Trigeminal Neuralgia and Long Term Disability Insurance Claims

What Is Trigeminal Neuralgia?

 Trigeminal neuralgia is a condition that causes chronic pain in the trigeminal nerve, through which sensation travels from your face to your brain. In a person with trigeminal neuralgia, even mild facial stimulation from putting on makeup or brushing your teeth can trigger a jolt of excruciating pain.

Your initial experience may be short, mild attacks, but trigeminal neuralgia can progress into more frequent and longer bouts of searing pain. It affects more women than men and is more likely to occur in people above the age of 50.

In trigeminal neuralgia, or tic douloureux, the function of the trigeminal nerve is disrupted. It’s usually a problem with contact between an artery or vein and the trigeminal nerve, found at the base of the brain. This contact adds pressure to the nerve and causes it to malfunction.

Trigeminal neuralgia can be related to multiple sclerosis, aging, or disorders that damage the myelin sheath that protects the nerves. It may also be caused by a tumor that compresses the trigeminal nerve.

Brain lesions and other abnormalities cause some people to experience trigeminal neuralgia. In other cases, it can be caused by stroke, surgical injuries, or facial trauma.

The pain of trigeminal neuralgia can be set off by a variety of triggers, including:

  • Washing your face
  • Smiling
  • Encountering a breeze
  • Putting on makeup
  • Talking
  • Brushing your teeth
  • Drinking
  • Eating
  • Touching your face
  • Shaving

Disability Evaluation of Trigeminal Neuralgia

Insurance companies who handle long-term disability claims may refer to the Center for Disease Control, or CDC, to evaluate disability claims due to Trigeminal Neuralgia. The CDC defines trigeminal neuralgia as a chronic pain condition that causes sudden, extreme, and sporadic shock-like or burning face pain. The pain itself only lasts a few seconds to a couple of minutes per episode, but the intensity of the pain can be mentally and physically incapacitating. To qualify for long term disability with this condition, you must demonstrate that the resulting symptoms and impairments from trigeminal neuralgia interfere with your social, personal, work, and school activities. To do so, you should consider submitting evidence that you experience one or more of the following symptoms:

  • Attacks that become more intense and frequent over time
  • Pain spread in a wide pattern or focused in one spot
  • Pain affecting one side of the face at a time, except in rare cases where both sides are affected
  • Pain in areas supplied by the trigeminal nerve, including the lips, gums, teeth, jaw, cheek, or sometimes the forehead or eye
  • Constant burning, aching feeling that may occur before the spasm-like pain of trigeminal neuralgia
  • Episodes of multiple attacks that last for days, weeks, months, or even longer – may intermit with periods of no pain
  • Pain episodes lasting from a few seconds to several minutes
  • Attacks triggered by simple things like brushing teeth, speaking, chewing, or touching the face, or spontaneous attacks
  • Episodes of shooting, severe, or jabbing pain that can feel like an electric shock

To qualify for a diagnosis of trigeminal neuralgia, you should have medical records to document the above criteria.

Disability Definition

Most LTD policies consider you disabled if you are (a) unable to perform the necessary duties of your current occupation for the first two years of the policy, and (b) unable to perform the duties of any job you might qualify for after the first two years of the policy are up. Every long-term disability policy is different, so you should review your specific policy to see how the terms “totally disabled” and “disability” are defined.

Evaluating Disability for Persons With Trigeminal Neuralgia

Your insurance company will assign an adjuster to your claim who may have your file reviewed by a physician, psychologist, or other medical disability examiners to determine your level of impairment. You may also be required to complete a compulsory medical examination or functional capacity evaluation. Your adjuster will consider every bit of evidence including all of your treatments from the onset of the illness to the impact of the illness on your body.

If there isn’t enough evidence available to make a decision, the insurance adjudicator may contact you for more. If you don’t have that information yourself, they may ask your or a separate medical source to find it and report back.

Simple symptomatology or diagnosis is not enough to prove you are disabled. You’ll need medical documentation that discusses clinical and laboratory findings. Be sure to have your doctor include all objective findings about your condition, even if they point towards another disorder.

If you suffer from the effects of trigeminal neuralgia or another mental or physical disorder that keeps you from adequately performing your work duties, you may be eligible for long-term disability benefits. Because approval can be difficult, it’s important to speak with legal counsel. If you’ve been denied for LTD but have a genuine disability, Nick Ortiz Law can help. Contact us today at (850) 308-7833 to find out how we can get you the benefits you deserve.