Spina Bifida and Long Term Disability Insurance Claims

What is Spina Bifida?

Spina Bifida, also known as splint spine syndrome, is a rare birth defect in which the spinal cord and vertebrae do not properly develop. There are gaps in the vertebrae that can expose sections of the spinal nerves, which can allow the spinal nerves to protrude out into the tissues of the back.

There are three different types of Spina Bifida, which range in severity. spina bifida occulta, meningocele, and myelomeningocele. Spina bifida occulta is the mildest form; some people never know that they have it until it shows up on a diagnostic test. In meningocele, the membranes that surround the spinal cord are pushed through an opening in the vertebrae and form a fluid-filled sac. Since the spinal nerves are not affected, there is less chance of nerve damage for people with meningocele. Myelomeningocele is the most severe form of spina bifida. Large or multiple openings in the vertebrae expose large sections of the spinal cord, pushing out through the openings and leaving the person vulnerable to nerve damage and infection.

Spina Bifida cannot be cured. People with spina bifida often have issues with learning disabilities and cognitive disabilities. Secondary conditions include gastrointestinal disorders, mobility issues, tendinitis, obesity, and depression. Severe cases of spina bifida can include paralysis, weakness of the extremities, mobility issues, abnormal eye movement, and cognitive dysfunction.

Diagnosing Spina Bifida

Spina bifida is usually diagnosed before or immediately after birth. Abnormalities can show up on ultrasound images in fetuses and infants. Often there are physical symptoms with more severe cases. Dimples, patches of hair or darkened skin, or lumps can develop over the area that is affected. If the nerves are damaged, the infant may have difficulty moving or responding to stimulus. 

In more mild cases, the individual may not know that they have the condition until it shows up in diagnostic images, usually taken for unrelated disorders. Even if the person already has a diagnosis, diagnostic tests are needed to determine the extent of the damage. Tests include:

  • MRIs and CAT scans
  • Ultrasounds
  • X-rays

Treating Spina Bifida

As there is no cure for spina bifida, treatment is focused on relieving symptoms and preventing future damage. Physical therapy can strengthen the area and help build up the muscles to hold the spine in place. Nutritional consultations are used to ensure growth is following recommended guidelines. In more severe cases, surgery may be used to relieve pressure on the brain through a process called shunting.

Disability Evaluation of Spina Bifida

If you cannot work because of your Spina Bifida, you may apply for long term disability insurance benefits. The insurance company will review claim to see if you meet the definition of disabled outlined by your 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 work in almost any job after that. Each LTD plan has a different definition of “disability”, so look over your plan policy to see how your plan determines “disabled.”

Evaluating Disability for Claimants with Spina Bifida

You must prove that your spina bifida keeps you from doing your old job (or – depending on how your LTD insurance policy defines the term “disability” – any job that you could be trained to do).

The insurance company adjuster handling your claim will also look at any Attending Physician Statement (also called a Residual Functional Capacity form) you submit to determine the extent of your symptoms and how they may keep you from working.

What the Insurance Company Needs From You and Your Medical Providers

You should tell the insurance company about any doctors you may have seen for your spina bifida. The insurance company will need to obtain all relevant medical records to get the full picture of your health. If for any reason they cannot get these records from your doctors, you should request them and provide them to the insurance company yourself. Important records to include are:

  • Physician notes
  • Physical therapy notes
  • Diagnostic test results

You will need to provide proof of your diagnosis and your ongoing symptoms, as well as proof of how you are affected by your symptoms. If your doctor diagnosed you by clinical assessment, you may want to get additional diagnostic testing to help your case. Providing detailed documentation is key to a successful claim. Attending Physician Statements (also called 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, if any, you may still be qualified to perform.

Working with an Experienced Disability Attorney

An experienced disability attorney will give you the best chance of getting the disability benefits you deserve for your Spina Bifida. Even if you have been denied disability benefits before, that does not mean you are out of options. It is not unusual to be denied the first time you apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.

While the process can be intimidating, your disability attorney is an expert on the process. You can seek help without worrying about upfront costs or unexpected bills because they are paid out of any awarded funds.

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 spina bifida and its impact on your ability to work, call us at 850-308-7833. We would be happy to evaluate your case and to discuss how to help you through the appeal process.