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Qualifying Conditions

Getting Long-Term Disability (LTD) Benefits for HIV/AIDS

Getting Long-Term Disability (LTD) Benefits for HIV/AIDS

There are around 1.2 million people who suffer from HIV in the United States alone.  However, many people with HIV do not know they have it — at least not initially.  Nevertheless, when a person is infected with this virus, they may become unable to work.  In such situations, they should consider filing for long-term disability (LTD) benefits.

While it may seem that an HIV diagnosis would be enough to receive benefits, this is usually not the case.  Insurance companies often deny claims, including ones for HIV/AIDS.  Therefore, it is vital to have a convincing case that demonstrates how your condition disables you.

What Is HIV?

HIV has been in the public discourse for decades.  It originated in chimpanzees in Central Africa but transferred to humans sometime in the nineteenth century.  This transfer likely occurred due to humans eating the meat of this specific type of chimpanzee.  HIV, or “human immunodeficiency virus,” spread through the African continent before being found in the United States sometime in the mid-1970s.  It was during the 1980s that it rose to heightened levels.

Long-Term Disability (LTD) 101

In short, HIV is a virus that infects a person’s immune system, thus compromising its ability to fight off diseases.  The virus itself is usually found in substantial amounts in a person’s bloodstream.  It is a lifelong condition with no known cure.  Since the symptoms may or may not occur during the beginning of the condition, many people may not realize they have it, especially since the early symptoms may seem like the flu.

HIV is spread primarily through two methods: sexual intercourse; and the sharing of needles, syringes, and other drug injection tools.

HIV is a progressive condition, which means that it gets worse over time.  Consequently, there are three stages of HIV, which are:

  • Acute HIV: The first stage can last from a few days to a few weeks.  During this time, the infected individual is highly contagious and may have flu-like symptoms, including fever and a cough.  Typically, these symptoms (if they happen at all) occur a few weeks after the person contracts the virus.
  • Chronic HIV: The second stage can last for years.  The virus reproduces within the body and, eventually, leads to AIDS.  A person with chronic HIV may or may not experience symptoms.  However, with proper treatment, some people may never develop AIDS.
  • Acquired Immunodeficiency Syndrome (AIDS): The final stage of HIV is when the amount of the virus within the body is so high that the immune system is completely compromised. When this occurs, they are highly susceptible to opportunistic infections and other illnesses.  Those with AIDS typically only survive three years without proper treatment.

While there is no cure for HIV or AIDS, these conditions may be prevented, and their progress mitigated.  Many people who have HIV can live healthy lives with the right antiviral treatment plan.  Nonetheless, this does not mean that a person who suffers from either of these conditions will be fit enough to work, and in these scenarios may need LTD benefits to help protect their income.

What Are the Symptoms of HIV and AIDS?

Those who experience symptoms are likely to believe they are suffering from the flu.  However, the symptoms associated with HIV are nonspecific, which means that, in and of themselves, they do not indicate that a person has HIV.  A person who experiences such symptoms should go to their doctor.  The only way to know for sure if you have HIV is to get tested.

The symptoms of stage one HIV include:

  • Fever;
  • Headaches;
  • Sore throat;
  • Mouth sores;
  • Muscle pains and aches;
  • Joint pains;
  • Coughing;
  • Diarrhea;
  • Sweating at night; and
  • Rashes.

A person may experience no symptoms, mild symptoms, or severe symptoms.  In most cases, a person may simply ignore these symptoms thinking it is something else.

The symptoms of stage two HIV can be similar to stage one.  However, it is during this second stage that the virus multiplies.  You may experience certain chronic signs, such as:

  • Swollen lymph nodes;
  • Fever;
  • Weight loss;
  • Shingles;
  • Fatigue;
  • Diarrhea;
  • Oral yeast infection; and
  • Pneumonia.

If your HIV progresses to the third stage, AIDS, you will find many of the same symptoms, only worse.  For example, you may have chronic diarrhea or persistent fatigue.  If you have AIDS, you may also experience white spots or lesions inside your mouth and on your tongue.

As mentioned earlier, with proper treatment, people with HIV can lead mostly normal lives.  This begs the question: “How can someone receive long-term disability benefits for a condition that responds well to treatment?”  Unfortunately, the antiviral medications needed to treat HIV have a host of side effects.

The Basic Elements of a Long-Term Disability Policy

You should include the side effects incurred from the treatment of HIV in your long-term disability claim or appeal.  These side effects may be the reason you cannot work, and, since treatment lasts indefinitely, you may not be able to work for an extended period.  The side effects of HIV treatment can include:

  • Nausea;
  • Vomiting;
  • Diarrhea;
  • Heart disease;
  • Weakened bones;
  • High blood sugar levels;
  • Kidney and/or liver damage;
  • Sleep issues;
  • Emotional issues; and
  • Cognitive issues.

Moreover, you must routinely see your doctor for treatment, which can also take time away from doing your job.

How Does Someone Receive an HIV Diagnosis?

The symptoms of HIV and AIDS do not constitute a diagnosis.  To receive an official diagnosis of HIV, you must take a blood or saliva test.  Several tests exist that can detect the HIV virus, such as:

  • Antigen tests: Blood is drawn, and antigens present within the virus may be detected.
  • Antibody tests: These types of tests may be done at home by the individual. It involves testing a blood or saliva sample to look for antibodies.  These tests typically will not show up “positive” until three to twelve months after infection.
  • Nucleic acid tests (NATs): These tests can detect the virus in the blood and may be used within a few weeks of potential exposure to the virus.

Additionally, there are tests that can determine which stage of the disease you are in.  These tests include:

  • CD4 T cell count: HIV attacks and destroys CD4 T white blood cells.  Your total count drops below 20 when you develop AIDS.
  • Viral load (HIV RNA): This test will measure how much of the virus is in your blood.  With treatment, the viral load in your blood can become undetectable, which can help keep you in stage two without progressing to stage three.
  • Drug resistance test: Sometimes a strain of HIV does not respond to certain drugs. This test can determine which drugs it is resistant to and can help your doctor create a specialized treatment plan for you.

Further, your doctor may also check for other infections, such as tuberculosis or a urinary tract infection.

How Does a Claimant Prove That HIV Disables Them?

It is important to include everything that contributes to your inability to work because of your HIV/AIDS diagnosis — this includes any side effects you experience from your treatments.  To receive long-term disability benefits, you must prove to your insurer that your HIV impairs your ability to perform the material duties of your job.  This not only includes your day-to-day tasks but also duties such as reliably arriving to work on time every day.

HIV is a progressive disease, but it progresses differently for every individual.  Therefore, it is important to show how your condition has progressed to the point that you can no longer work.  Insurance companies prefer “objective” evidence, such as blood tests, which can specifically point toward the disease in question.  When you submit your LTD claim, it is important to include the results of any tests you may have taken to receive your diagnosis.

Definition of Disability in Long-Term Disability Policies Explained

Moreover, it is important to submit your medical history, medical records, and specialized reports from your treating doctors as part of your claim.  These forms of evidence — along with your claimant forms, symptom journal, witness statements, and any additional evaluations — can bolster your claim and demonstrate your disability.

However, it is not enough to just prove that you have HIV and that it prevents you from working.  You must read your long-term disability policy wherein you will find a definition of disability.

You will either have an “own occupation” definition or an “any occupation” definition.  If you have an “own” definition, your evidence must show that you can no longer perform the duties of your job; if you have an “any” definition, your evidence must show that you can no longer perform any job whatsoever.

How Can a Long-Term Disability Lawyer Help?

Unfortunately, insurance companies deny many claims.  When this happens, it can be discouraging.  It is easy to make a common mistake when filing your claim, which can result in a denial of benefits.

Consulting a long-term disability lawyer is beneficial for any claim or appeal.  Our Chisholm Chisholm & Kilpatrick team has over 30 years of collective experience dealing with insurance companies.  We know what they are looking for and can help guide you through this process.

When you are suffering from HIV/AIDS, it can be difficult to know what to include with your claim and what not to include.  We have the necessary experience to ascertain the best evidence that will prove your disability per the definition within your policy.  We can collect this evidence and submit it on your behalf.

Moreover, we can track all deadlines to ensure your claim receives a fair review so that you may retain your rights to file for disability benefits.  This is not something you must do alone.  If your HIV, or your treatment for HIV, is preventing you from working, you may qualify for LTD benefits.

Call CCK Today

If you suffer from HIV or AIDS and can no longer work, you may qualify for long-term disability benefits.  This process may be overwhelming, but a long-term disability insurance attorney can help.  CCK understands the stress that comes from receiving an HIV diagnosis, and we know that filing for LTD benefits and dealing with the insurance company only makes it more burdensome.

Call CCK today at (800) 544-9144 for a free case evaluation concerning your claim or appeal.  Our team is prepared to assist you and will evaluate your case to see if we can help.