Patients with a lower extremity fracture like a fracture of the femur, tibia, fibula, or pelvis may be unable to work because of their conditions and related complications. Patients who find themselves unable to work because of their fractured femur, tibia, fibula, or pelvis may qualify for long-term disability (LTD) benefits. The insurance company will review their claim to see if they are eligible under the conditions of that plan.
Can a Fracture of the Femur, Tibia, Fibula, or Pelvis Qualify for Long-Term Disability Benefits?
When you think of a fractured bone, you usually do not consider that you may need disability benefits. That is because most bones are set back correctly and heal within six months. But what about bones that do not heal? What about large bones that can take up to a year or more to heal? In these cases, long-term disability benefits can help support you financially until you can return to work.
The femur, tibia, fibula, and pelvic bone are essential to daily movement and normal activities. Breaking one or more of them can make walking, bending, and climbing stairs very difficult for you. You may even need assistance with a walker, a wheelchair, or a cane. If your break is not set correctly, you may have to use these assistive devices long-term.
Fractured bones are almost always accompanied by pain. If they do not properly heal, the pain can last a lifetime. Medications needed to manage pain are frequently narcotics, which help with pain but create barriers as well. Working under the influence of certain types of painkillers is considered dangerous in many professions. Swelling is another common issue when a fracture is not healed correctly. Elevation is recommended to decrease swelling, which can also create a barrier to your work.
Example: A tree company employee has a fractured tibia. His usual job is to trim tree limbs around power lines in a bucket all day. How can he elevate his tibia while cutting limbs in a bucket off the ground? He can’t and should apply for disability benefits.
Applying for Long-Term Disability While You Recover and Proving Your Claim
The first thing to do when applying for long-term disability is to read your policy thoroughly. If you have a group policy through your employer, you can request a copy from your human resources department. After you read your policy, you can decide if you think you have a case for LTD benefits. When you start gathering information for your claim, include as much information as possible to “stack” your administrative file.
Your administrative file is everything in your case. It includes all the correspondence between you and your insurance company, medical information, doctor notes, and even surveillance footage. Creating a strong case for a long-term disability claim will help you. If you are experiencing pain and swelling even though your doctor says you should be healed, you should apply for long-term disability benefits. Your lack of mobility and your medical imaging results (X-rays, CT scans, and MRIs) should be the supporting documentation that you need.
You will also want to provide them with the following information:
- Why you can not perform your job duties (this will require medical documentation) and
- A list of all medical providers you have seen for this condition and a letter stating that your condition prevents you from working.
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Get Help with Your Long-Term Disability Claim
An experienced disability attorney can help you gather the necessary medical information needed for your claim. They can help you track your deadlines (which are very strict), gather evidence such as medical statements/opinions from your doctors, represent you during a field interview, and communicate with the insurance company for you.
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your fracture. 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 fracture and its impact on your ability to work, call us at (888) 321-8131. We would be happy to evaluate your case and discuss how to help you through the appeal process.
