Denied Disability for Epilepsy? Here's How a Disability Lawyer Can Help
If you’re living with epilepsy, you know the daily challenges: unpredictable seizures, medication side effects, and the constant worry about when the next episode might strike. Despite these legitimate struggles, many people with epilepsy are denied long-term disability benefits.
Epilepsy symptoms come and go and can be difficult to document, leading to misunderstandings about the condition’s true impact on your ability to work. If your epilepsy disability claim has been denied in British Columbia, an experienced disability lawyer for epilepsy, like Dyson Law Corp, can help.
This guide will walk you through common reasons we see epilepsy disability claims get denied and explain how a disability lawyer for epilepsy can help.
This article contains general information and is not legal advice. For qualified legal advice, please call 604-876-7000 to get in touch with a BC Disability Insurance Lawyer near you.
*Please note that if you are a union employee and are subject to a collective agreement that references a disability insurance plan, you should immediately discuss your claim with your union representative. Our firm may not be able to assist in these situations. Limitation periods can be very short—sometimes weeks—when a union grievance process is available.
Why Epilepsy Disability Claims Face Denial
Understanding why disability claims for epilepsy get denied can help you identify when further legal action is needed to secure benefits.
Firstly, epilepsy is hard to document. Seizure patterns are unpredictable and make it difficult to establish consistent evidence of disability. One person with epilepsy could be having daily seizures, others might experience clusters of seizures separated by weeks of apparent normalcy.
This creates a challenge because insurers look for consistent, measurable impairments, and often reject cases that don’t constantly demonstrate severe symptoms.
Unlike a missing limb or obvious physical impairment, seizures aren’t always witnessed or documented when they occur. Many people with epilepsy have learned to manage their condition privately, which unfortunately can make it appear less severe than it is.
Additionally, the cognitive impacts and side effects from medications can be as disabling as the seizures themselves, yet these aspects are often overlooked in disability assessments.
Common Misconceptions About Epilepsy
There are several common misconceptions about epilepsy that may cause insurers to deny your claims:
- Misconception: Modern medications can effectively control all types of epilepsy seizures for all patients.
- The Truth: The World Health Organization has claimed that 70% of those diagnosed with epilepsy could live seizure-free with proper treatment. However, this doesn’t account for the remaining 30%, and those who may develop drug-resistant epilepsy.
- Misconception: People with epilepsy can live a completely normal, neurotypical life with medication that effectively reduces seizures.
- The Truth: While epilepsy medication may be able to reduce seizures, side effects like severe fatigue, cognitive impairment, mood changes, and coordination problems still significantly impact day-to-day life.
- Misconception: As long as they don’t have frequent seizures, someone with epilepsy can definitely work.
- The Truth: The constant fear of having a seizure, combined with actual cognitive impacts from both the condition and medications, can make it impossible to perform many types of work safely and consistently (even if seizures are infrequent).
Safety concerns alone should disqualify many people with epilepsy from numerous occupations, yet these factors are frequently downplayed in initial long-term disability claims.
Top 5 Reasons Epilepsy Disability Claims Get Denied
Insufficient Medical Evidence
The most common reason for epilepsy disability claim denials is inadequate medical documentation. This is because insurers aren’t just looking for standard medical documentation, what they require is often entirely different.
Claimants get stuck in a loop of getting denied, asking for more documentation from their doctor, and getting denied again. Ultimately, this wastes valuable time that could be spent taking legal action.
Non-Compliance with Prescribed Treatment
Non-compliance with prescribed medication regimens is a frequent basis for denial, especially when the reasons for non-compliance aren’t clearly documented in medical records. This becomes particularly problematic for epilepsy patients who experience severe medication side effects but don’t have these reactions properly documented by their healthcare providers.
Insurers may question whether you’ve tried multiple medications, and whether you used them actively enough to be effective. Any non-compliance with a prescribed treatment must be proven medically necessary.
Condition Doesn’t Meet Severity Criteria
Another common reason epilepsy disability claims are denied is that the insurer decides your condition does not meet their internal “severity” definition.
Most long-term disability (LTD) policies do not simply ask whether you have epilepsy. Instead, they ask whether you are totally disabled under the terms of your specific policy. That often means proving:
- You are unable to perform the essential duties of your own occupation (for the first 24 months), and
- After that, you are unable to perform any job (which you are reasonably suited for).
If your seizures are not occurring weekly or daily, they may argue your condition is “controlled”. They can argue this even if seizures are unpredictable and postictal confusion lasts multiple hours or days.
Perceived Ability to Perform Work
Insurers may argue that you are capable of doing “lighter” or “modified” work. For example, if you previously worked in construction or as a driver and can no longer perform that role due to seizure risk, the insurer may claim you could perform sedentary office work instead.
But this suggestion overlooks many of the day-to-day struggles faced by someone with epilepsy. Some people with epilepsy cannot drive, making work travel options limited, and working at a desk can be unrealistic due to cognitive slowing, memory issues, and medication fatigue.
Additionally, the unpredictable nature of epileptic seizures means that there’s still risk of a seizure occurring while at work, even if it’s a desk job. This is compounded by the fact that stress is a common trigger for epileptic seizures, but nevertheless an unavoidable part of day-to-day work.
A disability lawyer for epilepsy can advocate for you in cases where your condition’s impact on your day-to-day life is minimized or misunderstood.
What to Do If Denied LTD For Epilepsy
If your long-term disability claim for epilepsy has been denied in British Columbia, don’t panic. This doesn’t have to be the end. Here are some steps to take after a denial:
- Do Not Assume the Insurer Is Right: A denial letter is not a final judgment on your medical condition. It is a decision made by an insurance company that has a financial interest in denying costly LTD claims. Insurers deny many legitimate claims.
- Be Careful With Internal Appeals: After a denial, your first thought will probably be to appeal with the same insurer. However, internal appeals aren’t always the best course of action, since they’re handled by the same insurer who denied your initial claim. We often recommend our clients move straight into legal action if they have reason to believe the denial was in bad faith.
- Be Mindful of Deadlines: BC has a strict 2-year limitation period for disability claims, meaning you will lose your right to benefits if you fail to file a lawsuit before the deadline. Appeals made internally will not prolong the limitation period.
- Get Tailored Legal Advice: The best way to understand your rights after denial is to consult with a disability lawyer for epilepsy at Dyson Law. We can help you determine the strength of your claim, your options moving forward, and how we can help your case.
- Continue Medical Treatment: Even after a denial, continue seeing your neurologist or healthcare providers regularly. Insurers will be observing for gaps in treatment that strengthen their case against you. Talk to your healthcare provider and ask for clear and continuous documentation regarding your symptoms, work limitations, and side effects from medication. This documentation will be important later.
Why Consult with a Disability Lawyer for Epilepsy
Epilepsy disability claims are medically complex and legally nuanced. Fighting a large insurance company should not be something you have to manage on your own. Our disability lawyers can advocate for you and ensure your claim meets key legal guidelines.
A Dyson Law disability lawyer for epilepsy can:
- Review your denial letter and insurance policy
- Identify weaknesses in the insurer’s reasoning
- Gather stronger medical and vocational evidence
- Work with your neurologist to clarify functional limitations
- Challenge surveillance or insurer-hired medical opinions
- File a lawsuit if necessary
- Negotiate a fair settlement or pursue trial if required
Don’t let yourself lose the benefits you deserve — get in touch with a British Columbia disability lawyer for epilepsy through the number below or through our contact form.