According to the Asthma and Allergy Foundation of America, the United States has more than 25 million Americans with asthma. Since the early 80s, the number of individuals affected by asthma has increased steadily. In recent years, one out of every thirteen Americans has been diagnosed with asthma. Many of the people diagnosed with asthma find themselves unable to maintain employment and have applied for long term disability insurance. Unfortunately, many claims for long term disability insurance are denied by the disability insurance company. Thus, people turn to a long term disability attorney to help solve their disability insurance claim problems.
Can You Qualify For Long Term Disability for Asthma?
Many people, including the claims representatives hired by your long term disability insurance company, may know something about asthma or someone who has it. However, they may not know how severe asthma can affect and impair a person’s life.
Patients with asthma may experience a sudden attack that requires a trip to the emergency room. There are close to 200,000 discharges from hospital inpatient care each year, and asthma is responsible for 9.8 million doctor’s office visits every year.
There is a potential for asthma to be quite deadly, especially when treatment is not prompt. As the Asthma and Allergy Foundation of America confirms, more than ten people in the United States die from asthma every day. The potential to die from asthma is four times higher for adults than children. If someone’s asthma is chronic and severe it may be considered a disability.
These numbers can be quite scary, but it is critical that the claim representative know how severe asthma can affect the claimant’s life. Some people struggle with the effects of this serious condition every day, while millions of other people continue to live their normal life with asthma. As such, those struggling to preserve a consistent ability to work due to their asthma diagnosis may find it quite hard to obtain disability insurance benefits.
You can get disability for asthma without a lawyer, but an experienced attorney can certainly help with your case. For many claimants, hiring a lawyer is the difference between being approved or denied for benefits.
If you have asthma that significantly affects your life and you have been unable to qualify for long term disability benefits on your own, you should consult an experienced long term disability attorney like Mr. Ortiz at Ortiz Law Firm. Our experienced legal team will guide you through the disability appeal process to help you in your effort to have your claim for disability benefits approved.
If necessary, our law firm will file a lawsuit against the insurance company. Below we will discuss asthma and its effects on the body, getting a proper diagnosis, and effectively documenting how asthma limits your capacity to work so that you can prove your disability and receive long-term disability due to asthma. We’ve also included additional information about how a lawyer can help you get the benefits you deserve.
What is Asthma
As an inflammatory lung disease, asthma constricts or narrows a person’s airways, thus impairing breathing capacity. The airways typically relax when a healthy person takes deep breaths. For an asthmatic, there is a possibility of going into a spasm, or finding their airways constricted when they take a deep breath. Someone who has asthma may be breathless, wheeze, or even gasp for air when their airways tighten. It is easy to see how these symptoms would interfere with a person’s ability to perform their job duties.
There are acute and chronic classifications for asthmatic episodes. The severity and length of the attacks tend to vary, with some people with asthma reporting attacks that may last for several days.
The two primary stages of asthma include:
· Inflammatory response
· Hyper-reactive response
The immune system triggers the inflammatory response, which causes the airways to produce a sticky mucous, fill airways with fluid, or causes airways to swell. Asthmatics tend to be sensitive to common factors in their environment due to continuous inflammation, including psychological stressors, ordinary exercise, pollution, dust, or cold air. If your work environment triggers your asthma you may be considered for disability benefits for asthma. Be sure to include information about workplace triggers in your application for benefits and include evidence if possible.
Symptoms of Asthma
You need to have a positive diagnosis of asthma in your medical records since several other conditions cause asthma-like symptoms. Though they are typically worse at night, normal asthma symptoms are:
· Coughing
· Trouble breathing
· Chest tightness
· Shortness of breath
· Recurrent wheezing
When trying to prove disability, it is not enough to simply identify your asthma symptoms. You also need to explain why your condition prevents you from doing your job duties. This could include having to regularly take sick days due to poorly-controlled chronic asthma or asthma attacks, leading to ineffectiveness in your work. You may also have fatigue due to wheezing and coughing at night. As such, you have distractive days where you cannot concentrate. Shortness of breath may prevent you from performing strenuous tasks, thus forcing you to seek help from a coworker.
You will improve your chances of being approved for disability benefits if you can connect your symptoms to specific a specific limitation such as an inability to concentrate. You or your lawyer need to make sure information about your symptoms and resulting limitations are documented in your medical records. Your attorney can also help you document your symptoms and limitations in a sworn statement. Our attorneys typically do so in the form of a notarized affidavit that our office will prepare for you.
Diagnosis of Asthma
A physician will conduct a full physical exam and complete a thorough medical history review after taking note of a patient’s reported symptoms. There are several common tests that a doctor may use to diagnose asthma, and your or your attorney can use the results to support your disability claim:
Lung Function Tests
Lung function tests are various breathing tests the doctor uses to confirm asthma. With these tests, patients can measure their breathing. It is easy to measure the maximum amount of air a patient can exhale or inhale with spirometry. The test also measures the amount of air a patient can exhale in one second. The doctor will take spirometry then give the patient an asthma medication called a bronchodilator, which is a medicine that works by opening the airways. There is a possibility of an asthma diagnosis if the patient’s scores improve significantly.
Even if the bronchodilator does not help and there is no improvement in their lung strength, the doctor may also choose to administer additional tests if they still believe that a patient may have asthma. Other common lung function tests physicians also use to diagnose asthma include:
· Provocation tests: a challenge test whereby the specialist may intend to induce asthmatic symptoms and then test again to see if the patient’s score fall with spirometry;
· FeNO tests: an exhaled nitric oxide test. High levels of nitric oxide may indicate inflamed airways; and
· Peak airflow tests: peak flow measurement can show the amount and rate of air that can be forcefully breathed out of the lungs.
You can also determine the amount of air that you inhale or exhale from your lungs through other tests, such as provocative testing for cold-induced asthma, sputum eosinophils, methacholine challenge, and allergy tests.
Depending on the terms of your long term disability policy, you may be required to provide objective evidence of asthma before you can be eligible for long term disability. Simply stating that you have been diagnosed with asthma, or listing symptoms such as shortness of breath and cognitive impairments, may not be sufficient in these circumstances. With results from one or more of the tests described above, you may be eligible to receive disability insurance benefits for your asthma disability claim.
Treatments and Therapies for Asthma
Most asthma treatment plans include creating an emergency action plan for severe attacks, using drug therapies, and identifying and avoiding the triggers for your symptoms. Physicians may also recommend to patients to monitor their asthma with a peak flow meter. As a hand-held device, patients can watch how much air they push out through their lungs. Allergists may tell the patient to change their treatment plan if their airflow is low. These changes may include a different asthma medication or additional environmental or behavioral changes. Each case is different, so patients may have very different treatment plans.
Some quick-relief medicines are effective in stopping asthma symptoms. However, they are not efficient in controlling the airway inflammation that causes the symptoms. A patient may not be maintaining their asthma well enough if they discover they are using their quick-relief medicine two or three nights a month or to treat asthma symptoms more than twice a week.
Getting Long Term Disability Benefits for Asthma
To qualify for long term disability insurance due to having asthma, you must demonstrate with your medical information that it seriously impairs your activities of daily living and your ability to perform work. An example of a serious asthma condition that may qualify for disability benefits is when the patient has persistent asthma attacks, defined as symptomatic episodes lasting at least one day and requiring intensive treatment, and/or when the patient has asthma attacks that necessitate a doctor’s treatment or hospitalization at least once every two months.
Policy Exclusions
It is important that you or your attorney carefully review the information in your disability insurance policy. Our attorneys often find that a disability insurance policy will not pay benefits for a claim for a pre-existing condition. Since asthma is a chronic condition, it is likely that you have been receiving treatment for your condition prior to the date you filed your claim. Be sure to check your policy for information about what is considered a pre-existing condition, as this information varies between one insurance policy and another.
Evidence to Support a Disability Insurance Claim for Asthma
Many cases are denied due to the claimant not providing enough information. So how do you prove long term disability?
To make sure you qualify for long term disability benefits, you should produce evidence such as a lung function test performed by a consulting doctor to show very limited airflow. For example, a spirometry test documenting your FEV1 value (your forced expiratory volume in one second, meaning the amount of air you can exhale in one second) should show significant limitations. If there is not enough evidence to support your claim, the insurance company may refer your claim for an independent medical evaluation. However, the results of these evaluations often state that the claim should be denied.
Reduced Capacity for Work
You may qualify for long term disability benefits if you can show that your asthma has affected your lung function to such an extent that you cannot hold down a job. To show that your breathing capacity and ability to exert yourself are so low that you cannot work, you should ask your doctor to provide an opinion on what kinds of activities you can and cannot do (such as lifting any more than 10 pounds, walking no more than a half-hour at a time, and no exposure to dust or fumes). Medical information such as a statement from your doctor will help to support your claim.
Residual Functional Capacity Assessments
The long term disability insurance company may give you an Attending Physician’s Statement (APS), also called a residual functional capacity (RFC) assessment, stating the type of work you can do (sedentary work, light work, medium work, or heavy work) based on your breathing test results and your doctor’s restrictions. However, the forms provided by the disability insurance company are designed to apply to claimants with any medical condition, whether it be a musculoskeletal condition or a heart problem. As such, the forms may not address the specific symptoms and limitations that come with asthma. If you work with an experienced disability lawyer, you may be able to obtain a custom RFC form that is specific to asthma. The Ortiz Law Firm has prepared hundreds of custom RFC forms for past disability insurance claims.
Having Multiple Medical Problems
Patients with asthma often have other serious medical problems as well, which can make it easier to get a claim for disability benefits approved. Many cases of chronic asthma are often connected to conditions like COPD, emphysema, chronic asthmatic bronchitis, or allergies. Some people with asthma experience the most symptoms at night, which can lead to chronic lack of sleep. Long-term sleep deprivation can affect your cognitive ability and may make it difficult for you to function at work. Asthma may also keep some people from participating in exercise or sports, which increases your risk for:
- Diabetes
- High blood pressure
- Weight gain
- Depression
When you have multiple medical conditions that limit your ability to work, you have a better chance that your claim for disability insurance benefits will be approved. You or your disability lawyer must make sure to let the insurance company know about any other health problems or treatment side effects that may contribute to your inability to work.
Should I File For Social Security Disability Benefits Too?
Your insurance company will often require you to file a disability claim with the Social Security Administration (SSA) if your long term disability claim is approved. This is because most insurance policies allow the insurance company to reduce the amount of your monthly disability insurance benefit by the amount of your monthly Social Security Disability (SSD) benefits. However, the law requires that your condition last, or be expected to last, for 12 months or more. This is not the case with long term disability benefits. As such, you could be denied Social Security Disability benefits despite your disability insurance case being approved.
Hire an Attorney Who Can Handle Both Claims
Since the Social Security claim process can take a long time it may be beneficial to file a disability claim with the Social Security Administration while your long-term disability claim is still pending. You may even be able to use one disability lawyer that is experienced with both types of cases to represent you in both disability claims, such as those at the Ortiz Law Firm. Nick Ortiz is a Board-Certified Social Security Disability lawyer with years of experience with Social Security law.
How a Long Term Disability Attorney Can Help
Asthma affects many Americans. Because of this condition’s nature, it significantly limits how some people work and live, even though many individuals can live with it. Essentially, everyday, mundane activities can be life-threatening for some people with severe cases of asthma.
An experienced disability lawyer is familiar with the tricks and tactics that the insurance company will use to deny your disability claim and will help you fight back against the disability insurance company.
If you are unable to work due to asthma you should consult with a lawyer. Ortiz Law Firm has an experienced and efficient long term disability legal team that knows that asthma, if severe enough, can be disabling. Mr. Ortiz is a highly-skilled disability claims lawyer and is dedicated to helping his clients obtain long term disability benefits. The Ortiz Law Firm has experience in handling long term disability claims for asthma. We will use that experience to help you get the disability insurance benefits you deserve so that you can focus on your health.
We would welcome the opportunity for you to tell us about your case. You can count on us to relieve your burden by fighting aggressively to protect your future. If the insurance company has wrongfully denied your disability claim call us today at (888) 321-8131 to schedule a free disability case evaluation. During your case evaluation, you will speak with an experienced lawyer and have the opportunity to tell us about your case and seek legal advice.