Patients with myasthenia gravis may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their myasthenia gravis 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 Myasthenia Gravis?
Myasthenia gravis means “grave muscle weakness.” It is an autoimmune neuromuscular disease that causes weakness in the muscles, which can lead to problems moving, eating, and breathing. Weakness of the muscles worsens after exercise and improves with rest for people with myasthenia gravis, though the muscle weakness may never fully go away.
The immune system attacks the connections between nerves and muscles, which prevents the nerves from correctly controlling the muscles. This can lead to overall muscle weakness or weakness in certain parts of the body. It may be difficult for the person to move their arms or legs, breathe, swallow, move their facial muscles, or control their eyelids. Common visible symptoms include dropping eyelids or facial muscles.
It most commonly occurs in younger woman and older men, but anyone may be affected by myasthenia gravis.
Diagnosing Myasthenia Gravis
Diagnosis begins with a physical and neuromuscular exam in a doctor’s office. The doctor will test the reflexes as well as muscle strength, coordination, and control of speech and eye movement.
Additional diagnostic tests include:
- Blood tests, particularly for acetylcholine receptor antibodies and anti-MuSK antibody;
- Electromyography (EMG);
- Diagnostic imaging like MRIs and CAT scans; and
- Pulmonary function testing.
Treating Myasthenia Gravis
While there is no cure for myasthenia gravis, treatment can improve symptoms. Medications such as anticholinesterase medications and immunosuppressive drugs are frequently prescribed. Plasmapheresis may be used to remove harmful antigens in blood. Intravenous immunoglobulin (IVIG) adds antibodies from healthy people, which can keep the immune system from attacking itself. Thymectomy, where the thymus gland is surgically removed, has been shown to drastically reduce symptoms in some individuals.
A myasthenic crisis may occur, where the muscles that control breathing do not function correctly. Individuals in myasthenic crisis require a ventilator to help them breathe or they will die.
Disability Evaluation of Myasthenia Gravis
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 work in almost any job after that. Each LTD plan has a different definition of “disability”, so look over your plan policy to see how your plan determines “disabled.”
Evaluating Disability for People with Myasthenia Gravis
You must prove that your myasthenia gravis keeps you from doing your old job (or – depending on the language of the long term disability insurance policy – any job that you could be trained to work ). Your insurance company will evaluate your symptoms from your myasthenia gravis as well as any other disorders that may affect your ability to work. Limitations due to myasthenia gravis may include one or more of the following:
- Limited ability to control two extremities, leading to extreme difficulty balancing, walking, or using the arms;
- Reduced function of the bulbar muscles, leading to needing parenteral or enteral nutrition or use of a ventilator; and
- Marked problems with:
- Interacting with others; and/or
- Finishing tasks.
The insurance company will also look at the Residual Functional Capacity (RFC) form to determine the extent of your symptoms and how they may keep you from working.
What the Insurance Company Needs From You and Your Medical Providers
You should tell the insurance company about any doctors you may have seen for your myasthenia gravis. The insurance company will need to obtain all relevant medical records to get the full picture of your health. 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 should include the physician notes from doctor visits as well as the records from any diagnostic testing. Important documents to include are:
- Physician notes;
- Diagnostic test results; and
- Blood tests.
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.
Working with a Disability Attorney
A knowledgeable disability attorney will give you the best chance of getting the disability benefits you deserve for your myasthenia gravis. Even if you have previously been denied, that does not mean you are out of options. It is not unusual to be denied the first time you 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 intimidating, your disability attorney is an expert on the process. You can seek help without worrying about upfront costs or unexpected bills because they are paid out of any awarded funds.
The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to one of our experienced disability lawyers about your myasthenia gravis 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.