According to the Sleep Foundation, 30% of Americans suffer from some form of insomnia, and 10% suffer insomnia to the point that it interferes with their daily activities and work function. If you are functionally impaired from working, you may qualify for long-term disability insurance benefits.
Patients with insomnia may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their insomnia 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.
Yet, when you have insomnia, insurance companies do not make it easy for you to apply for long term disability benefits. Many insurance companies will argue that you are suffering from a pre-existing condition or even a mental illness that comes with limited coverage periods. But you can build a strong claim by gathering as much information as possible before submitting your LTD claim.
What Is Insomnia?
Insomnia is a medical condition that prevents you from getting the amount of sleep your body needs to function properly. Symptoms can include fatigue, poor concentration, nausea, headache, pain, behavior problems, and impaired judgment or performance. Your symptoms can cause you to become a liability in your workplace if left untreated. For example, Mark is a construction worker who usually drives an excavator on the job. If he were to experience impaired judgment on the job, someone else could get seriously injured or even killed. Seeing a doctor for insomnia is very important when it comes to protecting your overall health and safety. Unfortunately, many employers and insurance companies don’t think about safety when denying employees long-term disability to seek treatment for insomnia.
Because insomnia is a known symptom of other conditions from pregnancy to mental illness, insurance companies often deny claims citing that insomnia is not a stand-alone condition but an underlying symptom of something else. Many insurance companies consider insomnia a mental illness condition unless you can prove otherwise. Mental illness conditions are limited to a two year maximum benefit period under most ERISA insurance policies. If you can prove to the insurance company that your insomnia is actually a physical condition, you have a better chance of getting approved for long term disability benefits.
How to Prove Your Insomnia Case?
To prove your case for insomnia, you should seriously consider consulting with a sleep specialist, like a board-certified sleep physician, in addition to your primary doctor. A sleep specialist is trained in treating people with sleep disorders, including insomnia. Since there are very few tests for insomnia, a sleep study will be performed during which they will monitor you while you sleep (or try to sleep) at a sleep center that provides a quiet, comfortable place to sleep while they monitor your sleep patterns. Using sleep study data, they can create a treatment plan for insomnia patients that includes cognitive behavior therapy, light therapy, or medications.
In addition to a treatment plan from a sleep specialist, you should also gather the following documents to support your claim:
- A copy of your individual or group long-term disability policy;
- A copy of your personnel file to look for data that shows how your insomnia has affected your work performance;
- A copy of your job description from your employer;
- A copy of your medical file that includes doctor’s notes about how insomnia has affected your life, your list of prescribed medications, test results like blood work, imaging tests, and sleep study results;
- A journal of daily notes showing how insomnia has affected your life and any side effects from medications; and
- Copies of all letters that the insurance company has sent you and you have sent them.
The use of vocational experts can help the insurance company and your claim. Vocational experts are experienced in researching jobs that you may be able to work given your insomnia condition. If the vocational experts believe that you are unable to work, their report will show that. The insurance company can hire vocational experts to argue that you can work as well, so it’s best to consult an attorney to assist you.
Consult An Attorney
Unlike some disabilities, insomnia can be difficult to get approved by your insurance company. They are not understanding the safety risk that they are putting other employees in by having someone on the job who is impaired. Using an experienced disability attorney can help you create a solid case for your claim and will help you protect yourself against the insurance company.
While the process can be daunting, your experienced 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 an experienced disability lawyer about your insomnia 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.