition, insurer representatives may struggle to understand the debilitating effects associated with your symptomology.
Insurance companies may question claims because:
- Symptoms fluctuate over time.
- Pain levels are highly individualized.
- Objective medical testing may be limited.
- The condition is often misunderstood.
- Functional limitations are not always obvious during a medical examination.
This gap in understanding unfortunately can cause legitimate claims to be denied.
Strong medical evidence explaining your functional limitations, not simply your diagnosis, is often the key to a successful claim.
How is CRPS diagnosed and treated?
There are multiple levels of treatment for CRPS. The type of treatment intervention depends on the recommendations of your medical provider.
Treatment includes:
- Medications (like steroids or anti-inflammatory prescriptions)
- Pain management procedures
- Surgery
- Movement and occupational therapy
- Psychological support and pain counselling
- Rehabilitation programs
Ongoing treatment records can also become valuable evidence supporting a disability claim.
How to apply for long term disability benefits for CRPS?
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
- Attending Physician Statement – A form filled out by your doctor
- Plan Sponsor Statement – A form filled out by your employer
Once you’ve submitted the completed forms, the ball is in the insurer’s court to approve or deny your claim.
How to strengthen your long term disability claim for CRPS?
CRPS is a complicated condition to understand. Most case managers may not have the knowledge or experience to evaluate or assess your condition appropriately resulting in the denial of a legitimate claim.
Because CRPS can be difficult to evaluate, comprehensive medical documentation is essential.
Helpful evidence includes:
- Detailed physician reports
- Specialist assessments
- Pain management records
- Physical therapy notes
- Documentation of medication changes
- A daily symptom journal
- Evidence explaining how your symptoms prevent you from performing your job duties
The stronger your evidence of functional limitations, the stronger your disability claim.
What should you do if your CRPS disability claim is denied?
A denial does not necessarily mean your claim lacks merit.
Many CRPS claims are denied because insurers misunderstand the condition or underestimate its impact on a person’s ability to work.
Contact a disability lawyer. A lawyer can provide legal representation and help challenge the denial in court.
Key takeaways:
- CRPS can qualify for long-term disability benefits when symptoms prevent you from working.
- CRPS disability claims are often denied because the condition is complex and difficult for insurers to evaluate.
- Strong medical evidence documenting functional limitations is essential to a successful disability claim.
- Legal advice can help protect your rights if your CRPS disability claim has been denied.
How Whitten & Lublin can help?
Living with CRPS is challenging enough without having to fight your insurance company for the disability benefits you deserve. If your long-term disability claim has been denied or you need guidance with the claims process, the experienced disability lawyers at Whitten & Lublin can help.
Contact us online or call (416) 640-2667 for a free consultation.
Frequently Asked Questions
Can CRPS qualify for long-term disability benefits?
Yes. If CRPS prevents you from performing the essential duties of your occupation, you may qualify for long-term disability benefits.
Why are CRPS disability claims often denied?
CRPS claims are frequently denied because symptoms fluctuate, pain is difficult to measure objectively, and insurers may underestimate the condition’s functional impact.
What medical evidence helps support a CRPS disability claim?
Physician reports, specialist assessments, pain management records, therapy notes, medication history, and documentation explaining how CRPS limits your ability to work can all strengthen your claim.
Can I receive disability benefits if my CRPS symptoms flare up?
Yes. Many people with CRPS experience periods of worsening symptoms. Disability benefits are based on your ability to work, not whether your symptoms remain constant.
What should I do if my long-term disability claim for CRPS is denied?
Speak with an experienced disability lawyer as soon as possible. Legal advice can help you understand the reason for the denial and determine the best strategy for challenging the insurer’s decision.
