Some people are unable to work because of a hernia. People who cannot work will need to apply for long-term disability benefits (LTD) for their condition. The insurance company will review their claim to see if they qualify under the conditions of that plan.
What are Hernias?
All the organs and other tissues in the abdomen are secured in place by a thick muscular wall called the peritoneum. Weaknesses in the peritoneum can allow tissues to push through, forming a hernia. Hernias most often form in the abdomen or groin. While common, hernias can lead to painful or life-threatening complications.
Weaknesses can be congenital (present from birth) or can occur because of strains or surgeries. Strains can be a result of workplace injuries, exertion, pregnancy, obesity, chronic constipation, or chronic coughs. Aging can make a person more likely to develop hernias.
Common types of hernias include:
- Stomach: Called hiatal hernias, hernias in the upper abdomen can allow part of the stomach to push up into the chest through the diaphragm.
- Groin: Women most often experience hernias in the inner groin, called femoral hernias. Men are more commonly affected by inguinal hernias, which can lead to swelling and bulges in the scrotum. Over 75% of hernias are either femoral or inguinal.
- Surgical incisions: Scar tissue from abdominal surgeries can allow tissues or organs to bulge outwards and even trap it within the scar tissue.
- Belly button: Also called umbilical hernias, hernias near the naval can allow tissue or parts of the intestines to bulge outwards. Umbilical hernias usually occur in infants and usually heal on their own by the child’s 5th birthday.
Symptoms of Hernias
Symptoms of hernias include visible bulges, swelling, and pain. Many people with hernias do not feel any sort of pain until the condition becomes more severe. Pain often gets worse when moving the affected part of the body, such as picking up a heavy object. Lumps or bulges usually get larger and more painful over time. Other symptoms can include indigestion, nausea, a feeling of fullness, chest pain, or difficulty swallowing.
Hernias are usually diagnosed by a simple clinical exam, since they can cause clearly visible symptoms. A doctor will perform a visual examination of the area and will palpate the tissues to feel for bulges and pain. Since bulges may become less visible or even disappear depending on the patient’s position, the doctor may have them move positions or cough to examine hidden hernias.
In some cases, diagnostic tests are used to examine the soft tissues in more detail. Usually a CT scan, these tests are used to see the area affected and to determine if surgery may be necessary. Blood tests are also used if infection is suspected, since an infection can be a medical emergency.
Some types of hernias can heal on their own, like umbilical hernias in infants, but most hernias do not get better without some type of surgery. Usually hernias get worse with time and can become painful or develop complications without repair. Because of the risk of complications, doctors may delay surgery to see if it becomes necessary. Corrective surgery can be performed through laproscopic or open incisions. While laproscopic incisions generally carry less risk than open incisions, a surgeon will evaluate each case individually to decide a course of treatment.
If left untreated, complications can include obstruction or strangulation. Both cases include tissue becoming trapped within the hernia. Obstruction occurs when tissue is simply stuck, causing symptoms such as pain and intense nausea. In strangulation, the blood supply is also cut off to the trapped tissue. This causes tissue death and requires immediate surgery to fix or the patient may become septic and die.
Disability Evaluation for Hernias
Under most LTD plans, a person must be unable to work in their position for the first 2 years of the policy. After those 2 years pass, they must be unable to work in almost any job to still qualify for benefits. Every plan is different, so it is important to review your policy for its specific requirements.
Evaluating Disability for People with Hernias
Disability claims are evaluated based on how the person is limited in their everyday activities. To evaluate disability status, adjusters look at what a person may still be able to do and what activities their condition prevents them from doing. People with hernias may face limitations bending, lifting, or carrying items and may find working in strenuous positions difficult if not impossible. Since many hernias are successfully surgically repaired, it can be difficult to prove disability. Luckily, insurers take the person’s total health into account and will decide considering all of the person’s conditions.
What the insurance company needs from you and your medical providers
The insurance company will need to know how to contact all the doctors who have treated you so that they can get your records when evaluating your claim. You may need to send those records yourself if your insurance company cannot get them from your doctors. While all your medical records are important, it is especially helpful to include a history of any treatments and surgeries as well as records of your ongoing symptoms. If you have other medical conditions that can impact your quality of life, you should include those records as well.
The insurance company will need to see proof of your diagnosis and your ongoing symptoms, as well as evidence of how those symptoms affect your life. 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 with your limitations. It is used to determine what jobs you may still be qualified to perform. Make sure that you are as honest as possible with your doctors so that they can complete a correct RFC for you.
Working with a Disability Attorney
Since you are so limited by the appeals process, consider consulting a disability attorney very early on. Even with a claim for a hernia, it can be tricky to navigate the claims and appeals process. Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve. 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 to get more information that may help your case.
While the process can be daunting, your expert disability attorney will be able to guide you through the process. Getting expert help is often the difference between being denied and being approved for benefits. An experienced long term disability attorney can help you stay on top of your deadlines, help you gather your documents, assist you during field interviews, and give you guidance that will help you get your claim approved. 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 hernia and its impact on your ability to work, the Ortiz Law Firm offers a free consultation with no obligation to use our firm. During the call, you can ask any questions you have regarding your claim, and we will answer them. To see how we can help you win your long-term disability case, call us at (888) 321- 8131.