If your insurance company has wrongfully denied your long-term disability (LTD) claim for rheumatoid arthritis, you may be able to take action with an appeal. The appeals process for attaining LTD benefits, however, can be a complicated one. Those living with the pain and regular flares that rheumatoid arthritis brings should not have to carry the stress of managing their appeal to an insurer as well.
After a denial, insurance companies will not provide you with benefits unless you fight back with an appeal. We understand that rheumatoid arthritis can render individuals unable to continue working.
At Chisholm Chisholm & Kilpatrick LTD, we have a history of preparing successful appeals for our clients. Let us use our knowledge of ERISA-governed and individual long-term disability policies to your advantage, so that you may focus on your health. Contact our office today for a free consultation: 401-331-6300.
About Rheumatoid Arthritis (RA):
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder in which your body’s immune system malfunctions and produces autoantibodies. These autoantibodies attack healthy cells in joints. The cells targeted by this immune response make up the synovium—the membrane lining protecting joints. This ‘attack’ of the synovium results in inflammation, causing the membrane to swell, resulting in limited mobility and pain.1
Approximately 1.5 million people across the United States suffer from RA. The average age of onset lies between 30 and 60 years old. Although it is not yet understood why, women are almost three-times more likely than men to develop rheumatoid arthritis; about 5% of women in the U.S. over age 55 are affected by RA.2
What causes Rheumatoid Arthritis?
Researchers do not yet understand the precise cause of RA; however, bacteria and infectious agents are thought to serve as triggers for developing the condition. Risk factors that increase a person’s likelihood of developing rheumatoid arthritis include:
- Genes can be passed down that make a person more susceptible to developing autoimmune diseases such as RA, or that make the condition progress more quickly.
- Age. Although RA can occur at any age, the disease’s onset most often occurs among adults over age 40.
- Women are two-to-three times more likely to develop RA.
- People who smoke cigarettes have a higher chance of developing RA. Smoking has also been shown to worsen the condition.
- Exposure to cigarette smoke, air pollutants, and occupational exposures (e.g. asbestos) have been linked to the development of RA.
- Those who are obese face an increased of developing RA.3,4
Symptoms of Rheumatoid Arthritis:
The symptoms that one may experience with rheumatoid arthritis vary per person, with equally varying levels of severity. RA flares occur in which symptoms are amplified and are followed by periods of little or no symptoms, making RA quite an unpredictable condition.
As rheumatoid arthritis progresses, symptoms can become mountingly more serious. The most commonly reported symptoms of RA are joint pain and swelling, stiffness (especially after long periods of rest), and fatigue. Other symptoms can include loss of appetite and fever.
Common symptoms affecting joints:
Often times RA symptoms (e.g. pain, stiffness, swelling, etc.) affecting the joints occur symmetrically; for example, if one wrist is affected, the other wrist will be as well. Areas of the body in which RA symptoms are most prevalent include, but are not limited to:
Not only joints are affected by rheumatoid arthritis; RA is a systemic disease, meaning it affects the entire body. Approximately 40% of people living with RA also experience non-joint related symptoms; commonly affected areas include:
- Skin. Rheumatoid nodules, small firm lumps under the skin near affected joints, can appear.
- Mouth. Gum irritation or infection and dry mouth may occur.
- Eyes. Patients have reported dry, painful, or red eyes with sensitivity to light and reduced vision.
- Heart and blood vessels. Those with RA are twice as likely than those without the condition to develop a cardiovascular disease.
- Blood. RA can cause a reduction in red blood cells, resulting in anemia.
- Lungs. Lung inflammation can lead to shortness of breath.
- Kidneys. Studies have shown that people with RA have a one in four chance of also developing kidney disease.
If RA goes untreated, serious complications can emerge, such as heart and kidney disease mentioned above. In joints, once the synovium is destroyed, RA can target joint cartilage. If cartilage deteriorates, joints can become unstable, painful, and even lose their mobility. RA can also damage bone, causing irreversible disfigurement.5,6,7
Diagnosis and testing:
Rheumatoid arthritis can be a difficult disorder to diagnose because there is no singular test that can confirm it. In addition, symptoms of RA manifest differently from person to person, and can resemble other diseases in its early stages.
To diagnose RA, doctors will first evaluate your personal and your family medical history; this is because if someone in your family has RA, it may be more likely that you have RA. . Next, a physical examination will be conducted to check for joint swelling and tenderness, as well as to test these joints’ range of motion. Following a physical examination, doctors perform blood tests and imaging tests to look for a variety of factors.8
- Rheumatoid factor tests reveal the presence of an autoantibody commonly present in the blood of those with RA.
- Anti-CCP tests also reveal the presence of autoantibodies often produced by the immune systems of those with RA.9
- Antinuclear antibodies (ANAs) are tested for because these antibodies often attack your body’s own cells.
- Complete blood count (CBC) is checked because patients with RA often have anemia, or a reduced red blood cell count.
- Erythrocyte sedimentation rate and c-reactive protein tests measure inflammation.
- X-rays can measure the amount of joint damage that has occurred
- MRIs and ultrasounds are conducted because they can provide a more detailed image of joints and cartilage.10
Currently, there is no cure established for rheumatoid arthritis. Treatment regimens are intended to slow the disease’s progression, reduce inflammation, and relieve pain. Usually, treatment methods are combined to achieve the best results.
- Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are used to slow the progression of RA by suppressing the immune system.
- Biologics, genetically-engineered proteins that target specific areas of the immune system, are prescribed to those whose symptoms are not improving with DMARDs alone.
- Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, can help those with RA manage pain and control inflammation.
- Steroids, such as prednisone, can slow joint damage and reduce pain and inflammation.
- Joint fusion, in which the two bones making up the affected joint are welded together to form one solid bone. This enables the afflicted joint to carry more weight and reduce pain.
- Joint replacement surgery can ease symptoms, although this option is usually recommended for patients over age 50 due to the artificial nature of these implants.
- Physical therapy can provide those living with RA exercise plans and teach proper stretching techniques that can ease joint stiffness.
- Occupational therapy can teach patients how to perform daily tasks more easily.
- Cognitive therapy in the form of pain management training can help patients cope with day-to-day symptoms
- Exercising enhances muscle strength and cuts down on RA pain.11,12
CCK understands Rheumatoid Arthritis disability claims
We understand that the pain, mobility restrictions, fatigue, and complications affecting vital organs caused by RA can easily inhibit a person from working. Frequent, unpredictable flares can make working uncomfortable and painful. As this condition progresses, you may find that you cannot perform tasks that you used to do with ease.
According to the CDC, those with RA who work in physically demanding professions have the highest rate of job loss; but even those with less physically demanding jobs can have their careers halted due to the condition. Those who require surgery, such as a joint replacement, may take months to sufficiently recover and may still be experiencing other symptoms elsewhere in the body.
Your insurance company may not understand why you are seeking long-term disability benefits after you have worked with RA for so long. We understand that RA is a progressive disease that can present many complications. We will work to prove that your condition has worsened to a point where working is no longer feasible.
How can CCK help you with your long-term disability appeal?
Let the experienced team of attorneys at Chisholm Chisholm & Kilpatrick apply their years of practice to your LTD appeal. When preparing our appeals, we take a comprehensive approach so that our clients can focus on their health and wellness.
Find insurance company errors
Our first step when preparing an appeal is to look for errors on your insurer’s part. To find these errors, we gather all documents pertinent to your claim, such as your denial letter, policy documents, the insurance company’s claim file, and other plan-governing documents. Our knowledge of ERISA law, the U.S. Department of Labor laws, and insurance policies allows us to identify these errors and strategically build an appeal.
Communicate with doctors during the appeal process
Doctors are often so busy in their day-to-day medical practices that they do not provide as much detail to your insurer as is necessary to reveal the severity of your condition. Proper communication among you, your doctor, and insurer is a critical element to your LTD claim. This is why we facilitate the flow of information between your doctor and insurer to ensure that all details surrounding your condition are communicated.
Gather evidence and write the appeal
CCK’s highly skilled attorneys know the importance of evidence to your appeal. This is why we gather all necessary information relating to your case, then submit it to the insurance company accurately and on time. Preparing a complete evidence record in a timely manner can greatly benefit your appeal, especially if your policy is ERISA-governed, because the administrative appeal stage is often your final chance to submit new evidence into the record. Common forms of evidence we gather for our clients include:
- Medical records
- Test results
- Reports from your treating physicians
- Expert opinions
- Witness statements from you, your family, friends, or co-workers
In our appeals, we use the evidence provided to prove that you meet your insurance policy’s definition of disabled. Our appeals are always based on facts and supported by evidence.
Call Chisholm Chisholm & Kilpatrick today
Let our years of experience handling long-term disability appeals benefit you. Call 401-331-6300 for a free consultation.
- Hitchon, C. A., & El-Gabalawy, H. S. (2011, December 30). The Synovium in Rheumatoid Arthritis. Retrieved March 01, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263474/
- Ruffing, V., R.N., C.C.R.P., & Bingham, C. O., M.D. (n.d.). Rheumatoid Arthritis Symptoms: Johns Hopkins Arthritis Center. Retrieved March 01, 2018, from https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-symptoms/
- Hoovestol, R. A., & Mikuls, T. R. (2011, October). Environmental exposures and rheumatoid arthritis risk. Retrieved March 01, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/21785978
- CDC. (2017, July 07). Arthritis. Retrieved March 01, 2018, from https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
- Arthritis Foundation. (n.d.). Rheumatoid Arthritis Symptoms. Retrieved March 02, 2018, from https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/symptoms.php
- Mayo Clinic. (2017, August 09). Rheumatoid arthritis. Retrieved March 02, 2018, from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
- Wait, M., M.D. (2016, January). RA and Your Kidneys: What You Need to Know. Retrieved March 02, 2018, from https://www.arthritis.org/living-with-arthritis/comorbidities/kidney-disease/rheumatoid-arthritis-and-your-kidneys.php
- Web MD. (n.d.). How Do Doctors Diagnose Rheumatoid Arthritis? Retrieved March 02, 2018, from https://www.webmd.com/rheumatoid-arthritis/diagnosing-ra#1
- Rheumatoid Arthritis Support Network. (n.d.). Cyclic Citrullinated Peptide (CCP) Antibody Test for RA. Retrieved March 02, 2018, from https://www.rheumatoidarthritis.org/ra/diagnosis/anti-ccp/
- Murphy, J., M.D. (2017, March). Rheumatoid Arthritis: How is rheumatoid arthritis diagnosed? Retrieved March 02, 2018, from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis
- Web MD. (n.d.). Understanding Rheumatoid Arthritis — Treatment. Retrieved March 02, 2018, from https://www.webmd.com/rheumatoid-arthritis/understanding-rheumatoid-arthritis-treatment#1
- Mayo Clinic. (2017, August 09). Rheumatoid arthritis. Retrieved March 02, 2018, from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653
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