What is Sickle Cell?
Sickle cell disease is a blood disorder in which the red blood cells are misshapen into a characteristic sickle shape because of abnormal levels of hemoglobin. Sickle cell is the most commonly diagnosed blood disorder, and the disease disproportionately affects African Americans and Hispanic people. Sickle cell disease is also known as sickle cell, sickle cell anemia, hemoglobin S, SS disease, and sickling disorder.
Early symptoms of sickle cell include pain, infections, delayed growth, and jaundice. As the disease develops, the person can suffer from chronic pain that flares up into what is called pain crises. The misshapen blood cells can block off regular blood supplies, causing heart attacks and strokes as well as tissue damage. Sickle cell can also cause severe anemia, jaundice, chronic pain, gallstones, and damage to the kidneys, liver, and spleen.
Diagnosing Sickle Cell
Most people with sickle cell are diagnosed as infants, as the US requires every newborn born in the US to undergo screening. Newborns are pricked at the heel for blood tests that will determine if they have the disease or linked traits. Follow-up care includes repeated blood tests to determine an accurate diagnosis. If the family suspects that the trait is present, the fetus may be tested as early as 8-10 weeks of pregnancy. Children or adults can also be diagnosed through a blood test.
Treating Sickle Cell
The only truly effective treatment for sickle cell is a bone marrow transplant. Unfortunately, most people do not qualify for transplants. Transplants are usually only used for children as adults can experience more severe complications from the procedure. Treatments can reduce symptoms and prolong life, especially if they are started at an early stage of the disease. Blood transfusions, both for acute symptoms and as ongoing treatment, are used for many patients. Oral medications like hydroxyurea have been shown to effectively reduce symptoms, though they can cause a wide range of side effects.
Ongoing medical care is necessary to prevent complications of this disease. Lifestyle changes to reduce stress and lessen the likelihood of infections can help to minimize complications. Patients should avoid triggers that can cause a symptom and pain crisis, such as sudden temperature changes and overexertion. Patients need to be monitored for signs of a crisis, such as sudden loss of vision and difficulty breathing. This requires immediate medical attention.
Disability Evaluation of Sickle Cell
Patients with sickle cell disease may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their sickle cell 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.
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 Sickle Cell
Patients seeking disability payments for their sickle cell 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. To qualify for disability benefits, the condition must prevent the person from working for a least one full year. They will need a Residual Functional Capacity (RFC) assessment that indicates how their symptoms affect and limit their life activities.
People with severe or advanced sickle cell disease may experience many symptoms that could prevent them from working. Leg and arm pain may prevent them from lifting objects, walking, or standing for extended periods. Nausea and vomiting caused by gallbladder issues or medications may necessitate sudden bathroom trips. Weakness and dizziness from anemia can prevent the patient from operating machinery or physical labor. Additionally, doctors appointments and treatments such as dialysis or transfusions may prevent them from regularly attending work.
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 sickle cell. The insurance company will need to obtain all relevant medical records to get the full picture of your health. These records include office notes, clinical exams, diagnostic tests, and lab results. If for any reason they cannot get these records from your doctors, you should request them and provide them to the insurance company yourself.
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. Make sure that you are as honest as possible with your doctors so that they can complete an accurate 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 sickle cell disease, 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 sickle cell disease 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.