Long-Term Disability for TMJ Disorder

Claims for long-term disability for TMJ disorder are often met with denials, citing insufficient medical evidence or lack of objective findings to support the claim. Most insurance companies are tough on these claims, arguing that TMJ doesn’t meet their criteria for a disabling condition. They demand concrete proof of severe, life-altering symptoms and a direct impact on your ability to work, which can be tough to document. Despite TMJ’s potential to cause debilitating pain, jaw dysfunction, and significant limitations in daily activities, insurance companies may classify it as non-severe.

Insurers play hardball, but with the right approach, you can get the benefits you deserve for your TMJ disorder. If your claim is denied, a skilled long-term disability attorney can effectively argue the severity of your condition and the affect it has on your ability to work, addressing any gaps or weaknesses in your initial application. Contact Ortiz Law Firm today to learn how we can help you get the disability benefits you deserve.

What Is TMJ Disorder?

Temporomandibular joint (TMJ) disorder is a common type of temporomandibular disorder (TMD) that affects the joints which connect the jaw to the skull and the muscles that control movement of the jaw. Temporomandibular disorders are frequently called TMJ after the joint that is affected, though some doctors may refer to it as TMD instead.

Symptoms of temporomandibular joint disorder include jaw pain, facial pain, shoulder or neck pain, difficulty moving the jaw to speak or chew, and locking of the jaw joint in the open or closed position. People frequently experience a clicking or grinding sound when moving the jaw. Patients can also experience muscle spasms in the face and neck, headaches, and difficulty sleeping because of discomfort.

Temporomandibular joint disorder has several known causes, though it may be impossible to determine what is causing a specific patient’s condition. Bruxism, or clenching and grinding the teeth, is a common cause. Other causes of TMJ include arthritis, jaw injuries, and connective tissue disorders. TMJ tends to run in families, so a close relative that suffers from the disorder can be a good indication that a person may be likely to develop TMJ themselves.

Diagnosing TMJ

Diagnosis of temporomandibular joint disorder begins with an examination by a dentist or physician. They will collect a medical history, including the location and duration of pain and other symptoms. The patient’s bite and jaw will be examined to observe the range of motion in your jaw and identify painful areas.

If the physician suspects TMJ, further diagnostic testing may be needed to understand the extent of deformity and inflammation, including:

• Dental X-rays of the teeth and jaw;
• CT scans for images of the bones that make up the joint; and
• MRI scans to examine the joint’s discs and the surrounding soft tissue.

TMJ arthroscopy is a technique sometimes employed to help diagnose TMJ disorder. Your doctor slips a slim tube called a cannula into the joint space and a tiny camera known as an arthroscope is inserted through the cannula, allowing for a clear view of the inside area.

Treating TMJ

Temporomandibular joint disorder is often a temporary, although painful, experience that goes away on its own. Many people with TMJ find relief through conservative home treatments such as non-steroid anti-inflammatory drugs like ibuprofen, mouth guards or splints, or stress-relieving therapies. Other prescription medication options include antidepressants and muscle relaxers. Arthrocentesis, the use of small needles to irrigate the joint, and injections of corticosteroids or Botox into the muscles surrounding the joint can ease the pain for severe cases. As a last resort, surgery might be an option.

Long-Term Disability Claims for TMJ Disorder

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 sets “disabled.”

Most patients with temporomandibular joint disorder are not considered disabled as the condition does not limit their life activities and resolves quickly, but others are not so fortunate. Severe TMJ may leave a patient unable to open or close their jaw, leaving simple tasks such as eating or speaking difficult if not impossible. If a person does not qualify due to TMJ alone, they may be eligible based on a the combined effects of multiple disabling conditions.

What the Insurance Company Needs to Approve Your Claim

You will need to provide proof of your diagnosis and your ongoing symptoms. Make sure you give the insurance company all the relevant medical evidence to provide a full picture of your health. Evidence may include office notes, clinical exams, diagnostic tests, and lab results.

You must also provide evidence of how your condition(s) prevents you from performing your own job or any job you could reasonably be trained for. A residual functional capacity (RFC) form completed by a treating physician can help document how your symptoms limit your ability to perform work activities.

Work with a Long-Term Disability Attorney to Appeal a Denial

Many people get turned down for benefits the first time they apply. However, you can appeal this decision and provide new evidence to support your case. Successfully appealing a denial requires a thorough understanding of the policy’s terms and proof of the affect TMJ disorder has on your ability to maintain employment. Expert assistance often makes the key difference in getting your benefits approved.

If you’re facing a rejection of your long-term disability claim, working with a disability lawyer can significantly increase your chances of success on appeal. Although the appeal process may seem overwhelming, a skilled disability attorney can navigate you through it smoothly. They only get paid if you win, so you can seek their help without the stress of upfront fees or surprise charges.

At Ortiz Law Firm, we have a track record of winning disability cases nationwide, and we only get paid if we recover your denied benefits. If you’re dealing with TMJ and its effects on your work life and need help getting the disability benefits you deserve, give us a call at (888) 321-8131. We’re here to assess your situation and discuss how we can support you in the appeal process.