How LTD Insurers Treat Different Medical Conditions in BC

Fact Checked by Long-Term Disability Lawyer Tim Louis

Why insurers look at different conditions differently

When people talk about long term disability, it can sound as if every claim is treated the same. In reality, insurers look at different medical conditions in very different ways. A big part of that comes down to the kind of evidence they expect to see.

For some conditions there are clear objective tests. An MRI can show a spinal cord injury. Blood work can reveal severe anaemia or kidney failure. Insurers are often more comfortable with these types of claims because there is a test result they can point to.

Other conditions rely much more on functional limits and self-reported symptoms. Chronic pain, fatigue conditions like ME/CFS, many mental health diagnoses, IBS and migraine often do not show up neatly on a scan. Your story is told through doctor’s notes, counselling records, pain and fatigue logs, and descriptions of what you can and cannot do in a real workday. Insurers sometimes call these claims “subjective,” even though the impact on your life is very real.

This also ties into the difference between visible and invisible illness. It is easier for an adjuster to accept that you cannot work after major surgery or a stroke than to understand why a person who “looks fine” cannot sit through a meeting or focus on a screen. That gap in understanding is where many disputes begin.

Most people in British Columbia are covered by group LTD policies through an employer. Those claims are handled by adjusters who may consult in-house nurses, doctors or psychologists, and who can send you to an independent medical examination (IME). These decision makers are trained to look for patterns. If your records do not match what they expect for your diagnosis, they may start to question the claim.

That is where the idea of “credibility” comes in. For conditions that rely heavily on your own reports, insurers often focus on whether your story seems consistent over time. Missed appointments, gaps in treatment, or off-hand comments in a medical note can be used to argue that you are not as limited as you say. It is not always fair, but it is how many files are reviewed.

The goal of this guide is to help you understand those patterns so you can plan your evidence and protect your claim. If you want a deeper dive into what kind of proof helps, you may also find it useful to read “Strengthen Your Long-Term Disability Claim with Medical Evidence” and “Your Rights and Responsibilities for Long-Term Disability Claims” on LongTermDisabilityInsights.com.

Chronic pain, fibromyalgia and similar conditions

For chronic pain and fibromyalgia, many people hear the same line from insurers: “There are no objective findings.” In practice that often means the adjuster is reading normal X-rays or MRIs and deciding the pain cannot be as bad as you say. File reviews by in-house doctors or nurses are common, and they sometimes carry more weight than the reports from the doctors who actually examine you.

What usually helps is a picture of your function over time, not just a diagnosis. That can include pain scales in your medical notes, descriptions of how long you can sit, stand or walk, and what happens if you try to lift, type or concentrate for more than a short period. A consistent treatment history also matters: visits with your family doctor, specialists, physiotherapy, pain clinics, counselling and medication trials. You do not need a single magic test that “proves” pain. You need steady, believable evidence that shows how pain limits a regular workday.

The traps are familiar. Gaps in treatment are sometimes framed as “non-compliance,” even when they happened because you could not afford a program or there were long waitlists. Pushing through work for years can also be turned against you. An insurer may say that because you worked while in pain before, you can simply keep going.

If you start seeing phrases like “subjective complaints,” “deconditioning,” or “no objective impairment” in letters from the insurer, it is a sign to get advice early. This is also a good time to read Tim Louis & Company’s guides on Chronic Pain Disability Claims and Fibromyalgia and Long-Term Disability Claims, and the LongTermDisabilityInsights articles on chronic illness, securing LTD benefits and common causes of disability claims.

Depression, anxiety and PTSD

Mental health conditions are some of the most common reasons people in British Columbia need time away from work. Insurers know this, and many LTD policies have special rules for depression, anxiety and PTSD. They often look for regular visits with a family doctor, psychiatrist or psychologist, and they may expect that you are trying medication, counselling or both. Some policies also include time-limited “mental nervous” clauses that cap benefits after a certain number of years, which can be confusing and frightening to read.

Evidence that helps in mental health claims focuses on how symptoms affect your day, not just the name of the diagnosis. Notes that describe problems with concentration, memory, stamina, sleep, irritability, panic, or the ability to cope with ordinary workplace stress are more powerful than a single short letter that simply says you are “off for stress.” Regular charts and progress notes show that treatment is ongoing, even if you are not improving as quickly as hoped.

Denials in this area often sound similar. You may be told there are “no objective findings,” that you could do a lower-stress job, or that because you are “stable on medication” you can now return to work. Stable does not always mean able to handle deadlines, conflict, public contact or complex decision making.

If you receive a denial, or the adjuster starts saying you are “just stressed,” it is time to get help. You can review Tim Louis & Company resources on Depression and Long-Term Disability Claims, PTSD Long-Term Disability Claims, and Denied LTD for Depression, PTSD or Anxiety, along with LongTermDisabilityInsights articles on mental health denials and mental health LTD claims. These tools can help you decide whether to appeal, negotiate or move toward a legal claim.

Chronic fatigue, ME/CFS and post-viral conditions (including Long COVID)

Fatigue conditions like ME/CFS and post-viral syndromes, including Long COVID, are some of the most misunderstood claims. Insurers often point to “lack of objective evidence” and lean heavily on outdated ideas like simple graded exercise or “getting back to routine.” What is frequently missed is post-exertional malaise: the crash in symptoms that happens after even small amounts of physical or mental effort.

Evidence that helps here is very specific. Fatigue logs that track your energy through the day, notes about how long you can concentrate before symptoms spike, and records of next-day crashes after activity can all support your claim. Reports from specialists, sleep studies or autonomic testing, where available, add weight, but day-to-day function still matters most.

A common trap is being pushed into an aggressive return to work plan that ignores your pacing needs. If you try to follow a plan that is too demanding, crash, and then have your benefits cut off, the insurer may argue that you did not cooperate with treatment.

If you notice the adjuster blaming you for needing rest, or suggesting that you are simply “deconditioned,” that is a good moment to reach out for advice. Tim Louis & Company’s Chronic Fatigue Syndrome (ME/CFS) LTD page and 24-Month LTD Change of Definition in BC guide are especially relevant, because fatigue-based claims are very vulnerable at the two-year mark. On LongTermDisabilityInsights.com, you can also explore articles on invisible illnesses, Long COVID and related conditions.

IBS and gut-related disorders

Irritable bowel syndrome and other gut-related disorders rarely appear in insurer marketing materials, yet they disrupt thousands of work lives. Tests are often normal or show non-specific irritation, which leads some adjusters to minimise the condition. It is common to see suggestions that “diet and lifestyle changes” will fix everything.

For these claims, the most powerful evidence shows frequency, severity and unpredictability. Symptom logs that track how often you need the washroom, how long flare-ups last, and how much pain or urgency you experience make it easier for someone who has never lived with IBS to understand why a normal workday is not realistic. Notes from your doctor or specialist that connect these symptoms directly to your ability to attend work, sit through meetings or travel to job sites are especially helpful.

One regular argument is that you can simply “work near a washroom.” That may ignore the reality of sudden urgency, cramping, exhaustion after attacks, and the impact of constant worry about accidents.

If the insurer keeps calling your IBS “mild” despite serious functional problems, it is a good time to ask for a legal review. You can also look at Tim Louis & Company’s IBS Long-Term Disability Claims page and LongTermDisabilityInsights resources on invisible and chronic illness claims to better understand the patterns you may be facing.

Autoimmune diseases (lupus, rheumatoid arthritis and more)

Autoimmune diseases form a wide family of conditions that can affect joints, organs, skin and energy levels. People may experience joint pain and swelling, deep fatigue, rashes, brain fog or organ involvement, often in unpredictable flares. Insurers sometimes focus on the idea that “between flares you are fine,” which ignores the cumulative impact of chronic inflammation, medication side-effects and constant uncertainty.

Blood tests and imaging, such as ANA levels or inflammatory markers, can support the diagnosis, but they do not always show day-to-day ability. On a practical level, what matters is how often flares occur, how long they last, and what you can realistically do on a regular schedule. Keeping a simple record of flare days, missed activities and medication changes can help your doctors explain this clearly in their reports. Side-effects like drowsiness, immunosuppression or stomach problems from strong medications should also be documented.

When an insurer focuses only on “good days” or uses isolated normal test results to say you can return to work full time, it may be time to push back. Tim Louis & Company’s Autoimmune Disease and Long-Term Disability page and the chronic illness and “top causes of LTD” articles on LongTermDisabilityInsights.com are designed to help people with lupus, rheumatoid arthritis and related conditions understand their rights and plan the next steps.

These condition clusters do not cover every diagnosis, but they show how patterns repeat. The more you understand how your condition is likely to be viewed, the better prepared you are to protect your benefits and decide when it is time to speak with a lawyer who handles long term disability claims every day.

Cancer and heart disease / stroke

Cancer, heart disease and stroke are often treated as “obvious” disabilities because there are scans, lab results and hospital records. In reality, many disputes happen after the main treatment phase, when the paperwork looks better than you feel.

After chemotherapy or radiation, people can be left with deep fatigue and cognitive changes sometimes called “chemo brain” difficulty focusing, slower processing, word-finding problems. After a heart attack or stroke, you may have limits on exertion, lifting or stress, along with memory or attention challenges. Insurers sometimes assume that if you can sit at a desk and use a computer, you can return to full-time sedentary work. That ignores how quickly you tire, how long it takes to recover after a busy day, and what happens when you face pressure or conflict.

Helpful evidence usually includes clear reports from your oncology or cardiology team, cardiac rehab notes, and any neuropsychological testing that documents cognitive changes. A simple log of what a “normal” day looks like now compared to before your diagnosis can also support your claim.

If you start receiving letters that say your treatment is “complete” and you are expected to return to work, even though your body has not caught up, it is a good time to get advice. This is where Tim Louis & Company’s pages on cancer related LTD claims and heart disease or stroke claims, can help you understand your options.

Neurological conditions: MS, Parkinson’s, vision and hearing loss

Neurological conditions such as multiple sclerosis and Parkinson’s often unfold over years. Symptoms can flare, settle and flare again. You might have days when you walk fairly well, and others when fatigue, spasticity or tremor make even simple tasks difficult.

Insurers sometimes focus on narrow abilities. They may say that because you can still type, sit at a desk or drive short distances, you can work full time. That view can ignore balance problems, muscle spasms, “brain fog,” or the effort it takes to manage personal care before you even think about work. For people with vision or hearing loss, the issue is not just whether you can see or hear at all, but whether you can reliably follow meetings, read screens, travel safely or manage customer contact.

Key evidence includes neurology reports, MRI findings and specialist testing, but also day-to-day functional assessments. Occupational therapy reports, mobility assessments and aids or adaptations recommended for home can all show how the condition affects your real life.

If your insurer keeps pointing to isolated “good days” or early test results while ignoring the bigger pattern, it may be time to talk with a lawyer who handles neurological LTD claims. Tim Louis & Company’s resources on MS, Parkinson’s and sensory loss, combined with LongTermDisabilityInsights guides on building and defending LTD claims, are a solid starting point.

Lyme disease and complex or controversial diagnoses

Lyme disease and similar complex conditions sit in a difficult space. Many people have symptoms that look like a mix of fatigue, pain, cognitive problems and neurological issues. At the same time, there are ongoing debates in the medical community about how to diagnose and treat “chronic Lyme.”

Insurers often lean heavily on this debate. They may say there is “insufficient evidence” of ongoing infection, or that your symptoms can be explained by something less serious. Guidelines disputes between different physicians sometimes become the focus, rather than the reality that you cannot reliably work a full week.

For these claims, long-term symptom records are especially important. A simple diary of pain, fatigue, headaches, cognitive problems and activity levels helps show that something serious is happening, even when tests are inconclusive. Support from mainstream specialists where possible infectious disease, neurology, rheumatology can carry weight, particularly when they describe functional limits clearly.

Because these files are often seen as “high risk” by insurers, early planning can make a real difference. If you live with Lyme or a similar complex diagnosis and you see the words “controversial,” “non standard” or “insufficient evidence” in your LTD correspondence, that is a strong signal to seek a legal opinion. Tim Louis & Company’s Lyme disease LTD page is designed with these realities in mind.

How the 24 month change of definition hits different conditions

Most group LTD policies in British Columbia have two main stages. For roughly the first two years, the question is whether you can do your own occupation. After about 24 months, the test usually shifts to whether you can do any occupation that fits your education, training and experience. This is called the change of definition, and it is one of the most common points where benefits are cut off.

Insurers often use broad assumptions here. For chronic pain or chronic fatigue conditions, you might see “you can do a seated job” even if sitting for more than half an hour triggers a flare. For mental health claims, the language may be “you can do low-stress part-time work” without considering how unpredictable symptoms are or how you respond under pressure. For autoimmune conditions, the focus may be on lighter duties between flares, while ignoring how disabling the flares themselves are and how often they occur.

Preparing for this change six to twelve months in advance can protect you. That preparation might include updated specialist reports, more detailed notes about what you can and cannot do on a consistent basis, and a realistic explanation of why proposed alternative jobs are not actually sustainable.

LongTermDisabilityInsights’ Any-Occupation Survival Plan and Denied LTD in BC articles walk through this stage in detail. Tim Louis & Company’s guide on the 24 month LTD change of definition in BC explains how courts and insurers look at this transition and what practical steps you can take if your benefits are under review.