Patients with eye disorders may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their eye disorders 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 Are Eye Disorders?
Eye disorders are a broad category of conditions that affect the eyes. These disorders can be the result of congenital disabilities, aging, injury, or disease. Medications can also sometimes have adverse effects on eye health. Eye disorders cause difficulties seeing, which can sometimes develop into total blindness. Those that cannot see well even with corrective lenses are said to have low vision.
Many people first notice their eye disorder from the effect it has on their vision. Vision may become blurry, clouded, or marked with flashing lights or dark streaks. Frequently people experience headaches, eye pain, or nausea. For some conditions, the effect on the eyes is one of the first symptoms that the patient may notice of their disease.
Some disorders are generally associated with aging, though younger people and even babies can also be affected. Cataracts, which commonly affects older people, is a condition where the clear lens gradually becomes opaque. This causes dark or unfocused spots in the field of vision, slowly making it more and more difficult to see. Glaucoma involves the buildup of fluid within the eye, causing the pressure within the eye to rise. The pressure eventually affects the optic nerve, causing loss of vision and pain.
Other disorders are the result of disease or genetic conditions. Diabetic retinopathy is the most common cause of blindness in persons with diabetes and one of the significant causes of blindness in all populations. In diabetic retinopathy the blood vessels of the eyes are damaged by fluctuations in blood sugar, causing blurriness and even blindness. Multiple sclerosis can affect the eyes, causing difficulties with vision and visual tracking.
The third category of disorders involves a physical deformation of the eye itself. This can be a result of injury or congenital disease. These conditions may not progress like other disorders, but they can still negatively affect vision. Crossed eyes and lazy eyes can create issues because the eyes are not moving in a typical fashion. Retinal detachment, often the result of injury, separates the light-sensitive portion of the eye from the rest of the eye. Retinal detachment is an emergency and requires immediate treatment, though the person may suffer from permanent visual impairment.
Some eye disorders only temporarily affect the vision and may disappear with treatment. Others can cause permanent vision loss or even blindness. Depending on the severity of the disorder and the visual impairment, the person may not be able to complete normal life activities and may qualify for disability benefits for their eye disorder.
Diagnosing Eye Disorders
Eye disorders may take a long time to diagnose, as frequently the symptoms appear gradually and the patient may not become aware of the symptoms until the condition is advanced. While the effect on the vision may first be noticed in an exam from a general practitioner, an eye doctor is needed to make an accurate diagnosis. Eye exams are necessary to diagnose the condition correctly and can include:
- Pupil dilation to examine the inside of the eye;
- Fluorescein angiography to see if the blood vessels around the retina are damaged or leaking;
- Optical coherence tomography (OCT) to examine the thickness of the retina and measure macular swelling;
- Electroretinography to examine the retina’s response to light;
- Ultrasonography to map the inside of the eye and any abnormalities;
- Pachymetry to measure the thickness of the cornea; and
- CT scans and MRIs to examine the structure of the eye and surrounding bone structure, especially useful for injuries.
Other diagnostic tests may be needed to determine the cause of the disorder. Blood tests can determine if the underlying cause is autoimmune or from something like diabetes. MRIs of the brain may be necessary to determine if the issue is within the brain itself, such as with multiple sclerosis or brain tumors.
Treating Eye Disorders
Many eye disorders are treatable. The type of treatment varies depending on the condition. For diseases caused by underlying conditions, treatment of the causal condition is essential. This is especially important for diabetic patients or those with high blood pressure, who may have their vision restored by correctly treating their conditions. Corrective lenses are commonly used as they can help those with difficulties seeing focus more clearly. Many disorders are not adequately treated with corrective lenses.
Medications are used to treat most disorders. This can include oral drugs such as steroids for swelling or anti-VEG medications to reduce macular swelling and degeneration. Injections into the eye can deliver the medication exactly where it is needed. Surgery is required to treat disorders like cataracts and more severe cases of multiple disorders. Laser eye surgery can shrink blood vessels in the eye, reduce retinal swelling, and correct physical deformation.
Disability Evaluation of Eye Disorders
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 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 determines “disabled.”
Evaluating Disability for People with Eye Disorders
Patients seeking disability payments for their eye disorder will have to prove that they are impacted in a way that they cannot perform their old job or any job that they could be trained to work. To qualify for disability benefits, the condition must prevent the person from working for a least one full year. They will need a Residual Functional Capacity (RFC) assessment that indicates how their symptoms affect and limit their life activities.
What the Insurance Company Needs From You and Your Medical Providers
You should tell the insurance company about any doctor that has treated you for your eye disorder. The insurance company will need to obtain all relevant medical records to get the full picture of your health. These records include office notes, clinical exams, diagnostic tests, and lab results. Vision tests are helpful, and all recent vision tests should be included. 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 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. Make sure that you are as honest as possible with your doctors so that they can complete an accurate RFC for you.
Working with a Disability Attorney
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your loss of vision. 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 expert 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 one of our experienced disability lawyers about your eye disorder 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 process.