Patients with inflammatory arthritis may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their inflammatory arthritis 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 Inflammatory Arthritis?
Arthritis is a term used to describe a medical condition where a person’s joints are inflamed. Inflamed joints cause stiffness, soreness, and swelling. There are many different types of arthritis, but the two most common forms are inflammatory and noninflammatory.
Non-inflammatory Arthritis
Non-inflammatory arthritis is known as osteoarthritis (OA). Even though it is called non-inflammatory, it can still result in some inflammation or swelling of the joints. The difference in this type of arthritis is that it results from the breakdown of cartilage. Cartilage acts as a barrier that covers the ends of bones in the joint. As that cartilage breaks down, bones can rub against one another causing pain. This breakdown often occurs when joints are injured, but it also happens as a result of wear and tear. Noninflammatory arthritis is most commonly found in the hands, knees, hips, and spine.
Inflammatory Arthritis
Inflammatory arthritis is often referred to as rheumatoid arthritis (RA). This type of arthritis often causes pain in the joints, but the cause and impact are very different. Inflammatory arthritis is an autoimmune disease which means that it is caused by the immune system. Normally, the immune system protects our health by attacking foreign substances like bacteria and viruses. But, in the case of inflammatory arthritis, the immune system mistakenly attacks the tissue that lines the joints resulting in inflammation.
Inflammatory arthritis isn’t limited to the joints. It is a systemic disease since it is capable of affecting your entire body, including your cardiovascular or respiratory systems. If someone with rheumatoid arthritis doesn’t get treated, this autoimmune disease can cause permanent damage.
When Inflammatory Arthritis is a Disability
Inflammatory arthritis is a debilitating condition that often impacts one’s quality of life and ability to work.
However, simply being diagnosed with inflammatory arthritis isn’t enough to be considered disabled. You are considered disabled when a condition limits your normal movements, senses, or activities. A determination of disability is made based on the activities you find difficult. For example, you may have trouble:
- Lifting more than 10 pounds;
- Grasping small objects;
- Standing or sitting for extended periods; or
- Walking upstairs.
Documenting Your Disability Due to Inflammatory Arthritis Is Essential
If you find that your inflammatory arthritis limits your ability to work, you should work closely with your doctor to document your condition. In order to qualify for long term disability benefits, you will need sufficient evidence detailing how your condition prevents you from working or performing daily tasks that you otherwise would be able to do.
Qualifying for Long Term Disability Insurance
Definition of Disability for Inflammatory Arthritis
Under most LTD policies, an individual is considered disabled if he or she is: (a) unable to perform the material duties of his or her own occupation for the first two years of the policy; and (b) unable to perform the duties of just about any occupation after the first two years of the policy. The definition of disability is specific to each individual policy, so you must review your own LTD policy to determine how the term “disability” or “totally disabled” is defined for you.
Your provider will then determine whether your inflammatory arthritis or osteoarthritis is severe enough to keep you from performing activities commonly required for working. These activities include:
- Sitting or standing;
- Kneeling or walking;
- Lifting; and
- Using fine motor skills.
Based on your limitations, you may be deemed capable of heavy, medium, light, or sedentary work.
Medical Evidence Proving Inflammatory Arthritis
You must also meet medical criteria to qualify for long term disability benefits. In the case of inflammatory arthritis or RA, you must have swelling and pain, and your joint movement must be limited or painful.
To prove the extent of your disability, you will likely need doctor and hospital records, laboratory test results, and sometimes a questionnaire that should be completed by your doctor. Your provider also may use information from the Arthritis Foundation when evaluating your inflammatory arthritis claim. In general, the records must include the following:
- A confirmed diagnosis of inflammatory arthritis;
- A doctor’s note detailing the frequency and severity of your symptoms;
- Blood test results indicating the likelihood of RA;
- A history of any treatments tried; and
- Any other test results such as imaging studies or those that measure the range of motion of the spine.
Evaluating Disability for Persons with Inflammatory Arthritis
The insurance company’s adjudicator is the insurance adjuster assigned to your claim. The adjuster may have your file reviewed by a physician, psychologist, or another medical disability examiner (such as a nurse practitioner) to give an opinion as to your level of impairment. The adjuster may also send you for a compulsory medical examination or functional capacity evaluation. In evaluating disability for persons with inflammatory arthritis, the insurance adjuster should consider all of the available evidence, including the clinical course from the onset of the illness, and should consider the impact of the illness on each affected body system.
If the insurance adjuster believes there is not enough information to make a decision, he or she may call or write you to find out if you have the needed information. If you do not, they may ask you or, in some circumstances, an independent medical source to provide the information.
Although your physician may reach a diagnosis of inflammatory arthritis on the basis of your symptomatology (after ruling out other disorders), your disabling impairment should still be documented by medically acceptable clinical and laboratory findings. Statements merely recounting your symptoms or providing only a diagnosis will not usually be sufficient to be approved for long term disability insurance benefits. The insurance company should have reports documenting your objective clinical and laboratory findings. Thus, it is essential that your doctor(s) submit all objective findings available concerning your condition, even if they relate to another disorder or establish that you have a different condition.
How the Insurance Company Assesses Your RFC
In light of your documented symptoms, the insurance company may develop an RFC for you that states, for example, that due to persistent pain or stiffness, you need to take frequent breaks throughout the day to rest as needed. Because most employers would not accommodate this limitation, it would be difficult for you to obtain and maintain most jobs.
If you suffer from documented joint pain, weakness, or physical deformities from your RA, your RFC may include limitations on certain work-related physical activities as well. For example, the RFC may state that you cannot lift or carry objects that weigh more than 10-15 pounds. This limitation would prevent you from doing jobs that required physical exertion, such as factory work, warehouse work, and most janitorial positions.
Living with chronic pain from inflammatory arthritis can also cause mental health problems such as depression or anxiety. If you are receiving mental health treatment, you should ask your treating physician (your psychiatrist or psychologist), to fill out a mental RFC form that details his or her opinions of your work-related limitations. Keep in mind that the insurance company will assign them weight only if they are supported by objective medical evidence.
Work with a Florida Long-Term Disability Insurance Attorney to Ensure You Get the Benefits You Deserve
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your inflammatory arthritis. 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 inflammatory arthritis 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.
