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Getting Long-Term Disability (LTD) Benefits for Lupus

If your claim for long-term disability (LTD) benefits for Lupus has been denied, this is not the end of the road for you. We understand that Lupus can be a debilitating and unpredictable disease that can render you unable to work.

Appealing to an insurer for benefits can take its toll on anyone, especially for someone suffering from symptoms of a chronic condition such as Lupus. We have years of experience in handling ERISA and non-ERISA LTD appeals, and are well equipped to help you fight against the insurance company for your disability benefits.

Let our experienced attorneys fight for you, so that you may focus on your health and well being. Call us for a free consultation: 401-331-6300.

About Lupus:

Lupus is a chronic autoimmune disorder that can affect many of your body’s systems and organs such as the skin, joints, and central nervous system. Inflammation and pain are caused by autoantibodies attacking healthy cells in your body. Sufferers of Lupus experience periods of illness, or flares, followed by periods of recovery and wellness, or remission. It is estimated that at least 1.5 million Americans have Lupus. Every 9 of 10 people diagnosed with Lupus are women.[1][2][3]

Forms of Lupus:

  1. Systemic Lupus Erythematosus (SLE) is the most common form of Lupus, with symptoms ranging from mild to severe. The term “systemic” means that this form of lupus can affect several areas of the body.
  2. Cutaneous Lupus Erythematosus is limited to the skin and can cause many types of rashes and lesions. These rashes or lesions have the potential to last from days to years, and may cause scarring. Some people with this form of Lupus also have Systemic Lupus Erythematosus (SLE), or may develop SLE in the future.
  3. Drug-induced Lupus is caused by certain medications, and shares symptoms comparable to SLE. Usually, these symptoms cease when the medication causing Drug-Induced Lupus is stopped.[4]

What Causes Lupus?

The cause of Lupus is still unknown. Scientists speculate that Lupus may be caused by a combination of genetic, hormonal, and environmental factors. People may be born with a genetic predisposition for lupus, as about 100 genes have been linked to the condition.[15] Although people can develop Lupus when there is no family history of it, other autoimmune disorders are often present. Women of African-American, Hispanic/Latino, Native American, and Pacific Islander descent face a greater risk of developing Lupus, which may be linked to genes they share.

It is believed that environmental factors such as exposure to certain chemicals (medications), viruses (e.g. mononucleosis), UV rays, exhaustion, and stress can lead to Lupus onset in those genetically predisposed. Hormones may also play a role in a person developing this disorder due to the fact that the vast majority of cases manifest in women of child bearing age, when hormones are abundant; however, no definitive proof exists to show a link between hormones and Lupus.[5]

Symptoms of Lupus:

  • Headaches, memory loss, and confusion
  • Unexplained fever
  • Joint pain or swelling
  • Mouth ulcers
  • Fatigue
  • Malar rash (butterfly rash) across cheeks and nose, or in other sunlight-exposed areas
  • Hair loss
  • Swollen glands
  • Sensitivity to sun or light
  • Shortness of breath or pain in the chest while inhaling
  • Anemia
  • Memory loss
  • Depression
  • Raynaud’s syndrome in which smaller arteries in the fingers constrict, reducing blood flow to finger tips
  • Swelling of the hands, legs, feet, or around the eyes[6][7]

Lupus symptoms one might encounter, and their severities, vary. Those with more serious cases of Systemic Lupus (SLE) may experience:

  • Lupus nephritis, or inflammation of the kidneys, impairs the body’s ability to filter waste from the blood; this condition may result in the need to undergo dialysis treatments or kidney transplants.[8]
  • Inflammation of the nervous system, especially in the brain, may result in memory problems, headaches, confusion, or strokes.
  • Vasculitis, or the inflammation of blood vessels, can affect how blood circulates through the body. Inflammation of blood vessel walls in the brain and other areas of the body can cause seizures, high fevers, and blood clots.
  • Increased risk of developing atherosclerosis, otherwise known as coronary artery disease.[9]
  • Pleuritis, or inflammation of the pleura (the lining covering the outside lungs), can cause severe, stabbing chest pain (called pleurisy) while breathing, coughing, sneezing, or laughing; those with pleuritis face an increased risk of developing conditions such as pneumonia. It is estimated that 40-60% of people living with Lupus experience pain caused by pleurisy.[10]
  • Pericarditis caused by inflammation of the lining around the heart may also occur, resulting in chest pain similar to pleurisy.[11]

Diagnosis and Testing:

Lupus shares many of the signs and symptoms associated with other disorders, making it difficult to diagnose. The effects that Lupus has on the body can vary greatly over time, and differ from person to person. When considering a Lupus diagnosis, physicians will first take a close look at your current symptoms, lab results, medical history, and the medical history of close family members such as parents, siblings, and grandparents. Since no singular test can definitively affirm a Lupus diagnosis, one may be required to undergo a combination of medical evaluations to receive a proper diagnosis.

  • Urine tests such as Urinalysis can measure effectiveness of the kidneys based on the presence of protein in urine.[12]
  • Blood tests are used to assess kidney and liver function by analyzing the patterns and presence of blood cells (red and white), antibodies, lipids, and proteins in the blood.
    • Antinuclear Antibody (ANA) Tests are very commonly used in diagnosing Lupus. An ANA test reveals the presence of antinuclear antibodies. These antibodies bind to the cell’s nucleus, resulting in extensive damage or destruction of the cells effected. Studies show that up to 97% of people with Lupus test positive for ANAs, although people without Lupus can also test positive.[12]
    • Complete Blood Cell Count (CBC) measures red and white blood cell, platelet, and blood serum levels.[12]
  • Chest X-rays and Echocardiograms can serve as a useful screening tool if your treating physician believes that Lupus is affecting your heart or lungs.[12]
  • Skin or kidney tissue biopsy can detect autoimmune antibodies to help reveal the amount of inflammation and damage occurring in these cells.[12]

The American College of Rheumatology (ACR) has developed a list of 11 criteria to help aid in diagnosing Lupus; if a person meets at least four of the following criteria, either currently or in the past, doctors believe that there is a strong chance that person has Lupus:

  1. Malar rash (butterfly rash) across the cheeks and nose
  2. Discoid rash appearing as red, circular patches
  3. Photosensitivity after being exposed to sunlight or fluorescent lighting, resulting in a rash or worsening of a rash
  4. Oral ulcers
  5. Arthritis, such as rheumatoid arthritis, where two or more joints become inflamed
  6. Serositis, or the inflammation of tissues lining the body, this term encompasses pleuritis and pericarditis
  7. Kidney disorder resulting in an inability to filter waste from the blood
  8. Neurological disorders, such as seizures and memory loss
  9. Blood disorders such an anemia
  10. Immunologic disorders
  11. Abnormal antinuclear antibody (ANA) test results[12]

Treatment:

  • Corticosteroids can be used to counter inflammation in Lupus-affected areas during flare-ups, and are especially effective in the kidneys and brain.[12]
  • Antimalarials can help prevent flares and improve such symptoms as skin lesions, mouth ulcers, pericarditis, pleuritis, muscle and joint pain, fatigue, and fever.[12]
  • Immunosuppressants may be helpful in treating more severe cases of Lupus where organs are at risk; by suppressing the immune system, immunosuppressants reduce autoantibody attacks on healthy cells.[13]
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain, swelling, and fever in those affected by Lupus.[12]

Proper medical regimens for Lupus vary from person to person. Other medications are available for case-specific symptoms to reduce the probability of complications. For example, those with an increased risk of developing blood clots may avoid complications by taking anticoagulants, which thin the blood.[14]

Regardless of what symptoms you are facing, or how far your Lupus has progressed, maintaining a healthy lifestyle remains important. Eating a well-balanced diet, getting sufficient rest, exercising regularly (if possible), wearing sunscreen, and getting vaccinated against conditions such as the flu and pneumonia can help prevent flares, avoid complications, and contribute to the best quality of life possible.[14]

CCK Understands Lupus Disability Claims

Your ability to work can be considerably impacted by the effects of Lupus. For example: joint issues can prevent those whose work involves manual labor, such as lifting or bending, from adequately performing; fatigue and fevers can make it difficult to concentrate while carrying out complex or even administrative tasks; and significant kidney damage can result in spotty attendance at work due to frequent dialysis treatments.

If you have long-term disability insurance and your Lupus claim was denied, consult an experienced ERISA or LTD attorney as soon as possible.

How Can CCK Help You With Your LTD Appeal?

CCK’s attorneys are well-equipped to take on the insurance company, and fight for your LTD benefits. We will integrate all of our knowledge and experience into preparing your appeal.

Find insurance company errors

We are diligent in gathering and analyzing all documentation related to your case, these documents may include: your denial letter, policy documents, the insurance company’s claim file, and other plan-governing documents. CCK is well aware of the rules by which insurers must abide, as well as ERISA and U.S. Department of Labor laws. We use this knowledge to identify errors made by the insurance company.

Communicate with doctors during the appeal process

Many doctors are so busy in their day-to-day medical practices that it may be difficult for them to adequately communicate your condition with the insurance company. This is why we ease the burden on your doctors by facilitating the flow of information between them and your insurer to ensure all necessary documents are completed and submitted on time. Our attorneys will also discuss with you how to most effectively communicate with your doctor about your condition, and how Lupus impacts your life.

Gather evidence and write the appeal

CCK’s experienced attorneys know how to gather all necessary information in order to build the strongest evidence record possible to then file with your appeal. Evidence we gather for the record can include:

  • Medical records
  • Test results
  • Reports from your treating physicians
  • Expert opinions
  • Witness statements from you, your family, friends, or co-workers

Preparing an exhaustive evidence record to file with an appeal is crucial. This is especially true with ERISA-governed policies, because the administrative appeal stage is often the final opportunity that a claimant has to submit substantive evidence into the record. We make certain that evidence-gathering is completed as thoroughly as possible for our clients. In our appeals, we thoughtfully explain why our clients meet the criteria for their policy’s definition of disability. Our arguments are based on, and supported by, evidence.

Call Chisholm Chisholm & Kilpatrick Today

Let our years of experience in LTD appeals benefit you. Call 401-331-6300 for a free consultation.

References

  1. https://resources.lupus.org/entry/what-is-lupus
  2. https://www.lupus.org/resources/what-is-a-flare
  3. https://www.lupus.org/resources/diagnosing-lupus-guide
  4. https://www.lupus.org/resources/types-of-lupus
  5. https://www.lupus.org/resources/what-causes-lupus
  6. https://www.lupus.org/resources/common-symptoms-of-lupus
  7. https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789
  8. https://www.lupus.org/resources/how-lupus-affects-the-renal-kidney-system
  9. https://resources.lupus.org/entry/vasculitis-and-lupus
  10. https://www.lupus.org/resources/how-lupus-affects-the-lungs-and-pulmonary-system
  11. https://www.lupus.org/resources/what-doctors-look-for-to-confirm-a-diagnosis
  12. https://www.lupus.org/resources/lab-tests-for-lupus
  13. https://www.hopkinslupus.org/lupus-treatment/lupus-medications/immunosuppressive-medications/
  14. https://www.webmd.com/lupus/understanding-lupus-treatment
  15. https://resources.lupus.org/entry/genetics

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