According to the National Institutes of Health (NIH), about 20 percent of those of us in the United States are affected by gastroesophageal reflux disease (GERD for short).
Occasional reflux is considered normal. However, when symptoms occur more than twice a week, it is considered GERD – a more serious, chronic health condition.
For some, GERD symptoms can be effectively controlled through diet, lifestyle adjustments and prescription medications. For others, however, GERD is a debilitating and disabling disease that can lead to serious – even life-threatening – complications.
If your GERD is not well controlled by available treatments or has led to serious complications, then you may qualify for long term disability (LTD) benefits.
The Effects of GERD
Someone suffering from GERD may require prescriptions, frequent doctor visits, and tests to monitor the condition of one’s esophagus, stomach, and lungs
The symptoms and complications of GERD may advance to the point decreased where you experience a loss of productivity and work absences, and may ultimately be unable to continue working.
Complications Due to GERD
Esophagitis, esophageal strictures, and Barrett’s esophagus are all common complications of GERD. If you have any of these conditions, your doctors will need to keep a close eye on them. Frequent endoscopies may be necessary, and prescription medications are bound to be a primary medical expense for you. Healthline statistics reveal that doctors in the U.S. write nearly 65 million GERD-related prescriptions annually. In fact, many patients must take multiple drugs to control or lessen the disease’s affects.
If your GERD causes respiratory complications, then you may require asthma medications or a CPAP machine. You may experience more frequent infections or aspiration problems as well, which may require frequent emergency room visits.
Medically Qualifying for Benefits with GERD
GERD alone is not usually enough to qualify for long term disability benefits. However, when long-term, chronic GERD causes serious complications, it may be disabling.
You will need to show a decreased work ability due to GERD to qualify for LTD benefits. The best evidence of your limitations may be in the form of an Attending Physician Statement (APS) or Residual Functional Capacity (RFC) evaluation. Such a form should specifically identify how your symptoms and complications are so severe that they prevent employment.
If you are able to demonstrate significant limitations in your activities of daily living (ADLs), then you may be able to establish a restricted RFC and receive a medical vocational allowance from the long term disability insurance company.
As you can see, your physician’s input on an APS or RFC can make or break your claim. Make sure your doctor is “on board” with your claim and will finalize and submit his or her forms quickly.
Long Term Disability Benefits with GERD
Your LTD disability application and/or appeal must be backed up with sufficient medical evidence. Certain medical records may play a key role in approval. Such records may include:
- Endoscopy results;
- ER and hospitalization records;
- Sleep studies;
- Respiratory evaluations;
- Surgical records; and
- Prescription drugs you’ve taken as well as their results.
Long-term reflux disease, evidenced with symptoms that do not respond well to treatment, may qualify for long term disability benefits. The insurance adjuster handling your claim will need to understand how the damage has progressed over time, decreasing your daily abilities, including your abilities to maintain a job and earn a living. A detailed statement from your doctor explaining the progression of your GERD complications can be especially beneficial.
You should work closely with your doctor before and during your LTD claim. You may also want to consider seeking help from an experienced long term disability insurance attorney.