Patients with immune-deficiency disorders may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their immune-deficiency disorders may qualify for long term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.
What are Immune-Deficiency Disorders?
Immune-deficiency disorders are a category of autoimmune system disorders. For people with immunodeficiency, their immune system is weaker than usual. This leaves them more prone to infections and illnesses.
There are many reasons a person may develop an immune-deficiency disorder. Some people have genetic conditions that can cause weakened immune systems. If the patient has immunodeficiency since birth, the condition is called primary immune deficiency. Others experience weakened immune systems as a result of medications or other illnesses. An immune deficiency that is caused by anything other than a genetic disorder is called acquired immunodeficiency.
Common causes of acquired immunodeficiency include cancer treatments, diseases such as lupus, severe malnutrition, and infection with viruses like SARS or HIV. The umbrella of immune-deficiency disorders includes numerous conditions. The World Health Organization recognizes over 300 immunodeficiency disorders.
Diagnosing Immune-Deficiency Disorders
Since immune-deficiency disorders are a broad category of illnesses, it can be difficult to determine what specific condition is present. Newborns are sometimes screened for genetic immunodeficiency disorders, as they are fatal if left untreated. A clinical exam can obtain a patient’s family history and determine which symptoms the patient is experiencing. However, diagnosis is dependent on laboratory testing. Blood tests are necessary to conclude that the patient is ill, the specific immune deficiency, and the possible cause.
Diagnostic blood tests include:
- Antibody production in response to vaccine exposure;
- Specific conditions, such as HIV; and
- DNA analysis for genetic disorders.
Treating Immune-Deficiency Disorders
Immune-deficiency disorders can be fatal if left untreated. The immune system is the body’s defense against infection and disease. In a weakened state, it leaves the person at risk of catching and dying from something as simple as a small infection. Some disorders are more severe than others, and each patient may experience their condition differently, but all conditions should be taken seriously.
Immunoglobulin therapy gives the patient a boost of antibodies and can allow the body to repair itself. Bone marrow transplants may be necessary to rebuild the immune system. Gene therapy or enzyme replacements are also options. Stem cell therapy is becoming an increasingly popular option and is proving to be a very effective treatment. Oral medications include steroids, which can keep the immune system from attacking itself or transplanted organs. Some patients may take antibiotics to prevent infection if the immune system is severely weakened. If the condition is due to a specific virus, such as HIV, antiviral therapy is an essential component of treatment.
Disability Evaluation of Immune-Deficiency Disorders
Definition of Disability
Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their work duties for the first two years of the policy and 2) be unable to complete the work duties of almost any occupation for the years following the initial 2-year period. Each LTD plan defines disability as slightly different, so look over your plan policy to see how your plan determines “disabled.”
Evaluating Disability for People with Immune-Deficiency Disorders
Patients seeking disability payments for their immunodeficiency disorder will have to prove that they are impacted in a way that they cannot perform their old job or any job that they could be trained to work. A claimant may qualify for benefits if they meet the following criteria:
- Have a severe infection that has not responded to medical treatment or requires hospitalization at least three times a year;
- Require a stem cell transplant; and
- Have a reoccurring immune-deficiency disorder that has at least two severe symptoms that limit major life activities.
Even if these conditions do not apply, it is still possible to qualify for disability benefits. The primary qualifier for many patients seeking disability benefits will be the Residual Functional Capacity (RFC) assessment that indicates how the disorder affects and limits their life activities.
What the Insurance Company Needs from You and Your Medical Providers
You should tell the insurance company about any doctor that has treated you for your immune-deficiency disorder. The insurance company will need to obtain all relevant medical records to get the full picture of your health. If for any reason they cannot get these records from your doctors, you should request them and provide them to the insurance company yourself.
Your doctors should send their complete exam notes and all relevant medical testing and lab results. You will need to provide proof of your diagnosis and your ongoing symptoms, as well as proof of how you are affected by your symptoms. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform.
The RFC form will take all your conditions into account. Even if your immunodeficiency is not severe enough to limit you from working, the other symptoms you experience may mean that you qualify for disability benefits. It is important to be honest and include all information that you may need.
Working with a Disability Attorney
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your immune-deficiency disorder. If you have been denied disability benefits, do not lose hope. Many people are denied benefits the first time they apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.
While the process can be daunting, your expert disability attorney will be able to guide you through the process. Since they receive their payment from awarded funds, they do not get paid unless you win your case. You can seek help without worrying about upfront costs or unexpected bills.
The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to one of our experienced disability lawyers about your immune-deficiency disorder and its impact on your ability to work, call us at (888) 321-8131. We would be happy to evaluate your case and to discuss how to help you through the appeal process.