Getting Long Term Disability for Stroke

What is a stroke?

The blood vessels that carry blood to the brain from the heart are called arteries. Our brains need a constant supply of blood, which carries the oxygen and nutrients our brains need to function. Each artery has a specific function and supplies blood to specific areas of the brain. A stroke occurs when one of these arteries to the brain is either blocked or bursts. A blocked blood vessel  causes an ischemic stroke. A brain hemorrhage causes a hemorrhagic stroke. Either way, a part of the brain starts to die when it does not get the blood it requires.

Note: A transient ischemic attack (TIA) occurs when the blood supply to the brain is blocked for a period of time. The stoppage of flow causes the brain to malfunction temporarily. If you’ve suffered TIAs but not full blown strokes, see our article on transient ischemic attacks.

The resulting after-effects of a stroke vary from person to person, but may include difficulty speaking, walking, and seeing. Most stroke patients suffer from numbness, a loss of sensation, and some sort of muscle weakness, which usually affects one side of the body. For some patients, the damage is only for a short period of time; for others it is irreversible. Specific examples of impairments include, but are not limited to:

  • difficulty in speaking or writing effectively due to either expressive aphasia (having difficulty forming words, also called motor aphasia) or sensory aphasia (characterized by fluent, nonsensical speech and the inability to understand, or also called receptive aphasia); and
  • difficulty controlling the movement of one’s extremities (arms and legs), causing serious problems walking and balancing or using one’s hands to grasp and manipulate objects.

Approximately 75% of stroke victims have residual effects from a stroke. For many, these effects make it difficult – if not impossible – to work.

Long Term Disability

Can you be approved for long-term disability (LTD) on the basis of having had a stroke? As with any disabling condition, you can be approved by satisfying the definition of the term “disability” under your LTD insurance policy. Under most policies you are considered disabled for the first 24 months if you are unable to perform the material and substantial duties of your occupation. After 24 months of receiving LTD benefits, the definition of disability typically broadens and you must show that you are unable to engage in any gainful occupation on a continual basis.  Each of these definitions are a medical-vocational allowance which compares your functional limitations to the vocational skills required by a job.

Getting Disability Due to Loss of Vision

A small percentage of stroke patients experience vision loss following a stroke. The most common type of loss of vision loss after a stroke is hemianopia, where a person loses sight in half of the visual field for each eye . For some stroke victims, this type of vision loss improves in the first few months following a stroke, but for others it does not. You can qualify for LTD disability benefits for hemianopia and other vision loss if your vision keeps you from working.

Obtaining a Medical-Vocational Allowance Based on Stroke

You may qualify for LTD disability benefits through a “medical-vocational allowance” by demonstrating you cannot return to your past work (or other work). To determine whether you can work, the adjuster assigned to your claim will evaluate your medical records and create an RFC for you, which is an assessment of your “residual functional capacity”. This is an assessment of how much you can still do after your stroke.

To assess your RFC, the insurance claims examiner will look to your medical records to see what common stroke-caused impairments you have. The adjuster will review your treatment notes, admission and discharge summaries, lab and imaging studies, and any supporting statements from your treating physician(s). To make your doctor’s role easier, you should make sure you take notes for your doctor on what you can and cannot do; for example, whether you can walk up stairs, how long you can stand or walk, whether you can use your hands to button your shirt, type on a computer keyboard, and so on.

If your doctor has documented that you have trouble walking, muscle weakness, difficulty with balance, difficulty reading, difficulty understanding directions or remembering, then these factors will influence the claims examiner’s opinion of what type of work you can still do. For instance, if you have a weakened arm, and you cannot use that hand to grasp and lift objects or do things requiring coordination, such as typing, you will not be able to perform many desk jobs. That’s because you need to have good control over both hands to work at most sedentary jobs. In this instance, your RFC might be for “less than sedentary” work, and you may be approved for long-term disability benefits. Or, if you have muscle weakness in your leg, and you cannot stand for six to eight hours per day, you will be limited to no more than sedentary work. If your old job required light, medium, or heavy exertion, you won’t be able to go back to it.

After the first two years (under most policies), if you cannot go back to your past work, the insurance company will try to determine whether there is other work you can do.

Hiring an Attorney

If you have suffered a stroke and the insurance company has denied your LTD claim or has terminated your benefits, contact the Ortiz Law Firm for a free consultation with an experienced long-term disability attorney. We can be reached at 850-308-7833.