Pelvic Floor Dysfunction and Long-Term Disability Claims

What Is Pelvic Floor Dysfunction?

The inability to control the muscles of your pelvic floor is called pelvic floor dysfunction (PFD). Your pelvic floor is made up of the ligaments and muscles in your pelvic region. It acts as a sling to hold up the organs in your pelvis including the prostate or uterus, rectum, and bladder. By relaxing or contracting these muscles, you control your urination, bowel movements, and sexual intercourse, particularly in women.

Dysfunction of the pelvic floor forces your muscles to contract instead of relaxing. Because of this, you may have difficulty with bowel movements. Left untreated, pelvic floor dysfunction can lead to infection, long-term colon damage, and discomfort.

Disability Evaluation of Pelvic Floor Dysfunction

Long-term disability insurance companies most commonly refer to the Center for Disease Control (CDC) to evaluate pelvic floor dysfunction. The CDC recognizes pelvic floor dysfunction if it significantly interferes with your social, personal, work, or school activities; has a definite onset date; and has no other known physical cause. Diagnosis also requires at least four of the following symptoms for at least six months:

  • Pelvic muscle spasms
  • Pelvic or rectal pressure
  • Sexual discomfort for women
  • Pain in the rectum, genitals, or pelvic region
  • Lower back pain
  • Bowel strains or constipation
  • An increased urge to urinate, painful urination, or other urinary issues

Your medical documentation must show the above criteria to prove your diagnosis and demonstrate that your symptoms didn’t start before the onset of your pelvic floor dysfunction.

Long-Term Disability and Pelvic Floor Dysfunction

Individuals with PFD may not be able to perform work duties on a full-time basis, leaving them with few financial options. Long-Term Disability benefits can help ease the burden, but you must apply for them. The insurance company will then decide whether you qualify as disabled under an LTD insurance policy.

The insurance company bases its decision on information provided by yourself and your medical doctors during the application or appeal process. The following information will help you understand what the insurance company is looking for in order to evaluate your LTD claim based on pelvic floor dysfunction.

Definition of Disability

You will be considered disabled under most LTD policies if you are (a) unable to perform the common duties of your current occupation for the first two years of the policy, and (b) unable to perform the job duties of any reasonable occupation after the first two years of the policy. The definition of disability varies with each individual policy, so you’ll need to review your own long-term disability policy to discover how “disability” and “totally disabled” are defined for your specific case.

Proof of Pelvic Floor Dysfunction

Your LTD benefit application will require you to submit medically acceptable clinical and laboratory findings to prove the existence of pelvic floor dysfunction. While the effects of your symptoms may be taken into consideration when the insurance company decides whether you are disabled, symptoms and a simple diagnosis are not enough for approval.

Evaluating Disability for a Pelvic Floor Dysfunction Diagnosis

The insurance company will assign an adjudicator, also known as an insurance adjuster, to your claim. They may work with the help of a physician or another medical disability examiner, such as a nurse practitioner, to provide an opinion about your level of impairment. In addition, you may be required to have a functional capacity evaluation or a compulsory medical examination. The insurance adjuster will then take all the available evidence into account, including treatment since the onset of the disorder and the impact of the disorder on your physical health.

If the adjuster finds that he or she doesn’t have enough evidence to make a formal decision, they may contact you to provide additional documentation. If you have it, you can submit this information yourself. Otherwise, an independent medical source may be required.

Your physician may diagnose your pelvic floor dysfunction based on your symptomatology, but you’ll need to back your diagnosis up with medical tests to qualify for long-term disability. The insurance company wants to see reports documenting your objective clinical and laboratory findings, so be sure your doctor submits all available evidence concerning your condition. This is true even if it points toward another disorder or condition.

Pelvic floor dysfunction can be a debilitating and painful disorder. If you suffer from these muscle contractions or another physical or mental disorder that keeps you from effectively performing your work duties, long-term disability benefits could be the answer to your financial woes. Unfortunately, these benefits can be difficult to obtain, so it’s imperative to speak with legal counsel. If you’ve been denied for LTD benefits despite having a genuine disability, contact Nick Ortiz Law today at (888) 321-8131 to find out how we can help you get the benefits you so desperately need.


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