Inflammatory Arthritis and Long Term Disability Insurance Claims

Are You Unable to Work Due to Inflammatory Arthritis?

You may be entitled to Long-Term Disability Benefits if your condition is severe, impacts your ability to work, and you meet specific requirements set forth by your insurance provider.  Our Northwest Florida Long-Term Disability Attorneys can help you evaluate your case and access any benefits you may be entitled to. For immediate assistance, contact The Ortiz Law Firm at (888) 321-8131.

Arthritis is a term used to describe a medical condition where a person’s joints are inflamed. Inflamed joints cause stiffness, soreness, and swelling. There are many different types of arthritis, but the two most common forms are inflammatory and noninflammatory.

Noninflammatory Arthritis

Noninflammatory arthritis is known as osteoarthritis (OA). Even though it is called noninflammatory, it can still result in some inflammation or swelling of the joints. The difference in this type of arthritis is that it results from the breakdown of cartilage. Cartilage acts as a barrier that covers the ends of bones in the joint. As that cartilage breaks down, bones can rub against one another causing pain.  This breakdown often occurs when joints are injured, but it also happens as a result of wear and tear. Noninflammatory arthritis is most commonly found in the hands, knees, hips, and spine.

Inflammatory Arthritis

Inflammatory arthritis is often referred to as Rheumatoid Arthritis (RA). This type of arthritis often causes pain in the joints, but the cause and impact are very different. Inflammatory arthritis is an autoimmune disease which means that it is caused by the immune system. Normally, the immune system protects our health by attacking foreign substances like bacteria and viruses. But, in the case of inflammatory arthritis, the immune system mistakenly attacks the tissue that lines the joints resulting in inflammation. 

Inflammatory arthritis isn’t limited to the joints. It is a systemic disease since it is capable of affecting your entire body, including your cardiovascular or respiratory systems.  If someone with rheumatoid arthritis doesn’t get treated, this autoimmune disease can cause permanent damage.

When Inflammatory Arthritis is a Disability

Inflammatory Arthritis is a debilitating condition that often impacts one’s quality of life and ability to work.

However, simply being diagnosed with inflammatory arthritis isn’t enough to be considered disabled. You are considered disabled when a condition limits your normal movements, senses, or activities.  A determination of disability is made based on the activities you find difficult. For example, you may have trouble:

  • Lifting more than 10 pounds
  • Grasping small objects
  • Standing or sitting for extended periods
  • Walking up stairs

Documenting Your Disability Due to Inflammatory Arthritis Is Essential

If you find that your inflammatory arthritis limits your ability to work, you should work closely with your doctor to document your condition. In order to qualify for Long-Term Disability benefits, you will need sufficient evidence detailing how your condition prevents you from working or performing daily tasks that you otherwise would be able to do.

Qualifying for Long-Term Disability Insurance

Individuals with Inflammatory Arthritis may not be able to perform work activities on a full-time basis and must apply for Long Term Disability (LTD) benefits. The insurance company must then decide whether the claimant is disabled under the LTD insurance policy.

The insurance company will base its decision on information obtained from your medical providers and upon any information you provide during the application and/or appeal process. The following will help you understand the kind of information your long-term disability insurance company needs to evaluate your LTD claim based on Inflammatory Arthritis.

Definition of Disability for Inflammatory Arthritis

Under most LTD policies, an individual is considered disabled if he or she is: (a) unable to perform the material duties of his or her own occupation for the first two years of the policy; and (b) unable to perform the duties of just about any occupation after the first two years of the policy. The definition of disability is specific to each individual policy, so you must review your own LTD policy to determine how the term “disability” or “totally disabled” is defined for you.

Your provider will then determine whether your inflammatory arthritis or osteoarthritis is severe enough to keep you from performing activities commonly required for working. These activities include:

  • Sitting or standing
  • Kneeling or walking
  • Lifting
  • Using fine motor skills

Based on your limitations, you may be deemed capable of heavy, medium, light, or sedentary work.

Medical Evidence Proving Inflammatory Arthritis

You must also meet medical criteria to qualify for Long-Term Disability Benefits. In the case of inflammatory arthritis or RA, you must have swelling and pain, and your joint movement must be limited or painful.

To prove the extent of your disability, you will likely need doctor and hospital records, laboratory test results, and sometimes a questionnaire that should be completed by your doctor. Your provider also may use information from the Arthritis Foundation when evaluating your inflammatory arthritis claim. In general, the records must include the following:

  • A confirmed diagnosis of inflammatory arthritis
  • A doctor’s note detailing the frequency and severity of your symptoms
  • Blood test results indicating the likelihood of RA
  • A history of any treatments tried
  • Any other test results such as imaging studies or those that measure range of motion of the spine

Evaluating Disability for Persons with Inflammatory Arthritis

The insurance company’s adjudicator is the insurance adjuster assigned to your claim. The adjuster may have your file reviewed by a physician, psychologist, or another medical disability examiner (such as a nurse practitioner) to give an opinion as to your level of impairment. The adjuster may also send you for a compulsory medical examination or functional capacity evaluation. In evaluating disability for persons with inflammatory arthritis, the insurance adjuster should consider all of the available evidence, including the clinical course from the onset of the illness, and should consider the impact of the illness on each affected body system.

If the insurance adjuster believes there is not enough information to make a decision, he or she may call or write you to find out if you have the needed information. If you do not, they may ask you or, in some circumstances, an independent medical source to provide the information.

Although your physician may reach a diagnosis of inflammatory arthritis on the basis of your symptomatology (after ruling out other disorders), your disabling impairment should still be documented by medically acceptable clinical and laboratory findings. Statements merely recounting your symptoms or providing only a diagnosis will not usually be sufficient to be approved for long-term disability insurance benefits. The insurance company should have reports documenting your objective clinical and laboratory findings. Thus, it is essential that your doctor(s) submit all objective findings available concerning your condition, even if they relate to another disorder or establish that you have a different condition.

How the Insurance Company Assesses Your RFC

In light of your documented symptoms, the insurance company may develop an RFC for you that states, for example, that due to persistent pain or stiffness, you need to take frequent breaks throughout the day to rest as needed. Because most employers would not accommodate this limitation, it would be difficult for you to obtain and maintain most jobs.

If you suffer from documented joint pain, weakness, or physical deformities from your RA, your RFC may include limitations on certain work-related physical activities as well. For example, the RFC may state that you cannot lift or carry objects that weigh more than 10-15 pounds. This limitation would prevent you from doing jobs that required physical exertion, such as factory work, warehouse work, and most janitorial positions.

Living with chronic pain from inflammatory arthritis can also cause mental health problems such as depression or anxiety. If you are receiving mental health treatment, you should ask your treating physician (your psychiatrist or psychologist), to fill out an RFC form that details his or her opinions of your work-related limitations. Keep in mind that the insurance company will assign them weight only if they are supported by objective medical evidence.

Work with a Florida Long-Term Disability Insurance Attorney to Ensure You Get the Benefits You Deserve

Your best chance of having a long-term disability case approved because of inflammatory arthritis comes by working with an experienced Disability lawyer.

Your Florida Long-Term Disability attorney will be familiar with how insurance providers handle RA claims and will help you prepare your application and collect essential evidence. It’s important to note that your Long-Term Disability attorney does not get paid until you do, so you can proceed with your case without fear of upfront legal bills or costs.

Although based in Florida, the Ortiz Law Firm represents claimants across the United States.

If you’d like to speak to one of our Pensacola Long-Term Disability Insurance Attorneys about your inflammatory arthritis condition and how it may be impacting your ability to work, contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access Long-Term Disability Benefits and how to move forward with the process.