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Qualifying Conditions

Getting Long-Term Disability (LTD) Benefits for Orthopedic Issues

Getting Long-Term Disability (LTD) Benefits for Orthopedic Issues

A wide variety of conditions can be classified as orthopedic issues.  In fact, orthopedic conditions affect at least 50 percent of Americans.  As such, many of these conditions can make it impossible to work or may lead to other complications.  If you suffer from an orthopedic issue, you may need to file for long-term disability (LTD) benefits.

It is common to wonder whether you will qualify for such benefits if you suffer from an orthopedic issue.  If your condition prevents you from performing the duties of your job, you may qualify for these benefits.  If you need help filing your claim (or appealing a denial of your claim), you can call us today at (800) 544-9144 for a free case evaluation with a member of our team.

What Are Orthopedic Issues?

Orthopedic issues are medical conditions or injuries that affect the musculoskeletal system of the body.  This includes conditions that affect a person’s muscles, bones, joints, connective tissues, and tendons.  When you suffer an injury or develop a disease that impacts these parts of the musculoskeletal system, it can drastically prohibit you from working and impact your quality of life.

Long-Term Disability (LTD) 101

There are a multitude of orthopedic issues from which you may suffer, including:

  • Arthritis: This umbrella term includes over 100 types of this disease that affects the joints in the body and is one of the most common disabling conditions in the U.S.
  • Bursitis: This painful condition affects the bursae — the fluid-filled sacs that cushion a person’s joints.  When a person suffers from bursitis, these sacs become inflamed.
  • Scoliosis: This condition affects a person’s back and is when the spine is curved sideways.
  • Lower back pain: Affecting the lumbar region of a person’s back, this pain is often caused by injuries to the ligaments and muscles in the back.  This pain, in some situations, may be chronic.
  • Musculoskeletal cancer: This umbrella term concerns cancers that affect the bones and muscles of your body.
  • Muscle atrophy: A person whose muscles are thinning may suffer from muscle atrophy.  In short, the person loses muscle tissue causing weakness in the affected areas.
  • Knee pain: Many conditions cause knee pain, but it can also be the result of an injury.  Usually, the ligament or cartilage in the knee is torn or ruptured.
  • Osteoporosis: This condition causes bones to become weak and brittle.
  • Fibromyalgia: While difficult to diagnose, this disorder can cause fatigue, sleep issues, changes in mood, and memory problems.  It can also cause musculoskeletal pain throughout the body.

As the abovementioned conditions show, it can be difficult to work while suffering from an orthopedic issue.  This list is not exhaustive.  If you believe you may be suffering from one, it is best to visit your doctor as soon as you can.

Can a Person with Orthopedic Issues Qualify for Long-Term Disability Benefits?

Orthopedic issues can cause a person to experience great pain; loss of movement; weakness; motor restrictions; and more.  Even a sedentary job may be too much for a person suffering from such an issue, for these issues can cause pain exacerbated by sitting or standing for extended periods.

7 Common Long-Term Disability (LTD) Claim Mistakes (Part 1)

As mentioned earlier, orthopedic issues may be caused by injuries, usually trauma to a joint or muscle.  However, this is not always the case.  Some orthopedic issues may develop on their own or with age.

Common symptoms of orthopedic issues include (but are not limited to):

  • Deformities around the joints;
  • Fatigue;
  • Numbness and/or tingling sensations;
  • Joint pain;
  • Joint swelling;
  • Joint stiffness (i.e., a limited range of motion);
  • Weakness in the affected areas; and
  • Pain that can be dull or sharp, and mild or severe.

These symptoms, even when mild, can make working difficult.  For example, if you feel fatigued you are more likely to make mistakes and lose focus while at work.  Moreover, if you experience joint stiffness and pain, you will not be able to move with your full range of motion, which can reduce what you are able to do.

Diagnosis and Treatment for Orthopedic Issues

How your orthopedic issue is diagnosed will depend upon the specific condition from which you suffer.  However, you will have to visit your doctor to receive an official diagnosis.  Moreover, your doctor will perform a physical exam and try and rule out other conditions.

Some common diagnostic tests that doctors use to test for orthopedic issues include skeletal scintigraphy; myelography; and bone densitometries.  Additionally, your doctor will likely conduct flexibility tests; stress tests; or muscle tests to further help diagnose your condition.  In some cases, a muscle or bone marrow biopsy may be necessary.

As with a diagnosis, the treatment of your orthopedic issue will depend upon which condition you have.  However, many orthopedic issues may be treated with over-the-counter pain and inflammation medications.  Moreover, hot and/or cold compresses may be used to reduce swelling and relieve pain.

In certain cases, you may need physical therapy or — in the case of scoliosis — a physical device such as a back brace.  Furthermore, in some situations, you may need surgery — though this is usually the last option for many conditions.

Filing a Long-Term Disability Claim for an Orthopedic Issue

Regardless of which orthopedic issue you suffer from, you must file a claim with the insurance company to receive LTD benefits.  These benefits are important because they can protect a portion of your income when you cannot work.

To file a claim with your insurance company, you must file a notice of claim; this alerts your insurer that you intend to file an LTD claim.  Next, you must submit the claim forms and all relevant evidence that proves your disability.  However, it is not enough to just show you have an orthopedic issue.

Your policy includes a definition of disability that is vital for your claim.  This definition will either be an “own occupation” definition or an “any occupation” definition.  In other words, are you disabled from only your specific job or from any job whatsoever?  The evidence you submit must prove your condition disables you per your policy’s specific definition of disability.

Definition of Disability in Long-Term Disability Policies Explained

Insurance companies often deny claims.  Consulting a long-term disability lawyer is beneficial.  CCK, for example, can review your LTD policy; collect evidence that proves your disability; and submit it on your behalf to the insurance company.  Moreover, we can act as a point of contact between you and your insurer.  This relieves stress and helps you avoid common mistakes when filing for long-term disability benefits.

Additionally, if you have a policy through your employer, you must be aware of ERISA, which has its own strict deadlines and regulations.  Our ERISA attorneys are well-versed in this federal law and will ensure your claim is compliant.

Appealing a Denial of LTD Benefits

Many insurance companies prioritize their own financial needs above those of their clients.  Typically, if an insurer can find a reason to deny a claim, then they will.  Sometimes they will hire a private investigator to surveil claimants to discover a discrepancy in their claims.  If they find one, they will use it against the claim.

Long-term disability claims for orthopedic issues may receive denials.  This can be disheartening and stressful; it may seem like an obstacle you cannot overcome.  However, you have the right to appeal your insurer’s decision.  Depending on your policy, you may be able to appeal several times.  A long-term disability attorney can also help you with your appeal; it is a crucial stage, especially under ERISA, since this is the last time you may submit evidence in support of your claim.

Call CCK Today for a Free Case Evaluation

Our long-term disability lawyers have over 30 years of experience dealing with insurance companies.  We know what they look for in a successful claim, and we will ensure they handle your claim fairly.  This is not something you must do alone.  We are prepared to help you at whatever stage in the process you are.

Call CCK today at (800) 544-9144 for a free case evaluation with a member of our team.  We will analyze your claim and determine if we can assist you.