Alzheimer’s Disease and Long Term Disability Insurance Claims

What is Alzheimer’s Disease?

Alzheimer’s disease, often referred to as Alzheimer’s by itself, is a type of dementia that causes progressive memory loss and impaired mental functioning. While common, it is a devastating diagnosis that can seriously disrupt a person’s life, eventually leading to their death. It is the sixth leading cause of death in the US. In its more progressed state, patients are dependent on others for all their basic needs. Impaired mental functioning can leave a person unable to complete sentences, dress themselves, or even feed themselves. Changes in the brain can leave a person unable to swallow or move normally. Alzheimer’s patients often require assisted living arrangements.

Alzheimer’s disease is strongly correlated with aging, with most patients over the age of 65, though it can appear in younger patients as well. Patients that are under the age of 65 when diagnosed are said to have early-onset Alzheimer’s. Scientists are still researching the disease to understand more about how it develops, but there seems to be a link between genetic, environmental, and lifestyle factors.

Symptoms may appear gradually and worsen over time. Once symptoms appear, they do not disappear without treatment. Often people with the condition do not realize that they are experiencing symptoms due to impaired mental functioning and may resist suggestions to seek treatment. One of the early signs is difficulty remembering new information, as Alzheimer’s first affects the regions of the brain responsible for learning. Other symptoms include disorientation, confusion, memory loss, mood and behavior changes, suspicion and paranoia, and difficulty speaking, swallowing, and walking. Severe loss of brain function can cause life-threatening dehydration or malnutrition or leave the body vulnerable to infections.

While some symptoms of Alzheimer’s can first appear to be a regular part of the aging process, Alzheimer’s is a serious disease. To best treat this condition, see a doctor as soon as Alzheimer’s is suspected.

Diagnosing Alzheimer’s Disease

Alzheimer’s disease may be difficult to diagnose, as patients are not always able to express their symptoms. A close friend or relative that is familiar with their symptoms can help with the diagnostic process if the patient is experiencing communication or memory problems.

A doctor will perform a physical exam and a test of neurological function. Neurological function tests can include in-office tests of reflexes, balance, and coordination. More intensive neuropsychological testing may be completed as well.

Further diagnostic testing includes:

  • Lab work to rule out other memory disorders
  • MRI to look for brain lesions, swelling, or shrinking
  • CT scan to look for tumors, stroke, or head injury
  • PET scan to look more closely at brain structures

Treating Alzheimer’s disease

Alzheimer’s disease cannot be cured, but treatment can help reduce the severity of symptoms and slow down the progression of the disease. Often the success of treatment depends on starting treatment as soon as possible.

Medications, such as cholinesterase inhibitors, can help slow the progression of symptoms and preserve some brain function. Antidepressants or antipsychotic drugs may be used to help treat behavioral changes. A healthy diet and exercise can support both brain health and physical coordination. Lifestyle changes, such as keeping a routine and using memory aids, can make day-to-day activities more comfortable. Caregivers and medical aids may be necessary for more advanced cases.

Eventually, people with Alzheimer’s require intensive care and help with daily activities. Living at home may not be an option. Long-term care facilities and memory units may be necessary for patients and their families.

Disability Evaluation of Alzheimer’s Disease

Patients with Alzheimer’s disease may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their Alzheimer’s disease may therefore be eligible to receive Long Term Disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.

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 sets “disabled.”

Evaluating Disability for People with Alzheimer’s Disease

Patients diagnosed with Alzheimer’s disease may not be considered disabled when they are first diagnosed, but as the disease progresses they may be considered disabled. Patients seeking disability payments for their Alzheimer’s disease 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.

The long term disability insurance claims adjuster reviewing the claim will evaluate medical records and physician statements to determine whether the claimant qualifies for LTD benefits. They are typically looking for impairments in one or more of the following categories:

  • Memory, especially short-term memory
  • Learning new things
  • Communicating
  • Listening or paying attention
  • Physical coordination
  • Social skills

To qualify for disability benefits, the condition must prevent the person from working. The claimant will want to provide the LTD insurance adjuster with evidence such as a Residual Functional Capacity (RFC) assessment that indicates how the claimant’s 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 Alzheimer’s disease. 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. Neurological testing, both in-office and diagnostic test results, are particularly important. 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 Alzheimer’s disease. 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 Alzheimer’s disease and its impact on your ability to work, call us at (850) 308-7833. We would be happy to evaluate your case and to discuss how to help you through the appeal process.