One of the most common types of injury, there are more than 3 million burn cases each year in the United States. A burn is tissue damage caused by heat, radiation from the sun or other sources, chemical reactions, or electrical currents. While all types of burns are painful, they range from mild annoyance to severely disabling. If a burn is too severe, it can even result in death.
Burns or other soft tissue injuries can leave you with a lifetime of scars, both physically and emotionally. Treatment for burns can take years to repair the damage that has been caused to the skin and muscles. Some injuries will allow you to return to work under certain restrictions, but in other cases, you might be able to return to work for a period of time. Patients who find themselves unable to work because of severe burns may qualify for long term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.
Types of Burns
Burns are classified depending on the size and depth of the damage. Since it can take days for the damage from severe burns to be visible, it is crucial to see a doctor right away if you do not know the extent of the injury. There are three types of burns:
- 1st-degree burns minor injuries that affect only the top layer of skin (epidermis), these burns cause redness and pain but usually respond well to at-home care
- 2nd-degree burns affect the top layer of skin (epidermis) and the second layer of skin (dermis). These burns swelling, and red, white, or splotchy skin. Blisters can form either on the epidermis or deeper in the dermis. Pain in 2nd-degree burns can be severe, and the burns usually cause scarring of the affected area.
- 3rd-degree burns the most severe type of burn, 3rd degree burns cause damage to the layers of skin and the fatty layers underneath the skin. In rare cases, these burns can even affect the muscles. Burned areas can appear white, brown, or black and sometimes have a leathery appearance. Since the nerves are damaged, 3rd-degree burns can cause numbness in the area.
Patients usually know right away if they have a burn. Most 1st-degree burns heal with home care and do not need to be seen by a doctor. A doctor must always treat electrical burns because the damage is generally underneath the top layer of skin and may be more severe than it appears. Even if the person is aware of the burn, a doctor must determine which type of damage has occurred. Severe burns must be diagnosed and treated immediately to prevent further tissue damage and life-threatening complications.
A burn diagnosis usually depends only on physical examination by a doctor. The doctor will examine the burn and grade it according to the types of burn. Diagnostic tests, such as blood tests or x-rays, may be ordered if complications such as sepsis are suspected or if the doctor suspects other injuries. Severe burns usually require treatment in specialized burn units of hospitals.
Treatment varies depending on the condition and its severity. Self-care measures, such as anti-inflammatory drugs and soothing topical creams like aloe, can treat mild 1st-degree burns. These burns usually heal within a few weeks and cause no long-term complications.
More severe burns require medical interventions. After immediate treatment to stabilize the patient, medical treatments for burns can include:
- Ultrasound treatments to promote healing
- IV fluids to replace fluids lost and prevent organ failure
- IV antibiotics to prevent and treat systemic infections
- Pain relievers and anti-anxiety medications to treat pain and to make dressing changes and treatments easier
- Debridement to remove damaged tissue and promote healing
- Skin grafts to replace damaged tissue and scars
- Plastic surgery to improve the appearance of scars and increase the flexibility of affected joints
- Physical and occupational therapy to aid healing, increase strength and flexibility, and adaptation to injury
- Breathing and feeding assistance in cases of severe burns
Untreated burns can lead to infections, dangerous loss of fluids, low body temperature, breathing problems, and permanent damage to the area. Scarring can limit the flexibility and range of motion and may cause bone and joint issues from the tightened tissue. Even treatment is immediate severe burns can cause life-long limitations.
Do Burns Qualify You For Long Term Disability?
Maybe. You will need to check your long term disability policy to determine what is covered. Most employers have some group policy that covers you as long as you are employed there. If you are self-employed and have an individual policy, check to see what is included. You can request a copy of your policy from your human resources department. It’s recommended that you request a copy in writing so you can start the documentation process. Some HR departments may try to delay sending you the policy or forms because they know you intend to file.
Disability Evaluation of Burns
If your burn keeps you from working, you must apply for long term disability (LTD) benefits. The insurance company will review the claim to see if you meet the definition of disabled outlined by your plan.
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 it is important to review the criteria your plan uses to determine disability.
Evaluating Disability for People with Burns
While mild burns are often merely a nuisance, severe burns can impact a person’s ability to perform even basic daily tasks. A person may be unable to work because of the pain of damaged or scar tissue, ongoing symptoms, or limitations from treatments. Limitations often depend on the location of the burn.
Even after the burn has healed, it may still be difficult or impossible to use the affected part of the body. It may be difficult to bend, kneel, walk, or use the arms to reach or hold items. Burns to the hands can make it challenging to write, type, or use a computer. Burns to the head and face can make seeing, breathing, talking, hearing, or eating challenging. The patient may be more susceptible to infections, which would keep them from working in close contact with people that may be sick or in an environment where contamination is likely.
Since burns often get better over time and generally respond to treatment, long-term disability evaluations of burns can depend on where the person is in their healing process. This may require repeated assessments of disability status. Even if a person does not qualify for long-term disability for burns, they may be eligible when their other conditions and symptoms are considered. It is important to list all of the ways a person is limited by their health when applying for long-term disability benefits.
What the Insurance Company Needs From You and Your Medical Providers
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. You should include all relevant documents, including records of diagnostic testing, office visits, surgeries and medical procedures, and any ongoing treatments.
You will need to provide proof of your diagnosis and your ongoing symptoms and how they affect your everyday 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.
Assessing Your Residual Functional Capacity
An insurance claim adjuster or examiner will assess your residual functional capacity (RFC), which is a measure of your remaining ability to perform work-related tasks, despite any physical or mental limitations you may have. This process involves a comprehensive analysis of several categories covered in the RFC, including:
Weight Lifting Capacity: The examiner considers your ability to lift and carry weight. For instance, a frequent capacity to lift 25 lbs and an occasional capacity to lift 50 lbs results in a medium RFC rating. A limitation to lifting only 10-25 lbs frequently would imply a light RFC rating.
Stamina for Sitting and Standing: The duration for which you can sit or stand is important. If a burn restricts you from standing for prolonged periods or makes it uncomfortable to sit continuously, these factors will be taken into account.
Range of Motion: The examiner will evaluate your ability to reach out or above your head.
Flexibility: Your ability to bend down, stoop, or crouch is considered. These actions are often integral to manual labor jobs, and any difficulty in performing these may restrict your employment options.
Dexterity: The extent to which you can grasp objects or utilize your hands will be assessed. If you are affected by conditions such as burns or soft tissue injuries, your ability to grasp tools or type consistently may be compromised due to a decrease in fine motor skills.
Sensory Perception: The last factor evaluated is your hearing and visual capacity. These senses are fundamental not just for work, but also for daily life. Any disability impairing your hearing, vision, or both could significantly affect your ability to function in a work environment.
Should I Resign If I Plan to Be Out of Work For a Long Time?
The simple answer is not until you consult an attorney. After an extended period, most employers will ask that you resign from your position. From the employers’ standpoint, they are trying to accomplish two things: (1) The job requires a non-disabled person to work the vacant position, and your resignation will allow them to hire someone to replace you and (2) If you do not word your letter carefully, they may be able to interpret your letter as an “I quit” and will be off the hook when it comes to paying your disability claim and any other benefits like FMLA, retirement, health insurance, etc.
When you use the term “resign,” you are telling your employer that you quit. Resigning your position is not the same as not being able to work your job due to your disability. This is why the correct language in your letter is so important. The best practice is to consult a disability attorney before you submit your letter to human resources.
Consult An Attorney
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your burn. Even if you have been denied benefits, that does not mean your fight is over. Many people are denied benefits the first time they 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 daunting, your experienced disability attorney will be able to guide you through the process. They do not get paid until you win your case. You can seek help without worrying about paying legal fees upfront.
The Ortiz Law Firm has successfully represented people in disability insurance claims across the United States. If you would like to talk to an experienced disability lawyer about your burn and its impact on your ability to work, call us at (888) 321-8131. We would be happy to evaluate your case and to discuss how to help you through the appeal process.