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 Multiple Sclerosis 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, 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 case evaluation to see if we can assist you.
Understanding Multiple Sclerosis
Multiple Sclerosis is a chronic condition in which the immune system malfunctions and attacks the central nervous system, causing inflammation. In MS, myelin, i.e., 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).
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.
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 percent of new diagnoses. The onset of symptoms often begins in a person’s twenties and thirties. People with RRMS experience an influx of symptoms (relapse), also known as an MS flareup, or an 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 workplace.
- Secondary Progressive MS (SPMS) is the second phase of RRMS, usually diagnosed after 10 to 20 years after your RRMS diagnosis. The disease gradually progresses over time, and the patient may or may not experience relapse and remission.
- Primary Progressive MS (PPMS) affects about 15 percent of those diagnosed. On average, diagnosis occurs in a person’s forties. 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 activities. For those suffering from PPMS, lesions appear in the spinal cord more often than in the brain. Therefore, people with this type of MS tend to experience more trouble walking and increased difficulty remaining a member of the workforce.
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 diagnosis. Moreover, women are two-to-three times more likely to develop MS.
Symptoms, Diagnosis, and Treatment of Multiple Sclerosis
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 above
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 fluency
Multiple Sclerosis 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 areas of the central nervous system such as the optic nerves, spinal cord, and brain.
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 diseases
At this point, there is no medical cure for MS. Yet there are different therapies used to manage MS symptoms, such as:
- Disease-modifying therapy to reduce the number of relapses and delay the disability’s progression.
- Corticosteroids to reduce inflammation during severe relapses.
- Rehabilitation such as gait assistance or physical therapy.
- Immunosuppressive drugs to reduce the strength of the immune system, slowing the attack of myelin.
- Medications to help manage specific symptoms such as spasticity or bladder function.
- 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 impacted.
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. The physical effects of Multiple Sclerosis 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. For 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 do not 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?
If you are unable to work due to MS, then you must consider filing for LTD benefits. However, insurance companies often deny long-term disability insurance claims. Regardless if you have an individual policy or an employer-sponsored plan governed by ERISA, you have the right to file an appeal.
To receive monthly benefits, you must prove that your condition meets your policy’s definition of disability. You must also demonstrate within your appeal that your insurer’s original decision was wrong. CCK helps level the playing field for you against the insurance company by using its knowledge and experience.
Finding Insurance Company Errors
We can analyze the insurance company’s denial letter. This letter will cite the reasons your insurer denied your claim. For example, they may cite a “lack of evidence.” We also collect the insurance company’s claim file, the LTD policy, and other plan-governing documents.
There are rules that the insurance company must follow too. 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 so that you may receive your long-term disability benefits.
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 do not like to get involved with disability claims. However, we have experience dealing with such doctors and can help obtain important reports from them.
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.
It is important to have open communication with your treating doctor so that they may fully understand the extent of your illness or injury, i.e., your MS. For example, it is important to ask your doctor to document examination findings, medication changes, medication 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 long-term disability 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. Under ERISA, the administrative appeal stage is often the last time you submit such evidence. This evidence 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
One of the major hardships that ERISA long-term disability claimants face is the fact that new evidence is seldom allowed in court.
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 we collect.
Call Chisholm Chisholm & Kilpatrick Today
People living with MS may try to work through the symptoms, but this can create more issues. Moreover, there are strict filing deadlines to which you must adhere. If you do not file your claim and/or appeals at the right time, you may lose out on your benefits entirely. Let us help you.
We understand how frustrating this process is and want to help. We can help you understand your long-term disability coverage and your policy, which contains essential information for your claim, such as the elimination period (i.e., the waiting period); length of benefits; how to appeal; the definition of disability; filing deadlines; limitations and exclusions; and more.
Contact CCK today at (800) 544-9144 for a free case evaluation. A member of our team will analyze your case and determine if we can assist you.
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