Pericarditis and Long Term Disability Insurance Claims

What is pericarditis?

The heart is held in place and supported by the pericardium, a two-layer wall separated by fluid. This fluid keeps the pericardium and heart from rubbing up against each other. Pericarditis occurs when the layers of the pericardium become inflamed and enlarged. This can cause the layers to become irritated or constricted.

The most common symptom of pericarditis is chest pain. Some patients describe it as feeling like a heart attack. The pain can feel like a stabbing pain or intense chest pressure and may spread into the chest and neck. Chest pain from pericarditis does not usually last long, but it can be severe. Other symptoms of pericarditis include changes in the heart rate, feeling like you can’t catch your breath, fatigue, and a mild fever.

There are different types of pericarditis. Acute pericarditis comes suddenly and lasts less than three weeks. Incessant pericarditis lasts less than six months, with most patients experiencing symptoms for four to six weeks. Patients with incessant pericarditis experience symptoms consistently, though they may change in intensity. If a person experiences symptoms of pericarditis for more than three months, their condition is considered chronic. Recurrent pericarditis occurs when a patient experiences a symptom-free period between their first case and their second.

Other conditions or medical disorders cause pericarditis. Common causes include heart attacks, blood clots in the lungs (pulmonary embolism), autoinflammatory diseases, and viruses or bacterial infections. Trauma to the chest, whether a result of an injury or from surgery, can also cause pericarditis. Many cases of pericarditis have no known cause and are considered to be idiopathic.

Diagnosing pericarditis

Pericarditis is often diagnosed when a person goes to the emergency room, thinking that they are having a heart attack. The condition may also be diagnosed as part of a clinical exam by a physician. Diagnosis begins with the doctor listening to the heart with a stethoscope. The doctor will look for changes in heart rhythm and listen for signs of pericarditis called pericardial rub, which is the sound of the layers of the pericardium rubbing up against each other.

Further diagnostic tests are necessary to look for other serious conditions that may be causing the pericarditis as well as to look for other symptoms that the person may be experiencing. Testing includes:

  • Electrocardiogram (ECG) of the heart to look at heart rhythms
  • Echocardiogram to look at heart structure and signs of fluid in the pericardium
  • Chest X-ray
  • CT scan
  • MRI

Treating pericarditis

Pericarditis is treated differently depending on the cause and the intensity of symptoms. The effectiveness of treatments depends on the underlying cause being adequately addressed. Since stress and strenuous activity can make symptoms worse, rest is crucial in recovering from pericarditis.

Medications can reduce swelling and inflammation, which often helps with the associated chest pain. Patients are generally started on anti-inflammatory drugs such as Ibuprofen. If those drugs do not help, other classes of medications such as steroids are considered.

Some patients experience a medical emergency called cardiac tamponade, where dangerous amounts of fluid build up around the heart. These patients are hospitalized for surgical interventions, as cardiac tamponade can be fatal. Doctors may use a needle to drain the excess fluid from the pericardium in a procedure called pericardiocentesis. In severe cases, the entire pericardium may be removed.

Disability evaluation of pericarditis

Some people can’t work because of their pericarditis. People who cannot work (and have the coverage) may apply for Long Term Disability (LTD) insurance benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.

Definition of disability

Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their work duties for the first two years of the policy and 2) be unable to complete the work duties of almost any occupation for the years following the initial 2-year period. Some plans are a bit different, so it’s essential to understand your specific policy and its limitations when applying for benefits.

Evaluating disability for people with pericarditis

Some people with pericarditis develop permanent scarring of the pericardium, called constrictive pericarditis, which can cause breathing problems and severe swelling throughout the body. These people may have difficulty walking or using their arms or hands for long periods. Shortness of breath can keep a person from working in labor-intensive jobs or in areas that require respirators.

People with chronic or recurrent pericarditis may qualify for long-term disability benefits because of the intensity of their symptoms and the difficulty of predicting when those symptoms will occur. Symptoms must be intense enough to interfere with work duties.

Even if a person may not qualify for long-term disability benefits for pericarditis alone, they may still be eligible if they have other conditions that are considered disabling. Evaluators look at a person’s entire medical health when making a consideration, so it is important to list all relevant medical conditions when applying for benefits.

What the insurance company needs from you and your medical providers

You will need to tell the insurance company about any doctors that have treated you for your pericarditis. They will need to get your medical records from those doctors when they are evaluating your claim. If the insurance company cannot get those records directly, you may need to get them from your doctors and send them in yourself.

The insurance company will need to see proof of your diagnosis and your ongoing symptoms, as well as evidence of how those symptoms affect your life. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform. Make sure that you are as honest as possible with your doctors so that they can complete an accurate RFC for you.

Working with an Experienced Disability Attorney

You do not have to fight the insurance companies alone. An experienced disability attorney will guide you through the process and give you the best chance of getting the benefits you deserve for your pericarditis. Even if you have already applied and you have been denied, you are not out of luck.

The experienced disability attorneys at the Ortiz law firm can help you through the process, from administrative appeals to potential litigation. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills. Our law experts will focus on your case so you can focus on your illness.

The Ortiz law firm has successfully represented people in disability cases across the United States. If you would like to talk to one of our experienced disability lawyers about your pericarditis and how it affects your life, call us at 850-308-7833.