Autoimmune Disorders and Long-Term Disability Benefits
Autoimmune disorders can be unpredictable, exhausting, and deeply disruptive to a person’s life. A person who suffers from an autoimmune disorder may find they are unable to work. If a person can no longer perform the duties of their job due to their medical condition, then they may be eligible for long-term disability (LTD) benefits.
Getting long-term disability benefits for an autoimmune disorder can be challenging. Insurance companies frequently deny LTD claims, and claimants must submit a plethora of evidence to prove they cannot work due to their conditions. Yet receiving benefits for an autoimmune disorder is possible.
In this article, CCK Law will discuss:
- Autoimmune disorders
- How an autoimmune disorder can affect a person’s ability to work
- If such disorders can qualify for LTD benefits
- What happens if an insurance company denies a claim for long-term disability benefits
What Are Autoimmune Disorders?
Autoimmune disorders are health conditions wherein a person’s immune system mistakenly attacks healthy tissues. There are over 100 different autoimmune disorders. These disorders can affect almost any tissue or organ in a person’s body. Some of the most common areas include a person’s joints, muscles, digestive system, blood vessels, skin, and nervous system.
Common autoimmune disorders include:
- Lupus
- Multiple sclerosis (MS)
- Rheumatoid arthritis
- Sjogren’s syndrome
- Scleroderma
- Psoriatic arthritis
- Inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis, etc.)
Since autoimmune diseases often involve “invisible” symptoms and fluctuating severity, they can be difficult to measure. Yet their impact can be substantial. Many of these disorders cause inflammation, which can lead to a feeling of warmth, skin discoloration, swelling, and pain.
While these disorders present themselves differently, many share symptoms like chronic fatigue, muscle or joint pain, cognitive difficulties, and organ inflammation. Other symptoms can include muscle weakness, severe weight loss, hair loss, anemia, and headaches.
How Autoimmune Disorders Affect the Ability to Work
Maintaining consistent employment with an autoimmune disorder can be difficult. For example, chronic pain and fatigue can prevent someone from sitting or standing for extended periods. Similarly, cognitive dysfunction, or “brain fog,” can interfere with focus and memory. Other symptoms, like joint swelling or muscle weakness, can limit both physical and sedentary work activities.
Another example of how an autoimmune disorder can affect a person’s ability to work is someone suffering from multiple sclerosis. A person with MS may struggle with balance and coordination, making jobs that require walking or fine motor skills difficult. Likewise, someone with lupus may experience severe flares of fatigue and pain that make it impossible to follow a regular work schedule.
Can Autoimmune Disorders Qualify for LTD Benefits?
Yes. If your autoimmune conditions prevent you from working, then you may qualify for long-term disability benefits. To be eligible for such benefits, individuals must prove to an insurance company that their autoimmune disorder prevents them from working under the terms of their insurance policy.
Every long-term disability insurance policy contains a “definition of disability.” LTD claimants must prove that they meet their policy’s definition, which will either be an “own occupation” or an “any occupation” definition.
In short, an own occupation definition asks the claimant if their autoimmune disorder prevents them from working in their own job as it is defined in the national economy. Alternatively, an any occupation definition asks the claimant if their disorder prevents them from working any job at all.
Building a Strong LTD Claim for an Autoimmune Disorder
If your autoimmune disorder prevents you from working—and you have an LTD insurance policy—then you can file a claim with your insurer. You should first review your insurance policy, notify your insurer of your intention to file a claim, and submit a formal claim with all necessary documentation.
Insurance companies require substantial medical evidence to support a long-term disability claim. As mentioned, the symptoms of many autoimmune disorders can be hard to prove through imaging or lab tests. As such, it is important to submit a range of evidence that shows how you are unable to work due to your condition.
Building a strong LTD claim for an autoimmune disorder involves gathering compelling evidence, which can include:
- Detailed medical records from all treating physicians and specialists
- Results from diagnostic tests, such as MRIs, blood panels, or biopsies
- Physician statements that explain your functional limitations
- Additional assessments, such as functional capacity evaluations (FCEs) or neuropsychological evaluations
- Witness statements from family, friends, and co-workers
- Symptom journals
Why Insurance Companies Deny LTD Claims for Autoimmune Disorders
Unfortunately, insurance companies frequently deny long-term disability claims. Even valid claims can receive a denial. When an insurer denies an LTD claim, it will send the claimant a denial letter in the mail that will cite the reasons for its decision.
Insurance companies often dispute autoimmune-related disability claims due to:
- Lack of objective evidence
- Perceived inconsistencies in the claimant’s medical records
- Surveillance or social media monitoring appears to contradict the claim for benefits
- Independent medical exam results contradict the claim for benefits
- Not meeting the applicable definition of disability
If your claim is denied, then you have the right to file an administrative appeal. Under most LTD policies—especially those governed by ERISA—you have 180 days to submit this appeal. Often, this is your last opportunity to submit new or updated evidence in support of your claim.
How CCK Law Can Help
Appealing a long-term disability denial can be overwhelming, especially while managing a serious health condition. CCK Law has been helping LTD claimants for over 25 years and understands this. Our team can help you at any stage of the LTD claim and appeal process. We tailor our approach for each individual client based on their specific situation.
Some of the ways we help include:
- Gathering and submitting all evidence
- Acting as a point of contact with the insurance company
- Tracking all filing deadlines
- And more
Autoimmune disorders can impact your ability to work and your ability to financially support yourself and your family. If you need help with your LTD claim, appeal, or lawsuit, then CCK Law may be able to help. Call us today at (800) 544-9144 for a free case evaluation with a member of our team.
