If your long-term disability (LTD) claim for osteoarthritis has been denied, you can take action with an appeal. Appealing for LTD benefits, however, can be a challenging process for anyone, especially for those managing the pain and mobility hindrances that can accompany osteoarthritis.
Insurance companies act in favor of their own financial interests, not yours. They will not award you the disability benefits that you deserve without a fight. This is why preparing a well-orchestrated appeal is crucial to your disability claim. Don’t leave your financial future in the hands of your insurance company.
At Chisholm Chisholm & Kilpatrick LTD, we help to relieve the stress easily encountered throughout the appeals process by applying our years of experience to your case. We have achieved many favorable outcomes for our clients. Let us put our knowledge of ERISA-governed and individual long-term disability policies to work for you. Contact our office for a free consultation: 401-331-6300.
Osteoarthritis is a chronic degenerative joint disease in which the cartilage between load-bearing joints erodes slowly over time, resulting in joint stiffness, limited mobility, and pain. Cartilage is a slippery tissue that covers the ends of bones in a joint to cushion the shock of movement, and to prevent bones from rubbing together.
Osteoarthritis is the most common form of arthritis, effecting approximately 27 million people across the United States. It is also a top cause of disability in the country, with about every one-in-two adults developing symptoms of knee osteoarthritis during their lives, and every one-in-four adults developing symptoms of hip osteoarthritis by age 85.1,2
Who gets Osteoarthritis?
There are a variety of factors that may put one at risk for developing osteoarthritis. Some of these risk factors include:
- Genetics. Inherited genes may result in defective collagen (the protein that makes up cartilage) production in the body, leading to an increased rate of deterioration in joints. People may also inherit joint abnormalities, changing how bones fit together, causing cartilage to erode faster.
- Weight. Carrying additional body weight can create added stress on load bearing joints, such as the knees and hips, causing more rapid deterioration of cartilage. In addition, fat cells release inflammatory agents called cytokines, which can increase joint-damaging inflammation.
- Injury. Those who have suffered injuries to their joints, such as fractures or torn ligaments, are at an increased risk for developing osteoarthritis in those joints.
- Overuse. Repetitive use of joints, such as bending at the knees or standing for long periods of time, can result in cartilage deteriorating more quickly. Those whose jobs demand repetitive use of their joints face a substantially higher risk of developing osteoarthritis.
- Gender. Women face an increased risk of developing osteoarthritis, although it is not yet understood why this occurs.
- Other diseases. People with rheumatoid arthritis or conditions involving overproduction of growth hormone are more likely to develop osteoarthritis.3,4
Symptoms of Osteoarthritis:
Osteoarthritis manifests itself differently among patients with the condition, depending on which joints are affected and how deteriorated the cartilage between them is. Osteoarthritis can occur in any joint. The areas most commonly affected by osteoarthritis are load-bearing joints such as the hips, knees, and spine; however, the condition can also affect joints in the fingers, thumb, neck, and big toe.
Common symptoms and complications associated with osteoarthritis are as follows:
- Soreness or stiffness of joints after periods of inactivity, resulting in a limited range of mobility;
- Swelling around one or more joints;
- A “scraping” sensation, or the feeling of bones rubbing together;
- Pain that worsens after activity, or at the end of the day;
- Bone spurs forming near damaged joints;
- Joints “giving away” or “locking,” mostly in advanced cases.5,6
Changes in joint function and/or pain slowly worsen over time as more “wear and tear” occurs to cartilage. The effects of osteoarthritis can, and often do, result in disability.7
Diagnosis and Testing:
When approaching an osteoarthritis diagnosis, doctors first take your personal and family medical history into consideration. You are often asked questions regarding when and how your pain began, details about other conditions you may have, and if you have a history of osteoarthritis in your family. Doctors also ask patients to describe the location of their symptoms, and how these symptoms affect their daily lives.
To receive an osteoarthritis diagnosis, a physical examination must be conducted so that a doctor may check for joint tenderness, swelling or redness, and the joint(s) range of motion. Following a physical exam, doctors may order an array of lab tests to check for osteoarthritis. Other tests will be conducted to rule out other conditions. Tests often administered to diagnose osteoarthritis include:
- X-ray testing. This is performed to identify factors such as bone spurs and narrowing of space between joints, revealing cartilage loss.
- MRI tests. These can produce detailed images of bones and cartilage that x-rays sometimes cannot.
- Joint aspiration, or joint fluid analysis, in which fluid is extracted from a joint. This test can rule out other medical conditions such as infections or inflammatory conditions such as rheumatoid arthritis.
- Blood tests. Conducted to rule out other conditions.8,9
There is no cure for osteoarthritis. Many forms of treatment are available for those with the condition, with the purpose of making symptoms more manageable. Which treatment your doctor selects for you will be based on your age, medical history, overall health, the location(s) in which osteoarthritis has manifested, and the severity of your symptoms.
Osteoarthritis treatments include certain therapies, lifestyle changes, medication, and surgical procedures. Methods that are commonly used to treat osteoarthritis, or to help patients manage their symptoms, include:
- Weight management. Losing weight decreases the stress put on weight-bearing joints, which, in turn, reduces pain felt in these joints.
- Physical exercise. Exercise and physical therapy can help to build muscle around affected joints, making them more stable, improving range of motion, and reducing pain. Low-impact exercises such as swimming, yoga, and tai chi are recommended for people living with osteoarthritis to improve joint flexibility and reduce stiffness.
- Analgesic drugs such as acetaminophen, opioids, and tramadol are used to reduce pain and inflammation. In addition, duloxetine (Cymbalta) has been FDA-approved to treat chronic musculoskeletal pain caused by osteoarthritis.
- Non-steroidal anti-inflammatory drugs (NSAIDS) are recommended to reduce inflammation and pain.
- Corticosteroids that can be taken orally, or as an injection. Corticosteroids in the form of cortisol are administered directly into the joint to ease inflammation and pain.
- Hyaluronic acid, a naturally occurring joint fluid that acts as a lubricant, can be injected directly into the joint to ease friction.
- Osteotomies, a surgical procedure intended to shift body weight away from affected joints can reduce pain and improve mobility.
- Arthroplasty, or joint replacement surgery, may be required in advanced-stage osteoarthritis patients.10,11,12
CCK understands Osteoarthritis Disability Claims
Osteoarthritis can severely limit your motor capabilities due to chronic pain and limited range of motion, making it harder to carry out activities you were once able to accomplish easily. Osteoarthritis can negatively impact just about anyone trying to remain working, especially for those with physically demanding jobs. Osteoarthritis can prevent these individuals from performing required occupational tasks. Even for those with sedentary jobs, osteoarthritis can make it difficult to work; for example, osteoarthritis in the hands can prevent a person from typing consistently throughout the day due to pain and limited mobility in the fingers.
Your insurance company may dispute your claim because you have been able to consistently work through past years. We understand that osteoarthritis progresses over time, and damage caused to joints can be extremely painful, require surgery, and may be irreversible .
If your long-term disability claim for osteoarthritis has been denied by your insurer, consider contacting an experienced ERISA or LTD attorney as soon as possible.
How can CCK help you with your long-term disability appeal?
Let Chisholm Chisholm & Kilpatrick’s skilled attorneys put their years of practice into your long-term disability appeal. We take a comprehensive approach when preparing appeals for our clients, so that they can focus on their health and wellbeing.
Find insurance company errors
To root out any errors that your insurer may have made, we collect all of the insurance documents pertinent to your case. These can include: your denial letter, policy documents, the insurance company’s claim file, and other plan-governing documents. Using our knowledge of ERISA law, the U.S. Department of Labor laws, and insurance policies, we will identify any errors that the insurance company may have made and hold them accountable.
Communicate with doctors during the appeal process
Effective communication among you, your doctor, and the insurance company is essential to a successful long-term disability appeal. It is for this reason that we facilitate the flow of information between your doctor and insurer to ensure that all documents and necessary medical records are thoroughly completed and submitted in a timely manner. We also instruct our clients as to how they can most effectively communicate their condition with treating physicians, so that the most accurate picture of their disability is provided.
Gather evidence and write the appeal
At Chisholm Chisholm & Kilpatrick LTD, we build you a complete and thorough evidence record so you can win the benefits that you are rightfully owed. Forms of evidence we gather can include:
- Medical records
- Test results
- Reports from treating physicians
- Expert opinions
- Witness statements from you, your family, friends, co-workers, etc.
An exhaustive evidence record is key to winning your long-term disability appeal. If your LTD policy is ERISA-governed, gathering and submitting evidence in a timely and complete manner is especially important because the administrative appeal stage is often your final opportunity to submit substantive evidence into the record. All of our arguments will work to prove that you meet your policy’s definition of disabled, and will be based on fact.
Call Chisholm Chisholm & Kilpatrick today
Let our knowledgeable attorneys apply their years of experience to your long-term disability appeal. Contact our office for a free consultation: 401-331-6300.
- Arthritis Foundation. (n.d.). What is Osteoarthritis. Retrieved February 27, 2018, from https://www.arthritis.org/about-arthritis/types/osteoarthritis/what-is-osteoarthritis.php
- Vincent, K. R., Conrad, B. P., Fregly, B. J., & Vincent, H. K. (2012, May 4). The Pathophysiology of Osteoarthritis: A Mechanical Perspective on the Knee Joint. Retrieved February 27, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635670/
- Web MD. (n.d.). The Basics of Osteoarthritis. Retrieved February 27, 2018, from https://www.webmd.com/osteoarthritis/guide/osteoarthritis-basics#2-4
- Arthritis Foundation. (n.d.). Osteoarthritis Causes. Retrieved February 27, 2018, from https://www.arthritis.org/about-arthritis/types/osteoarthritis/causes.php
- National Institutes of Health. (2016, May 30). Osteoarthritis: What are the Symptoms? Retrieved February 28, 2018, from https://www.niams.nih.gov/health-topics/osteoarthritis#tab-symptoms
- Arthritis Foundation. (n.d.). Osteoarthritis Symptoms. Retrieved February 28, 2018, from https://www.arthritis.org/about-arthritis/types/osteoarthritis/symptoms.php
- CDC. (2018, February 7). Osteoarthritis. Retrieved February 28, 2018, from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
- Mayo Clinic. (2017, August 16). Osteoarthritis. Retrieved February 28, 2018, from https://www.mayoclinic.org/diseases-conditions/osteoarthritis/diagnosis-treatment/drc-20351930
- Arthritis Foundation. (n.d.). Osteoarthritis Diagnosis. Retrieved February 28, 2018, from https://www.arthritis.org/about-arthritis/types/osteoarthritis/diagnosing.php
- Bathon, J. M., M.D., & Manno, R. L., M.D., MHS. (n.d.). Osteoarthritis: Treatment. Retrieved February 28, 2018, from https://www.hopkinsarthritis.org/arthritis-info/osteoarthritis/oa-treatments/#funct
- Arthritis Foundation. (n.d.). Osteoarthritis Treatment. Retrieved February 28, 2018, from https://www.arthritis.org/about-arthritis/types/osteoarthritis/treatment.php
- American College of Rheumatology. (n.d.). Osteoarthritis: How do you treat osteoarthritis. Retrieved February 28, 2018, from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoarthritis
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