Patients with diverticulitis may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their diverticulitis 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 is Diverticulitis?
Diverticulitis is a digestive system disorder in which small pouches called diverticula form along the wall of the intestines and become inflamed or infected. Diverticulitis can range from small abscesses to large-scale infection and can be acute or chronic. If it is chronic, symptoms can subside but never completely disappear. While a definitive cause has not been discovered, experts believe that low-fiber diets can be a contributing factor.
Symptoms of diverticulitis include severe abdominal pain and cramping, bloating, abdominal tenderness, blood in stools, constipation, diarrhea, fever, and nausea and vomiting.
If left untreated, diverticulitis can lead to severe and painful complications. These can include bowel obstructions, abscesses, peritonitis (an infection of the abdominal lining), fistulas (connections between the bowels and other organs like the bladder), severe loss of blood, and sepsis.
If you think you may have diverticulitis, see a doctor immediately. The doctor will conduct an in-office exam to determine what possible conditions you may have and will usually order some blood tests to find out what infections may be present in the blood or to screen out other digestive disorders. At this point, the doctor will probably also order further medical tests to make the diagnosis.
Diagnostic tests can include:
- CT Scans of the abdomen (with and without contrast); and
- X-rays of the abdomen.
For patients with severe symptoms, colonoscopies can risk damaging the intestines, and CT scans are preferred.
Antibiotics to treat infection are one of the major treatments of diverticulitis. Depending on the severity of the condition, other treatments like IV fluids or blood transfusions can be necessary. Many people see relief by following a change of diet. Eating high-fiber foods can prevent diverticulitis from reoccurring and eating bland foods like broths and cooked fruit can help with symptoms during a flare-up. Some severe cases require surgery to remove affected tissue and to insert a special bag to collect waste through an opening in the stomach.
Qualifying for Long Term Disability Benefits Due to Diverticulitis
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.”
Disability Evaluation of Diverticulitis
Not everyone with diverticulitis can be considered disabled. Some people can resume all normal activities once their symptoms are under control. Others find their symptoms too severe or erratic to work. Individuals who cannot work while experiencing symptoms of diverticulitis may qualify for long term disability (LTD) benefits. Individuals experiencing many complications from diverticulitis will be more likely to be considered for disability benefits. The insurance company will review all of the claimant’s medical records and other evidence in the claim to determine if the claimant is disabled according to their policy.
Evidence the insurance is looking for may include:
- Documentation by medical imaging showing the condition;
- A draining abscess or fistula;
- Significant or severe involuntary weight loss;
- Requiring a feeding tube;
- Severe abdominal pain that is not controlled by narcotic pain relievers;
- Bowel obstructions requiring hospitalization at least two times in 6 months; and/or
- Significant chronic anemia.
What the Insurance Company Needs Fom You and Your Medical Providers
You should tell the insurance company about any doctor that has treated you for your diverticulitis. 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.
For example, if you have chronic diarrhea, you may not be able to perform a job that does not allow you to take bathroom breaks without notice and whenever you need them. If you have chronic anemia from rectal bleeding, you may be too weak to operate heavy machinery or perform strenuous manual labor. Consider the full scope and implication of all your symptoms when evaluating how they may impact your work and be honest with your doctors.
Working with an Experienced Disability Attorney
Working with an experienced long term disability attorney will give you the best chance at getting the benefits you deserve. The application process can be confusing and complicated, especially if you have no experience filling out legal paperwork. Missing a deadline can cause you to lose your case and need to reapply.
If you have been denied disability benefits for your diverticulitis, 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 knowledgeable help is often the difference between being denied and being approved for benefits.
While the process can be daunting, your long term 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 and rest assured that they will fight for you.
The Ortiz Law Firm has successfully represented people in numerous disability cases. While our firm is in Florida, we have helped people across the United States. If you would like to talk to an experienced disability lawyer about your diverticulitis and its impact on your working career, 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.