Diabetic Ketoacidosis and Long Term Disability

What Is Diabetic Ketoacidosis?

The serious diabetes complication that happens when your body produces extreme levels of blood acids called ketones. It develops when your body can’t make enough insulin. Insulin is used to help glucose (sugar), a major source of energy for your tissues and muscles, enter your cells. When your body doesn’t produce enough of it, it begins to destroy your fat cells as fuel. This process creates a buildup of acids called ketones in your bloodstream, which lead to diabetic ketoacidosis when left untreated.

Diabetic ketoacidosis can be triggered by:

  • A problem with insulin therapy: Inadequate therapy or missed treatments can leave your system low on insulin, triggering diabetic ketoacidosis.
  • An illness: Illness or infection can cause your body to create higher amounts of certain hormones like cortisol and adrenaline. These hormones counteract the effects of insulin which can trigger an episode of diabetic ketoacidosis. Common culprits are urinary tract infections and pneumonia.

Other possible triggers are:

  • Certain medications, such as diuretics or corticosteroids
  • Abusing alcohol or drugs, especially cocaine
  • Cardiac arrest
  • Emotional or physical trauma

Left untreated, diabetic ketoacidosis can lead to loss of consciousness or even death.

Disability Evaluation of Diabetic Ketoacidosis

Long-term disability insurance companies most often refer to the CDC (Center for Disease Control) to evaluate diabetic ketoacidosis. The CDC recognizes diabetic ketoacidosis if your symptoms have a definite onset date, have no other physical cause, and substantially interfere with your work, school, social, or personal activities. You must also experience four or more of the following symptoms for at least six months:

  • Fruity-scented breath
  • Shortness of breath
  • Fatigue or weakness
  • Abdominal pain
  • Vomiting or nausea
  • Frequent urination
  • Excessive thirst
  • High ketone levels in your urine
  • High blood sugar level (hyperglycemia)

Turn in medical records with your application that document the above criteria and prove your diagnosis by showing that your symptoms didn’t start before the onset of diabetic ketoacidosis.

Definition of Disability

You are considered disabled under most LTD policies if you are (a) unable to complete the work duties of your current occupation for the first two years of the policy, and (b) unable to perform the work duties of any occupation after the first two years of the policy. Every policy defines disability differently, so you’ll need to review your own LTD policy to determine how “disability” and “totally disabled” are defined in your specific case.

Proof of Diabetic Ketoacidosis

Along with your application, you’ll need to submit medically acceptable clinical and laboratory findings to prove the existence of your diabetic ketoacidosis. Symptomatology and medical diagnoses are not enough on their own, but the effects of your symptoms may be taken into consideration in the insurance company’s disability decision.

Evaluating Disability for a Diabetic Ketoacidosis Diagnosis

Your LTD insurance company will assign an adjudicator, or insurance adjuster, to your claim. With some help from a physician, psychologist, or another medical disability examiner like a nurse practitioner, your adjudicator will give an opinion on your level of impairment. You may be required to have a functional capacity evaluation or a compulsory medical examination. The adjudicator will look at all the available evidence including the impact of the illness on your body and the treatments you’ve received since the onset of the disease before making his or her decision.

If the adjuster finds that there’s not enough evidence to make an informed decision, you may be expected to provide additional documentation. In some cases, you can turn this information in yourself. In others, an independent medical source may be contacted for more information.

While your doctor may initially diagnose diabetic ketoacidosis based on your symptoms, you’ll need medical test results to back it up if you want to qualify for long-term disability benefits. The insurance company wants reports that document your objective clinical and laboratory findings, so your physician should submit everything concerning your condition, even if those results might point to another condition or disorder.

Diabetic ketoacidosis can be a dangerous and debilitating disorder. If you suffer from severe sugar problems or another physical or mental disorder that keeps you from successfully performing your job duties, long-term disability benefits can be a great financial help. Sadly, approval can be difficult, so speaking with legal counsel is imperative. If you’ve been denied for LTD benefits despite having a genuine disability, contact Nick Ortiz Law today at (850) 308-7833 to find out how we can help you get the benefits you deserve.