Long-Term Disability for TMJ Disorder

Temporomandibular joint (TMJ) disorder can be more than just jaw pain—it can severely interfere with your ability to eat, speak, sleep, and perform work duties. If your condition is chronic or treatment-resistant, you may be eligible for long-term disability (LTD) benefits.

Unfortunately, many insurance companies do not consider TMJ to be a disabling condition. Claims are often denied for “lack of objective evidence,” even when the symptoms are clearly debilitating. In this guide, we’ll explain what TMJ disorder is, how it can impact your ability to work, and what you need to build a strong disability claim or appeal.

What Is TMJ Disorder?

TMJ disorder, or temporomandibular joint disorder, affects the joints that connect your jaw to your skull and the muscles that control jaw movement. Although the terms TMJ and TMD (temporomandibular disorder) are often used interchangeably, TMJ technically refers to the joint itself, while TMD refers to dysfunction in the joint or surrounding tissues.

Common Symptoms of TMJ Disorder:

• Jaw pain or stiffness
• Clicking, grinding, or popping sounds when opening the mouth
• Locking of the jaw in an open or closed position
• Difficulty chewing
• Headaches and migraines
• Shoulder and neck pain

TMJ disorder can be caused by a variety of factors, including:

• Bruxism (teeth grinding or clenching)
• Arthritis
• Jaw injury or trauma
• Connective tissue disorders

Diagnosing TMJ Disorder

Diagnosis typically begins with a clinical exam by a dentist, oral surgeon, or physician. Your provider will evaluate your range of motion, bite alignment, and areas of pain.

If TMJ is suspected, your doctor may order imaging to assess joint damage or inflammation, including:

• Dental X-rays to view teeth and jawbone alignment
• CT scans to visualize the bones of the jaw joint
• MRI scans to assess the disc and surrounding soft tissue
• TMJ arthroscopy, in which a small camera is inserted into the joint to observe internal damage directly

Treatment Options for TMJ Disorder

TMJ is often treated conservatively at first, with non-invasive methods such as:

• Over-the-counter anti-inflammatory medications (e.g., ibuprofen)
• Prescription muscle relaxants or antidepressants
• Custom mouth guards or oral splints
• Stress reduction techniques (e.g., physical therapy or counseling)

More severe or chronic cases may require:

• Arthrocentesis to irrigate the joint to remove debris and inflammatory byproducts
• Corticosteroid or Botox injections
• TMJ arthroscopy is also sometimes used to treat TMJ disorder
• Surgery (in rare cases)

While many people recover with conservative treatment, others experience persistent pain, restricted jaw movement, and secondary conditions like chronic headaches or sleep disturbances.

Can TMJ Disorder Qualify for Long-Term Disability?

Yes—in severe cases, TMJ disorder can meet the definition of disability under a long-term disability insurance policy. However, most insurers require detailed medical evidence showing how your condition prevents you from working.

Most LTD policies require that you prove:

1. You are unable to perform the material duties of your own occupation (typically for the first 24 months), and
2. You are unable to perform any occupation for which you are reasonably suited by education, training, or experience (after 24 months)

Because TMJ is often seen as a “non-severe” condition, insurance companies are quick to deny claims that do not include extensive documentation of pain, functional limitations, and treatment resistance.

Even if TMJ alone does not qualify you for disability benefits, you may be eligible based on the combined effects of TMJ and other medical conditions.

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What the Insurance Company Needs to Approve Your Claim

1. Proof of Diagnosis and Treatment

Submit all relevant medical records, including:

• Office visit notes
• Clinical evaluations
• Imaging results
• Surgical or injection procedure reports

2. Documentation of Functional Limitations

You must show how TMJ affects your ability to work, not just that you have the diagnosis.

Common functional limitations include:

• Pain while eating or chewing
• Limited jaw movement interfering with communication or concentration
• Sleep disturbance and associated fatigue
• Medication side effects (e.g., drowsiness, cognitive impairment)

3. Residual Functional Capacity (RFC) Form

Ask your treating provider to complete an RFC assessment. This form describes how your symptoms limit your ability to perform essential job tasks, such as:

• Talking on the phone
• Attending meetings
• Focusing on tasks without interruption
• Working a full 8-hour day without excessive breaks

A detailed RFC form is one of the strongest pieces of evidence you can submit in support of your LTD claim.

Appealing a Denied TMJ Disability Claim

Many TMJ-related disability claims are denied on the first try. However, a denial is not the end of the road. You have the right to appeal the decision and submit additional evidence to strengthen your case. This might include:

• Personal statements or functional assessments
• Updated imaging or treatment records
• A more detailed RFC form
• Specialist opinions from oral surgeons or neurologists

Why You Should Work With a Long-Term Disability Attorney

Insurance companies make it difficult to win TMJ claims on your own—but a skilled long-term disability attorney can:

• Review your policy and explain your legal rights
• Help gather the right medical evidence
• Work with your doctors to prepare stronger documentation
• Prepare a persuasive appeal package
• Represent you in court if your appeal is denied

At the Ortiz Law Firm, we have experience handling TMJ-related LTD claims and represent claimants across the United States. We work on a contingency fee basis, so you don’t pay anything unless we recover your benefits.

Contact Us for a Free Case Review

If TMJ disorder is interfering with your ability to work and you’ve been denied long-term disability benefits, we’re here to help.

Call the Ortiz Law Firm at (888) 321-8131 to schedule your free case evaluation. We’ll review your claim, identify areas for improvement, and guide you through the appeals process to help you get the benefits you deserve.