Getting Long-Term Disability (LTD) Benefits for Multiple Sclerosis
The process for getting your long-term disability (LTD) benefits for multiple sclerosis (MS) is not always as easy as filing a claim and then receiving your checks. Wrongful denials are all too common for those who suffer from MS.
Coping with MS can be difficult enough without also having to fight with the insurance company, particularly if your LTD claim has been denied and you need to file an appeal for LTD benefits.
Insurance companies are powerful, have a lot of resources, and can be motivated by their own financial interests to deny your claim. At Chisholm Chisholm & Kilpatrick LTD, our team of attorneys and professionals help clients access their ERISA and non-ERISA LTD benefits from insurance companies. We have experience helping MS claimants.
We can take on the burden of dealing with the insurance company for you, so that you can focus on your health and family. Contact us now at 401-331-6300 for a FREE consultation to see if we can fight for you.
Multiple Sclerosis is a chronic condition in which the immune system malfunctions and attacks the central nervous system, causing inflammation. In MS, myelin, or the “insulation,” surrounding neurons in the brain and spinal cord are damaged or destroyed by the immune system’s T cells, forming scar tissue (sclerosis).Definition of MS. (n.d.). Retrieved January 25, 2018, from 2 https://www.nationalmssociety.org/What-is-MS/Definition-of-MS
Lesions materialize in the brain and spinal cord where myelin is damaged or destroyed. Nerve impulses to and from the brain are distorted or interrupted when myelin is damaged, causing the symptoms of MS.Magnetic Resonance Imaging (MRI). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI
MS is not a cookie cutter disease. There are different types of MS, and the disease impacts people’s ability to work in different ways:
- Relapsing-remitting MS (RRMS) is the most frequently diagnosed form of the disease, making up around 85% of new diagnosesRelapsing-remitting MS (RRMS). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS. Onset of symptoms often begin in a person’s 20’s and 30’sRelapsing-Remitting Multiple Sclerosis. (n.d.). Retrieved January 25, 2018, from https://www.webmd.com/multiple-sclerosis/relapsing-remitting-multiple-sclerosis#1. People with RRMS experience an influx of symptoms (relapse), also known as an MS flareup or MS attack followed by periods of partial or complete recovery, remission. Relapses can be sudden and debilitating, and it can take weeks, months, or years for a person to reach the level of remission needed to function in the workplaceRelapsing-remitting MS (RRMS). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS.
- Secondary Progressive MS (SPMS) is the second phase of RRMS, usually diagnosed after 10 to 20 years from your RRMS diagnosisRelapsing-Remitting Multiple Sclerosis. (n.d.). Retrieved January 25, 2018, from https://www.webmd.com/multiple-sclerosis/relapsing-remitting-multiple-sclerosis#1. At this stage of the MS, the disease gradually progresses over time, and the patient may or may not experience relapse and remissionSecondary progressive MS (SPMS). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Secondary-progressive-MS.
- Primary Progressive MS (PPMS) affects about 15% of those diagnosedPrimary progressive MS (PPMS). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS. On average, diagnosis occurs in a person’s 40’sPrimary progressive MS (PPMS). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS. PPMS is characterized by progressively worsening symptoms over time, and tends to reach disabling levels sooner than other forms of MS because people with PPMS may require more assistance carrying out everyday activitiesPrimary progressive MS (PPMS). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS. For those suffering from PPMS, lesions appear in the spinal cord more often than in the brainPrimary progressive MS (PPMS). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS, therefore people with this type of MS tend to experience more trouble walking and increased difficulty remaining a member of the workforcePrimary progressive MS (PPMS). (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS.
The exact cause of MS is still unknown. Research is being conducted to determine the immunologic, environmental, infectious, and genetic factors that may contribute to an MS diagnosisWhat Causes MS? (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/What-Causes-MS. Women are two-to-three times more likely to develop MSWho Gets MS? (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS.
Symptoms, Diagnosis, and Treatment
Symptoms of MS vary from case-to-case, and can include both physical and cognitive symptoms. Some physical symptoms include:
- Tingling or progressive numbness
- Sensory impairment such as optic neuritis or double vision
- Bowel and bladder problems
- Involuntary muscle spasms
- Difficulty walking due to a lack of balance
- A combination of symptoms listed aboveRelapsing-Remitting Multiple Sclerosis. (n.d.). Retrieved January 25, 2018, from https://www.webmd.com/multiple-sclerosis/relapsing-remitting-multiple-sclerosis#1,MS Symptoms. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms
It is also common for someone with MS to display inhibited cognitive functions related to:
- Processing sensory information
- Retaining, gaining, or retrieving new information (memory)
- Verbal fluencyCognitive Changes. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Cognitive-Changes#section-3
MS can be difficult to diagnose. Often, some people experience MS symptoms before they are officially diagnosed. Your doctor may look for damage or deterioration in two separate areas of the central nervous system such as the optic nerves, spinal cord, and brainDiagnosing MS. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-MS.
Common diagnostic tests include:
- MRI to detect lesions
- Cerebrospinal fluid assessment
- Visual evoked potential test to measure nerve-response time to stimulation
- Blood tests to rule out other diseasesDiagnosing MS. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-MS
At this point, there is no medical cure for MS. There are different therapies used to manage MS symptoms. Here are some examples:
- Disease modifying therapy to reduce the number of relapses and delay the disability’s progressionMedications. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/Treating-MS/Medications
- Corticosteroids to reduce inflammation during severe relapses Disease Modification. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/For-Professionals/Clinical-Care/Managing-MS/Disease-Modification
- Rehabilitation such as gait assistance or physical therapy Disease Modification. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/For-Professionals/Clinical-Care/Managing-MS/Disease-Modification
- Immunosuppressive drugs to reduce the strength of the immune system, slowing the attack of myelinRelapse Management. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/For-Professionals/Clinical-Care/Managing-MS/Relapse-Management
- Medications to help manage specific symptoms such as spasticity or bladder functionMultiple sclerosis. (2017, August 04). Retrieved January 25, 2018, from https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274
- Cognitive rehabilitation such as restorative and compensatory techniques. These include learning and memory exercises as well as everyday methods to compensate for what skills have been lost or impactedCognitive Changes. (n.d.). Retrieved January 25, 2018, from https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Cognitive-Changes#section-3.
CCK Understands Multiple Sclerosis Disability Claims
We know that MS can progress and your symptoms can worsen over time. This condition can severely affect your ability to work. Cognitive complications caused by your MS can result in forgetting information needed to successfully do your job, or impact your ability to effectively communicate. Physical effects of MS can be debilitating and greatly impact your ability to perform basic tasks.
Your insurance company may not understand your MS and how it impacts your ability to work. By way of example, you may have worked with MS for years before having to stop work altogether. The insurer might ask you what changed. You worked for years with MS, why do you have to stop now? They don’t get it. We do. At CCK, we understand how physical and mental fatigue, and other symptoms progress to the point of disability. We also have experience working with professionals like you who, after years of pushing through and overcoming MS symptoms to remain working, had to abruptly stop after an MS flareup.
How can CCK help you with your LTD appeal?
CCK helps level the playing field for you against the insurance company by using its knowledge and experience assisting people, including those with MS, access their LTD benefits.
Finding insurance company errors
We analyze the insurance company’s denial letter. We also collect the insurance company’s claim file, as well as the policy and other plan-governing documents. There are many rules that the insurance company must follow. We use our knowledge of and experience with ERISA, the U.S. Department of Labor Regulations, and insurance policies to identify errors made by the insurance company.
Communication with doctors during the appeal process
It is important to have treating doctors that support your claim and who are willing to thoughtfully complete forms and provide reports. Some doctors don’t like to get involved with disability claims. We have experience dealing with that at CCK. Most doctors want to help, but they are busy with the demands of their medical practices. We work to facilitate the flow of information from your doctor to the insurance company. We do what we can to ease the burden on your doctor. We also talk to our clients about how to discuss their disability with their doctors. For example, it is important to ask your doctor to document examination findings, medication changes and side effects, your symptoms, and how they impact your ability to function.
Gathering evidence and writing the appeal
Handling an LTD appeal requires much more than just completing paperwork. An out of work note from your doctor is probably not enough to convince an insurance company to pay you your benefits. At CCK, we take a comprehensive approach to appeals. We gather the evidence that you will need for court and submit it with your appeal in an effort to put you in the strongest position possible. This might include items such as:
- Medical records
- Test results
- Reports from your treating doctors
- Expert opinions
- Witness statements from you, your family, friends, or co-workers
Preparing a strong and complete evidence record to file with an LTD appeal is particularly important with ERISA-governed LTD appeals because often, the administrative appeal is the last chance that claimants have to submit substantive evidence into the record. One of the major hardships that ERISA LTD claimants face is the fact that new evidence is seldom allowed to be added to the administrative record in court. We take care of this for our clients.
After gathering the evidence, we write the appeal. We thoughtfully explain why our clients meet the policy’s definition of disability and other conditions for coverage. Our arguments are based on and supported by the evidence.
Call Chisholm Chisholm & Kilpatrick Today
Let us help you. Contact us now at 401-331-6300 for a FREE consultation to see if we can fight for you.
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