If your disability insurance claim for a lung disease or respiratory condition was denied, the insurance company’s decision may not be final.
An insurer may accept that you have breathing problems but argue that your medical evidence does not prove you are unable to work. It may also claim that medication controls your symptoms or that you can perform sedentary or remote employment.
The insurer should consider how shortness of breath, coughing, fatigue, reduced stamina, flare-ups and treatment side effects affect your ability to perform your job safely and reliably.
The disability lawyers at Samfiru Tumarkin LLP represent people with denied and terminated disability claims throughout Canada, excluding Quebec.
On This Page:
- Lung Disease and Disability
- Lung Conditions That May Qualify
- How Lung Disease Affects Work
- Why Claims Are Denied
- Evidence for Your Claim
- What to Do After a Denial
- Frequently Asked Questions
Can Lung Disease Qualify for Disability Benefits?
A lung disease or respiratory condition may qualify for disability benefits when its symptoms prevent you from performing your job safely, consistently and reliably.
A diagnosis alone does not automatically qualify someone for benefits. The insurer will usually consider the severity of your symptoms, the treatment you receive and the physical and cognitive demands of your occupation.
Depending on your circumstances, you may be eligible for:
Each program uses different eligibility rules. Approval or denial under one program does not automatically determine whether you qualify under another.
You Do Not Have to Be Completely Unable to Function
You may still qualify for disability benefits if you can occasionally walk, drive, shop, attend appointments or complete household activities.
These activities are different from working several hours a day, five days a week. Regular employment may require repeated physical activity, sustained concentration, prolonged speaking, reliable attendance and consistent productivity.
What Lung Conditions May Qualify for Disability Benefits?
Many chronic or serious respiratory conditions may support a disability claim when they interfere with your ability to work.
Examples include:
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Chronic bronchitis
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Emphysema
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Pulmonary fibrosis
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Interstitial lung disease
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Bronchiectasis
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Pulmonary hypertension
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Cystic fibrosis
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Occupational lung diseases
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Lasting complications from pneumonia or another serious respiratory infection
The name of the condition is not the only factor. Two people with the same diagnosis may have very different symptoms and work limitations.
Multiple Medical Conditions Should Be Considered Together
A respiratory condition may exist alongside heart disease, chronic pain, fatigue, anxiety, depression or sleep problems.
The insurer should consider the combined effect of all your conditions. It should not assess your breathing difficulties in isolation while ignoring other symptoms that also affect your ability to work.
How Can Lung Disease Prevent You From Working?
Lung and respiratory diseases can affect much more than your ability to complete heavy physical work.
Possible symptoms and limitations include:
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Shortness of breath
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Persistent coughing
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Wheezing or chest tightness
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Reduced stamina
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Severe fatigue or weakness
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Difficulty walking or climbing stairs
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Difficulty lifting, carrying, pushing or pulling
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Difficulty speaking for extended periods
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Poor concentration caused by fatigue or disrupted sleep
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Frequent respiratory infections or flare-ups
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Medication or treatment side effects
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Frequent medical appointments or hospital visits
Physical and Safety-Sensitive Work
Breathing difficulties may make it unsafe or impractical to perform jobs involving walking, lifting, climbing, driving or operating machinery.
Some workplaces also expose employees to dust, smoke, chemicals, fumes, extreme temperatures or poor air quality that can aggravate respiratory symptoms.
Sedentary and Remote Work
An insurance company may argue that you can perform office or remote work because it does not involve heavy physical activity.
However, sedentary work may still require:
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Regular and predictable attendance
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Sustained concentration
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Telephone or video calls
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Prolonged speaking
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Meeting deadlines
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Consistent productivity
Severe fatigue, coughing, breathlessness and unpredictable flare-ups may prevent reliable work even when you can remain seated.
Why Are Lung Disease Disability Claims Denied?
An insurance company may deny a disability claim even when your doctor supports you being off work.
Common reasons for a lung issue disability insurance claim denial include:
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The insurer says your test results do not show a severe impairment
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Your oxygen levels appear normal while you are resting
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Medication appears to control some of your symptoms
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Your doctor’s records do not clearly explain your work restrictions
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The insurer says you can perform sedentary or remote work
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You do not use supplemental oxygen
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Your symptoms fluctuate and are not consistently documented
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Your occasional daily activities are presented as proof that you can work
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Fatigue, cognitive problems or medication side effects are overlooked
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The insurer says you have not followed recommended treatment
The Insurer Relies on Pulmonary Function Tests
Pulmonary function and breathing tests can provide important medical evidence. However, they may not show the complete effect of your condition on an entire workday.
Your claim should also address what happens when you walk, climb stairs, lift objects, speak for extended periods or repeat physical activities.
The Insurer Says Treatment Should Allow You to Work
Medication, inhalers, oxygen therapy or pulmonary rehabilitation may improve symptoms without restoring your ability to work consistently.
Your medical evidence should explain the limitations that remain despite reasonable treatment.
Your Benefits Are Cut Off After Two Years
Many long-term disability policies change their definition of disability after approximately two years.
The insurer may accept that you can’t return to your previous occupation but argue that you can perform another job.
It should consider whether the proposed occupation is genuinely suitable and whether you can perform it consistently given your breathing limitations, fatigue, education, training and work experience.
What Evidence Supports a Lung Disease Disability Claim?
A strong claim should explain more than the name of your condition. It should show how your symptoms affect your actual job.
Helpful evidence may include:
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Medical records from your family doctor and respiratory specialists
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Pulmonary function and spirometry results
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Oxygen level or exercise testing
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Imaging and laboratory results
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Records of emergency visits or hospital admissions
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Information about respiratory infections and flare-ups
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Your medication and treatment history
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Medication or treatment side effects
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A detailed description of your job duties
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Workplace accommodation attempts
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Failed or unsuccessful return-to-work attempts
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Evidence of other medical conditions
Describe Your Functional Limitations
Specific examples are more useful than general statements such as “I have trouble breathing.”
Explain:
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How far you can walk before stopping
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Whether you can climb a flight of stairs
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How much weight you can safely lift or carry
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How long you can speak before becoming breathless
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How often you need to rest
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How long it takes you to recover after activity
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How often you experience flare-ups
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How frequently you miss work or attend medical appointments
Continue Reasonable Treatment
Continue attending medical appointments and following reasonable treatment recommendations where possible.
If you can’t complete a treatment because of side effects, cost, long wait lists or another valid reason, discuss the issue with your doctor. The explanation should be documented in your medical records.
What Should You Do If Your Lung Disease Disability Claim Is Denied?
A denial letter is the insurer’s position. It does not necessarily determine whether you are legally entitled to disability benefits.
After a denial:
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Read the denial letter: Identify the exact reasons the insurer refused or ended your benefits.
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Continue treatment: Keep attending medical appointments and following reasonable medical advice.
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Request your disability policy: The policy contains the definition of disability and other important terms.
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Save your documents: Keep your application, medical records, test results and insurer communications.
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Do not return against medical advice: Discuss any return-to-work proposal with your doctor.
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Speak with a disability lawyer: Get advice before filing an internal appeal or missing a legal deadline.
Do You Have to File an Internal Appeal?
An insurance company may invite you to appeal its decision. However, the same insurer that denied the claim will also review the appeal.
An appeal may have limited value without meaningful new evidence. It may also delay legal action while important deadlines continue to run.
Learn more about what to do when your long-term disability claim is denied.
How Can a Lung Disease Disability Lawyer Help?
A disability lawyer can review the denial letter, insurance policy and medical evidence to determine why your lung disease claim was refused or terminated.
A lawyer may help by:
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Explaining the definition of disability in your policy
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Identifying weaknesses in the insurer’s decision
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Determining what medical evidence may be missing
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Showing how your condition affects your actual occupation
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Responding to claims that you can perform sedentary or remote work
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Communicating directly with the insurance company
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Starting legal action when appropriate
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Negotiating reinstatement, unpaid benefits or a settlement
Some members of the Samfiru Tumarkin LLP legal team previously worked for insurance companies. We understand how insurers assess respiratory conditions and what evidence may be needed to challenge a denial.
Frequently Asked Questions About Lung Disease Disability Claims
Can lung disease qualify for disability benefits?
A lung disease may qualify for disability benefits when breathing difficulties, fatigue or other symptoms prevent you from performing your job safely and reliably.
Can you qualify if you do not use oxygen?
Yes. You do not have to use supplemental oxygen to qualify. The insurer should consider your complete medical condition and how it affects your ability to work.
Can you qualify with normal oxygen levels?
Potentially. Oxygen levels measured while resting may not show how your condition affects you during walking, lifting, speaking or repeated activity.
Can an insurer say you are able to perform desk work?
An insurer may argue that you can perform sedentary work. However, office and remote jobs still require stamina, concentration, communication, attendance and consistent productivity.
Can COPD qualify for disability benefits?
COPD may qualify when shortness of breath, coughing, fatigue, flare-ups or related symptoms prevent reliable work. Read our guide to COPD and disability benefits in Canada.
Can asthma qualify for disability benefits?
Severe asthma may qualify when frequent attacks, breathing difficulties or environmental triggers prevent you from working safely and consistently.
Should you appeal a denied lung disease claim?
Do not assume an internal appeal is the best option. The same insurer that denied your claim will review the appeal. Speak with a disability lawyer before proceeding.
Get Help With a Denied Lung Disease Disability Claim
Living with a serious lung or respiratory condition is difficult enough. Fighting with an insurance company while managing breathing problems, fatigue and financial uncertainty can make the situation worse.
Samfiru Tumarkin LLP represents people with denied and terminated disability claims throughout Canada, excluding Quebec.
Contact us for a free consultation if your short-term or long-term disability claim has been denied or cut off.