Patients with paralysis may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their paralysis 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 Paralysis?
Paralysis is the loss of function of at least one muscle group. If there is nerve damage, it can also include loss of feeling in the area. The paralysis may be partial (some muscle control) or complete (no muscle control). It may be temporary or permanent. Localized paralysis affects only a small portion of the body, such as the vocal cords, while generalized paralysis affects a more substantial part of the body. Generalized paralysis can affect only a small muscle group, just one arm or leg, one entire side of the body, both limbs, or all limbs.
Usually, paralysis is not caused by a muscle disorder, but by damage to the nerves because of disease or injury. Multiple conditions can cause paralysis. Common causes are multiple sclerosis, stroke, Guillain-Barre syndrome, and peripheral neuropathy.
Paralysis can be diagnosed by a simple clinical assessment and medical history. The doctor may ask the patient to move the affected area, test the reflexes, and ask the patient about possible injuries.
It is essential to determine the cause of paralysis; not only does the prognosis change depending on the cause, but some of the underlying conditions can be severe and life-threatening. Diagnostic tests can determine the cause of the paralysis, the severity of the paralysis, how badly the nerves are affected. Diagnostic tests include:
- CT scans;
- Electromyography (EMG); and
- Spinal tap.
There is no cure for paralysis. If the paralysis is because of an underlying condition, it may improve when the cause is adequately treated. For people with Bell’s palsy, their paralysis may completely disappear with treatment. In some conditions, treatment is necessary to prevent the paralysis from worsening. Multiple sclerosis is one of these conditions.
Rehabilitation is the primary treatment for paralysis. The focus of rehabilitation is to equip the person with the tools they need to live well. Physical therapy can help strengthen the muscles and stimulate the nerves, while occupational therapy focuses on providing the person with the skills they need for everyday tasks. Mobility aids and supportive devices can keep the person mobile inside and outside the home. For more severely affected people, assistive technology such as voice-activated lights, computer-assisted communication, and voice-activated computer programs can help. Specialized adaptive equipment can include specially designed tableware and adaptive controls for the car.
Disability Evaluation of Paralysis
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 Paralysis
To be considered disabled, you will have to prove that your paralysis keeps you from doing your old job (or – depending on the language in your long term disability insurance policy – prevents you from working at any other job).
Your insurance company looks at your paralysis symptoms as well as any other disorders that may affect your ability to work. Paralysis may involve one or more of the following conditions:
- Spinal injuries;
- Spinal cord disorders or lesions;
- Multiple sclerosis;
- Systemic lupus erythematosus; and
- Malignant neoplastic diseases of the nervous system.
The insurance company will look at the Residual Functional Capacity (RFC) form to determine the extent of your symptoms and how they may keep you from working. For example, you may not be able to lift heavy objects if your limbs are affected by paralysis. Paralysis that affects the vocal cords could prevent someone from working even a sedentary job like a receptionist. Make sure that you are honest with your doctors when filling out the RFC form, as it may be the thing that makes or breaks your case.
Even if your paralysis is not considered disabling, you may still be awarded benefits based on your other conditions.
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 paralysis. 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:
- Physician notes;
- Diagnostic test results; and
- Physical therapy records.
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.
Work With a Long Term Disability Attorney
Working with an experienced disability attorney will put you in the best position to get the benefits you deserve for your paralysis. Even if you have been denied disability benefits before, 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 paralysis 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.