Patients with gastroparesis may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their gastroparesis 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 Gastroparesis?
Gastroparesis is a disorder in which the spontaneous movement of the muscles (motility) in one’s stomach does not function normally. Also known as delayed gastric emptying, gastroparesis is a medical condition that prevents the body from moving food from the stomach to the small intestine.
The effects of gastroparesis can be severe and may be unpredictable from day to day. Because of this, individuals suffering from gastroparesis may find that their symptoms make it impossible to continue working. If this individual has long term disability benefits, then they may be eligible to collect LTD benefits.
Definition of Disability
Long term disability benefits are intended to provide financial assistance to individuals with long-term health conditions. Although gastroparesis is not typically thought of as a totally disabling medical condition, applicants with this condition may be able to receive benefits if they meet the LTD policy’s definition of disability.
This definition of the term “disability” or “totally disabled” is defined in each LTD insurance policy. You should review your own policy to determine your specific definition. A sample definition states:
“Total Disability or Totally Disabled means that during the first 24 consecutive months of benefit payments due to Sickness or Injury:
You are continuously unable to perform the Material and Substantial Duties of Your Regular Occupation, andYour Disability Earnings, if any, are less than 20% of Your pre-disability Indexed Monthly Earnings.
After the LTD Monthly Benefit has been paid for 24 consecutive months, Total Disability or Totally Disabled means that due to Injury or Sickness:
You are continuously unable to engage in any Gainful Occupation, andYour Disability Earnings, if any, would be less than 20% of Your pre-disability Indexed Monthly Earnings.”
If you do not meet your LTD policy’s definition of “Total Disability” or “Totally Disabled”, it is not likely that you will be approved for benefits. However, if you do meet the policy’s definition, you will be further evaluated based on specific technical and medical requirements.
Medical Eligibility
It is important to note that applicants should inform the long term disability insurance company of any and all health conditions that they have. This means that if your gastroparesis is caused by another condition or you have another serious medical condition in addition to gastroparesis, you should inform the insurance company. This is due to the fact that the insurance carrier will evaluate you based on the combined effects of all conditions that you may have. For example, someone with gastroparesis alone may have his or her application denied. However, if the same person has diabetes and gastroparesis, he or she may stand a better chance of approval.
Medical-Vocational Allowance
To be able to qualify under a medical-vocational allowance, you will be evaluated based on your ability to perform work-related activities. To do this, the insurance company will send your medical records to an “independent medical examiner” who will review your records and give a Residual Functionality Capacity (RFC) assessment. The RFC will determine what type(s) of work you can be expected to perform. Depending upon the results of your RFC, you will either be awarded benefits or recommended to return to work.
Beginning Your Application
As you begin the application process, you should collect extensive medical and non-medical documentation to support your claim. Medical documentation includes the medical records that serve as proof of your illness or disability. Without sufficient medical documentation, the insurance company will likely deny your claim for disability benefits. If you want to be really proactive, you should work with your doctor to collect copies of the following:
- Record of your diagnosis or diagnoses;
- A history of hospitalizations and/or medical appointments;
- The findings from physical and mental examinations;
- A history of any treatments you have received and your body’s response to these treatments;
- Lab results;
- A written statement from your doctor outlining your condition and the limitations that it causes you to experience; and
- Non- medical documentation may include financial records, employment records, and various forms of identification.
Once you are ready to begin your application, you will need to fill out several forms your insurance company or employer will provide to you. Be sure to answer all questions completely and accurately. Your application should provide the insurance company with an understanding of your condition and the daily limitations that it causes. Any missing or inconsistent information could cause your application to be unreasonably delayed or even denied.
Receiving a Decision
The standard LTD application is processed within several weeks to several months. If your claim is denied, you may appeal the decision. Your denial letter should identify any time-limits for the appeal, but you should work diligently to file the appeal in a timely manner.
Although it can be discouraging to receive a denial, the appeals process is your chance to correct any mistakes in your application and provide further medical evidence to support your claim. It is important to note that many LTD applicants are approved during the appeals processes.
Legal Representation
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your gastroparesis. Even if you have been denied benefits, that does not mean your fight is over. 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 experienced disability attorney will be able to guide you through the process. They do not get paid until 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 an experienced disability lawyer about your gastroparesis 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.
