Coronary Heart Disease Long-Term Disability Insurance Claims

Understanding Coronary Heart Disease

Coronary heart disease happens when plaque builds up inside the arteries that supply the heart muscle. Healthy arteries have smooth inner walls that allow blood to flow easily. Plaque forms on artery walls as cholesterol builds up. This plaque can slow down or block blood flow in large coronary arteries. When this happens, the heart doesn’t get enough oxygen, which can lead to serious problems.

The most common symptoms of coronary heart disease include chest pain and discomfort (angina) and shortness of breath. Many people are unaware of the problem until they experience chest pain, plaque completely blocks blood flow to the heart, causing a heart attack, or the heart stops pumping blood, also called cardiac arrest.

Depending upon the extent and severity of their symptoms, patients with coronary heart disease may not be able to work, and may, therefore, be eligible for long-term disability benefits. However, having a heart attack, a coronary bypass, stenting, etc., does not guarantee approval of an LTD claim. LTD insurance companies do not approve claims based on the particular impairments in question. Rather, they base each decision on the impact a particular impairment has on the individual claimant’s ability to work and perform daily living activities.

How to Qualify for Long-Term Disability Benefits with Coronary Heart Disease

Assuming you have long-term disability (LTD) coverage through your employer, you may qualify for disability benefits for coronary artery disease by demonstrating that your heart condition has so reduced your functional capacity (your ability to exert yourself or otherwise perform work activity) that you cannot hold a job.

The long-term disability insurance company will evaluate your coronary heart disease based on the medical evidence from your treating physicians and any other evidence the insurer may get while reviewing your claim, such as a peer review report or a vocational assessment. The insurance company may also order an “independent medical examination” to help them evaluate the extent of your impairment.

Symptoms That Support Heart Disease Long-Term Disability Claims

The following are symptoms that the insurance company will look for in evaluating your coronary heart disease claim:

• Angina pectoris: Also known simply as angina, is chest discomfort that is caused by activity or emotion and quickly relieved by rest (or by rapidly acting nitrate medications such as nitroglycerin tablets)
• Atypical chest pain: Atypical chest pain is a stabbing or burning pain and may feel like indigestion. The pain may spread beyond the chest, such as to the inner left arm, jaw, neck, back and upper abdomen;
• “Anginal equivalent”: AE is shortness of breath upon exertion or after activities of daily living, but without complaints of chest pain or discomfort;
• Prinzmetal or variant angina: VA refers to episodes of angina that occur overnight at rest because of a spasm of a coronary artery (shown on an electrocardiogram), or
• Silent ischemia: SE is the occurrence of myocardial ischemia or myocardial infarction without pain or other related symptoms.

Besides the symptoms described above, the long-term disability insurance adjuster handling your claim will be interested in any other medical evidence showing the extent and severity of your disease, including an abnormal stress test, ischemia/ischemic episodes, or abnormal imaging. This type of evidence is more fully described below.

Medical Evidence of Disability because of Coronary Heart Disease

The basic documentation you should supply to the LTD insurance company includes detailed reports of your medical history, physical examinations, laboratory tests, medically acceptable imaging (such as a stress echocardiography or an angiography), and any treatment that your doctor has prescribed to you.

You may also include evidence of your response to such treatment. For example, ischemic episodes may require revascularization, which refers to angioplasty or bypass surgery. So you may provide evidence from such procedures to the insurance company to support your claim.

Your medical records should include electrocardiograph or electrocardiogram (ECG) results, which are also referred to as stress tests. A doctor may perform an electrocardiograph while the patient is exercising or at rest. An EKG records electrical impulses of your heart onto a strip of paper known as an electrocardiogram or tracing. An ECG may disclose important information, such as the fact that your heart muscle is not receiving enough oxygen, resulting in ischemia.

You should also include the results of any exercise tolerance tests performed. Exercise tests are the primary method of testing used to identify myocardial ischemia and to provide an estimate of your aerobic capacity. Besides submitting the angiographic evidence and other objective medical evidence, you should be able to prove that your coronary heart disease seriously limits your ability to engage in daily activities.

If you have been undergoing regular medical treatment, be sure to tell your doctor about all the symptoms you experience because of coronary heart disease. For example, tell your doctor about chest pain or discomfort, where the pain is located, and whether it interferes with your ability to concentrate or complete tasks.

As another example, if you have difficulty walking certain distances without shortness of breath or fatigue, be sure it is in your medical records. If you are taking medication for coronary heart disease, tell your cardiologist about all side-effects you may experience, such as fatigue/lethargy, headaches, dizziness, nausea and vomiting, depression, mental fogginess, memory loss, or blurred vision.

Coronary Heart Disease and Your Residual Functional Capacity

In a coronary heart disease claim, the adjuster assigned to your claim must consider whether your heart impairment has reduced your capacity to work. The claims handler will consider all the relevant medical evidence in your case file to determine what is called your residual functional capacity (RFC). Your RFC is the most work activity that you can sustain on a regular and continuing basis despite your medical conditions. In assessing your RFC, the insurance adjuster will try to rate your ability to perform work-related activities, such as sitting, standing, walking, lifting, carrying, pushing, and pulling.

You may have your doctor fill out a Residual Functional Capacity Assessment, or Medical Source Statement, giving an opinion as to your level of impairment. For example, if your doctor states—in a written letter or on an assessment form—that you cannot lift over 10 pounds because of shortness of breath and that you should walk or stand less than 2 hours of an 8-hour workday because of fatigue, you have an RFC for sedentary work. The claims handler will ultimately consider your RFC to decide if you can perform other work.

Get Help with Your Heart Disease Long-Term Disability Claim

Sometimes long-term disability insurance companies just make bad, unfair decisions. If you have a long-term disability claim because of coronary heart disease and your insurance company has denied your claim, contact our office today to schedule an appointment to discuss your rights. Call the Ortiz Law Firm today at (888) 321-8131.