Getting Long-Term Disability (LTD) Benefits for Organ Transplants

In the United States, there are around 25,000 organ transplants performed each year.  The people who require these procedures often cannot work — both before and after receiving the organ.

In situations where the person cannot work, they may need to file for long-term disability (LTD) benefits.  Such benefits can protect a percentage of their pre-disability income.  However, getting long-term disability benefits for organ transplants is not always easy.

As with any LTD claim, the process is often complex.  You must file your claim with your insurance company.  Insurers, however, issue many denials of claims, which can be disheartening to receive.  If you are in the process of receiving an organ transplant and cannot work, you may qualify for long-term disability benefits.  Call us today at (800) 544-9144 for a free case evaluation; we may be able to help you.

What Are Organ Transplants?

An organ transplant is when one of the 78 organs in the human body is surgically removed from one person (i.e., the donor) and surgically inserted into another (i.e., the recipient).  The primary reason a person needs an organ transplant is that their organ is either damaged or has failed entirely.

While this medical procedure can save a person’s life, it carries with it inherent risks.  Moreover, there are far more people in need of organ transplants than there are donors.  This results in lengthy waitlists and, in some cases, patients dying when they cannot receive an organ quickly.

The most common types of organ transplants include:

• Heart transplants;
• Liver transplants;
• Pancreas transplants;
• Kidney transplants;
• Lung transplants;
• Intestine transplants;
• Stomach transplants;
• Vascular tissue transplants; and
• Cornea transplants.

The above list is not exhaustive, but it represents some of the more common transplants that people seek.

How Does an Organ Transplant Prevent a Person from Working?

When a person needs an organ transplant it means that an organ within their body is no longer functioning properly, often due to disease or injury.  An organ transplant itself may prevent you from working.  Likewise, the condition from which you suffer that necessitates an organ transplant may also prevent you from working.

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The Social Security Administration (SSA) automatically considers those who receive an organ transplant as disabled for 12 months.  After this 12-month period, they reevaluate the person’s condition to determine if benefits should be extended.  Now, while the SSA is no indication of whether your insurer will approve or deny your LTD claim, it does offer some insights into how long recovery can take.

Often, when you receive an organ transplant, you are prescribed medication.  This medication can have debilitating side effects, such as:

• Nausea;
• Vomiting;
• Diarrhea;
• High cholesterol;
• Anemia;
• Weakened bones;
• Sleep issues; and
• Tremors.

Other side effects may occur from medications.  After an organ transplant, your body needs to “accept” the new organ.  Some people’s bodies reject the new organ, which can lead to serious complications.  If your body rejects the new organ, you may experience pain; fatigue; swelling; and flu-like symptoms.  This rejection can be acute or chronic.  If it is chronic, it can lead to the organ failing.

Moreover, after you receive an organ transplant, there are further complications that can arise because of this procedure.  Complications such as:

• Diabetes;
• High blood pressure;
• Gastrointestinal issues;
• Gout; and
• Anxiety/depression.

If you develop one of the abovementioned conditions, then you may find it inhibits your ability to work even further.

Filing a Long-Term Disability Claim for an Organ Transplant

If you suffer from a condition that requires you to undergo an organ transplant, or you have received an organ transplant and are in recovery, long-term disability benefits may be necessary.  If you find that your condition or your transplant is preventing you from working then you need to consider such benefits, which can protect a percentage of your income if you become unable to work due to your organ transplant.

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You may have an LTD policy through your employer (i.e., ERISA-governed group policies) or directly with an insurance company (i.e., an individual policy).  Regardless, it is vital that you read it thoroughly as your policy may have exclusions, which are not covered.  We encourage claimants to verify that their organ transplant or related condition is not listed.  Moreover, you should also pay attention to any limitations your policy may have, which may limit how long you can receive long-term disability benefits.

Your LTD policy also includes a definition of disability.  This definition is especially important when seeking benefits.  In short, you must prove that your condition — in this case, your organ transplant — disables you per the specifics of your policy’s definition.

Filing a long-term disability claim for an organ transplant can be difficult.  You must submit a notice of claim; documentation explaining your condition; physician and employer forms; and evidence that supports your claim.  Moreover, you will have to deal with the insurance company.

While obtaining such benefits is not impossible, consulting with an experienced long-term disability insurance attorney can help your chances of receiving the financial support you require.

What Happens If the Insurance Company Terminates Your LTD Benefits for an Organ Transplant?

If your initial claim is denied by your insurance company,  then you have the right to appeal.  However, what if your claim or appeal is approved, you begin to receive benefits, but then your insurer terminates your benefits?

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When you begin receiving LTD benefits, your insurance company will likely inquire periodically about your condition.  They may request further information to see if your condition still impairs you.  You may also have short-term disability benefits that are being reevaluated before transitioning to long-term disability benefits.  In any case, they may terminate your benefits.

If your insurer terminates your benefits because they think your condition no longer impairs you, you have the right to appeal this decision.  While this is something you can do on your own, having a long-term disability lawyer help you with your appeal is vital.  CCK has over 20 years of experience working with insurance companies and we know how they operate.  We can help you appeal their decision so that you may have your benefits reinstated.

Call CCK Today for a Free Case Evaluation

If you have received an organ transplant and cannot work, then consider filing for long-term disability benefits.  The side effects of transplant treatment; the complications that may arise from the procedure; and the conditions that cause an organ to fail (and that will continue to impair you while you wait for a compatible donor) can all sideline you and prevent you from working.

It is not always a straightforward process to obtain LTD benefits.  These benefits, however, are important.  We understand how difficult this process is.  We know how stressful it can be to file for benefits and manage your condition.  The long-term disability attorneys at Chisholm Chisholm & Kilpatrick are prepared to help.  Call us today at (800) 544-9144 for a free case evaluation with a member of our team.  We will analyze your case and see if we can assist.