Are you wondering what medical conditions qualify for Long Term Disability benefits? Many medical conditions qualify someone for disability if severe enough. Examples include back and neck problems, multiple sclerosis, epilepsy, non-epileptic seizures, cancer, and Parkinson’s disease. However, we often find that a claimant’s disability is not due to a single illness or injury. Instead, we usually find that a person’s combination of impairments renders him or her disabled.
Illnesses and injuries are compounded by other illnesses and injuries. Moreover, a claimant’s medical problems may be further compounded by chronic pain or fatigue and by negative side effects to potent medications. So, with that in mind, what medical conditions qualify for long-term disability? Almost any combination of medical conditions, if severe enough, will prevent you from working.
What If The Combined Effects of Multiple Conditions are Disabling?
Disability insurance companies tend to evaluate whether conditions qualify without appreciating the full impact that the illness and/or injury has on your life. For example, do your medical records adequately convey the fact that you are constantly in pain? Does sleep deprivation leave you extremely fatigued during the day? Has your doctor stated that you are unable to work? You need to make sure all of your symptoms and limitations are documented during the claims process so the insurance company will approve your claim for short-term disability or long-term disability benefits.
Each illness and injury has a range of symptoms, including pain, fatigue, cognitive mental deficits, and negative side effects to medication. Here at the Ortiz Law Firm, we recognize that your disabling illnesses and/or injuries are best presented in combination. It is not simply a matter of determining the appropriate diagnoses for your medical problems. It is also important to understand how your illnesses and injuries affect your ability to perform daily activities and impair your ability to perform full-time work activities.
The Ortiz Law Firm makes connections between your documented medical conditions and your resulting impairments. This enables us to properly develop your disability case as your advocates. Long-term disability attorney Nick Ortiz uses his experience in handling a wide variety of medical problems to work with your doctors to obtain medical opinions that will be important to getting your benefits approved on appeal or in litigation. The Ortiz Law Firm is ready to support you in getting your long-term disability claim approved or reinstated so that you receive the disability benefits you are entitled to under your insurance policy.
Medical Conditions That May Qualify for Long Term Disability
So what medical conditions qualify for long-term disability? Below is a list of qualifying conditions that may be considered severe enough by disability insurance companies to qualify a claimant for short-term disability, long-term disability, or individual disability insurance benefits. These conditions and/or the necessary medical treatment can significantly interfere with an individual’s ability to obtain and maintain gainful employment, thereby making such individuals eligible for disability insurance benefits.
- Anterior Poliomyelitis
- Back Pain
- Carpal Tunnel Syndrome
- Cervical Stenosis
- Chiari Malformation
- Degenerative Disc Disease
- Degenerative Joint Disease, or other joint disorders
- Fracture of the Femur, Tibia, or Pelvis
- Fracture of an Upper Extremity
- Herniated Disc
- Inflammatory Arthritis
- Lumbar Stenosis
- Marfan Syndrome
- Mixed Connective Tissue Disease
- Muscular Dystrophy
- Pectoralis Major Injury
- Pelvic Floor Dysfunction
- Reflex Sympathetic Disorder
- Rheumatoid Arthritis
- Ruptured Disc
- Soft Tissue Injury (Burns)
- Spina Bifida
- Spinal Arachnoiditis
- Spine Disorders
- Undifferentiated Connective Tissue Disease
- Alzheimer’s Disease
- Amyotrophic Lateral Sclerosis (ALS)
- Bell’s Palsy
- Cerebral Palsy
- Empty Sella Syndrome
- Guillain-Barre Syndrome
- Meralgia Paresthetica
- Multiple Sclerosis (MS)
- Myasthenia Gravis
- Non-epileptic Seizures
- Parkinson’s Disease
- Seizure Disorder
- Stroke (Cerebrovascular Accident)
- Traumatic Brain Injury
- Allergic Reactions, Severe
- Chemical Sensitivity
- Graves Disease
- Immunodeficiency Disorders
- Aspergers Syndrome
- Attention Deficit Hyperactivity Disorder (ADHD)
- Anxiety Disorder
- Bipolar Disorder
- Drug Addiction
- Dysthymic Disorder
- Mood Disorder
- Obsessive-Compulsive Disorder
- Organic Mental Disorders
- Panic Attacks
- Post Traumatic Stress Disorder
- Eye Disorders, including Diabetic Retinopathy and Macular Degeneration
- Vision Loss
- Meniere’s Disease
- Otolaryngology (Hearing Loss)
- Loss of Speech
- Chronic Obstructive Pulmonary Disease (COPD)
- Chronic Restrictive Ventilatory Disease
- Cystic Fibrosis
- Lung Transplant
- Mycobacterial, Mycotic, and other Chronic Lung Infections
- Sleep-Related Breathing Disorders
- Aneurysm of the Aorta or Major Branches
- Chronic Venous Insufficiency
- Coronary Heart Disease
- Cor Pulmonale Secondary Chronic Pulmonary Hypertension
- Heart Attack
- Congestive Heart Failure
- Heart Transplant
- Ischemic Heart Disease
- Left Ventricular Assist Device
- Orthostatic Hypertension or Hypotension
- Peripheral Artery Disease (PAD)
- Postural orthostatic tachycardia syndrome (POTS)
- Recurrent Arrhythmia
- Symptomatic Congenital Heart Disease
- Crohn’s Disease
- Inflammatory Bowel Disease (IBD)
- Irritable Bowel Syndrome (IBS)
- Kidney and Bladder Disorders
- Kidney Failure
- Liver Disease
- Necrotizing Colitis
- Primary Biliary Cirrhosis
- Primary Sclerosing Cholangitis
- Short Bowel Syndrome
- Temporomandibular Joint Disorder (TMJ)
- Ulcerative Colitis
- Wilson’s Disease
- Autoimmune Hepatitis
- Epstein-Barr Virus
- Hepatitis B
- Hepatitis C
- Enlarged Prostate
- Interstitial Cystitis
- Kidney and Bladder Disorders
- Kidney Failure
- Genital Organ Disorders
- Nephrotic Disorder
- Urinary Tract Infections
- Uterine Prolapse
- Aplastic Anemia with Bone Marrow or Stem Cell Transplantation
- Chronic Anemia
- Chronic Granulocytopenia
- Sickle Cell Disease
- Chronic Thrombocytopenia
- Coagulation Defects and Hemophelia
- Hereditary Telangiectasia
- Liver Transplantation
- Polycythemia Vera
- Spleen Diseases
- Systemic Vasculitis
- Bullous Diseases
- Chronic Skin Diseases
- Genetic Photosensitivity Disorders
- Sebaceous Cyst
- Adrenal Gland Disorders
- Parathyroid Gland Disorders
- Pituitary Gland Disorders
- Thyroid Gland Disorders
- Mosaic/Non-mosaic Down Syndrome
- Trisomy X Syndrome (XXX Syndrome)
- Fragile X Syndrome
- Phenylketonuria (PKU)
- Caudal Regression Syndrome
- Fetal Alcohol Syndrome
- Acute Leukemia
- Cancer, including Breast Cancer and Prostate Cancer
- Chronic Lymphocytic Leukemia
- Chronic Myelogenous Leukemia
- Hodgkin’s Disease
- Multiple Myeloma
- Chronic Fatigue Syndrome
- Chronic Radiation Enteritis
- Headaches, including Migraine Headaches
- Seasonal Affective Disorder
- Sleep Apnea
- Sleep Disorder
This list is not exhaustive, and you may still qualify for long-term disability benefits even if your condition is not listed above. Each case is unique, so we encourage you to contact us for help determining whether will be able to access long-term disability benefits. We will help you determine if you qualify to receive benefits under the terms of your insurance policy.
Why Would Long-Term Disability be Denied?
Long-term disability claims can be denied for various reasons. Some of the most common reasons for denial include:
- There is not enough evidence to support your claim.
- You did not file your application on time.
- You did not submit supporting medical evidence on time; and
- Your condition is considered pre-existing under the terms of the policy.
I Was Approved for Social Security Disability, but My Long Term Disability Claim Was Terminated
Qualifying for short-term or long-term disability benefits is very different from qualifying for Social Security Disability benefits. We frequently receive calls from claimants whose long-term disability claims were terminated, but they continue to receive Social Security Disability benefits. For example, The Social Security Blue Book is the Social Security Administration’s (SSA) listing of disabling impairments. The Blue Book lists specific criteria under which claimants who suffer from a disabling condition can qualify for Social Security disability benefits. Your long-term disability insurance company will not use the same criteria to evaluate your claim.
What If I Can Only Work Part-Time?
If your medical conditions prevent you from working full time, but you can still work part-time, you’ll need to check your insurance policy to make sure benefits are payable for partial disability. The exact definition of partial disability will vary between policies. Some policies may not pay any benefits for partial disability. If you’re not sure if your policy includes benefits for partial disability then contact us to request a free case evaluation.
Objective Evidence to Support a Long Term Disability Claim
The burden to prove that a condition has impacted the claimant in such a way that they are unable to work falls on the claimant. You are expected to provide medical evidence to support your claim during the claims process. It is not unusual for an insurance company to require proof of objective evidence before it will pay long-term disability benefits. Objective evidence is the evidence in your medical records that insurance companies cannot deny exists. It may be difficult to qualify for benefits if there is no objective evidence to support your claim.
Why Objective Evidence is Needed
Objective medical evidence includes medical signs and laboratory findings. Signs are anatomical, physiological, or psychological abnormalities that can be observed by a medical provider. Signs are separate from the claimant’s statements (which are often referred to as “subjective complaints” or symptoms). Signs may be shown by medically acceptable clinical diagnostic techniques.
Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception. They must also be shown by observable facts that can be medically described and evaluated. Laboratory findings are anatomical, physiological, or psychological phenomena that can be shown by the use of medically acceptable laboratory diagnostic techniques. Some of these diagnostic techniques include chemical tests, electrophysiological studies (electrocardiogram, electroencephalogram, etc.), X-rays, MRIs, CT-Scans, blood tests, and psychological tests.
Objective evidence is especially important in proving hidden disabilities that are typically diagnosed based on the claimant’s subjective complaints, such as fibromyalgia, chronic pain syndromes, chronic fatigue syndromes, and chronic back pain conditions.
Psychological and neuropsychological testing are objective tools that may be used to defeat the insurance company’s position that the claimant is malingering or exaggerating his or her disabling condition.
A functional capacity evaluation (FCE) may also provide objective clinical evidence to prove whether the claimant is physically capable of performing the regular duties of a specific occupation.
What If Objective Evidence is Not Available?
When conclusive objective evidence is unavailable, a disability may still be validated through the use of subjective evidence. Subjective evidence is a combination of the patient’s self-reports and the observations of friends and family. If objective evidence is unavailable to prove up a claim, we will develop subjective evidence to ensure that we “stack the record” with all available information substantiating disability. It is possible to qualify for benefits even if objective evidence is unavailable.
Is Coverage Limited for Certain Conditions?
Mental Health Conditions
Most LTD policies have a maximum payout of 24 months for mental health conditions. These conditions could include medical conditions like depression (including postpartum), bipolar disorder, PTSD, and anxiety. The insurance company uses the reasoning that these illnesses are hard to prove with medical testing and lab reports, so they can be faked or exaggerated. Although these illnesses are serious, you must prove the existence of your illness and the resulting limitations. That is very hard to do.
Chronic Medical Conditions
Some LTD policies have a maximum payout for chronic illnesses like arthritis, back pain, and carpal tunnel syndrome. Conditions associated with lifestyle choices like COPD from tobacco use, alcoholism, or other diseases related to drugs or alcohol use could result in termination of benefits after 24 months or less. Check your policy for limitations based on these types of conditions.
The most difficult part of the long-term disability claim process is obtaining the evidence to support your claim. The burden of proof falls on the claimant, and you will need to submit proof of your disability to the adjuster that is assigned to your claim. You need to include objective evidence from each doctor treating you, not just your primary care doctor. If objective evidence is not available, you need to include self-reports and statements from friends and family.
You do not have to carry the burden alone. If your medical condition makes it impossible for you to work and you have been denied your disability benefits, long term disability attorney Nick Ortiz and the legal team at Ortiz Law Firm can help you cut through the red tape and fight for the disability benefits you deserve, no matter where you live in the United States or what medical condition you have. We have represented claimants in claims with Cigna, Hartford, Lincoln, MetLife, Prudential, Reliance Standard, Unum, and a variety of other disability insurance companies. Call us today at (888) 321-8131 or contact us online to discuss your claim.