Fracture of an Upper Extremity and Long Term Disability

A fractured upper extremity (hand, wrist, arm, shoulder) can be very painful and require a lengthy recovery period. Surgery is sometimes necessary to properly treat breaks that are complicated, severe, or resistant to healing. Surgical treatments include fixating (keeping together) the broken parts of the bone using metal pins, screws, or plates. If you are unable to work because of a fractured upper extremity then you may qualify for long term disability (LTD) benefits if you meet the definition of disability as defined by your specific policy.

In this article, we will discuss:

• Limitations From an Upper Extremity Fracture
• How to Apply for LTD benefits While You Recover
• Suggested Way To Stay Organized

Limitations From an Upper Extremity Fracture

Some bones heal quickly and others more slowly.  The speed at which a bone heals depends on the size of the bone, the severity of the break, and the number of nutrients and blood supply around the bone.  Other things that affect the body’s ability to heal a broken bone are age, general health, and nutrition.  As a general rule, the larger the bone, the longer it takes to heal.

Limitations from an upper extremity fracture will include:

• Pushing;
• Pulling;
• Grasping;
• Lifting; and
• Dexterity.

Most jobs require some ability to do all of these things, but people that are in specific job fields like surgeons, dentists, and construction workers will find it impossible to work during their recovery period. In fact, they could be putting themselves or others at risk if they return to work too early.

Bones also have sharp edges. Depending on how severe trauma to the upper extremity is, the bone could have damaged nerve endings that may not ever heal. A considerable amount of physical and occupational therapy will be needed to help the body recover. Therapy is often excruciating and energy draining for patients. Rest and recovery are essential after therapy, which will limit your ability to work on days you have therapy, maybe even days after therapy, depending on how intense the treatment is.

Applying for Long-Term Disability During Your Recovery Period

The first step in seeking long-term disability benefits is to review your policy. If you are covered under a group policy via your employer, you can easily obtain a copy from your HR department.

Once you’ve gone through your policy, gather evidence to support your claim. Make sure to stack your administrative file with supportive evidence. This file is the complete record of your claim. It details all interactions between you and your insurer, any relevant surveillance footage, as well as the medical and vocational evidence used to decide your claim. Check out our article about harmful elements on your disability application for information about bad facts that could hurt your claim for benefits.

Suggested Way To Stay Organized

Create a binder or filing system for the following documents:

• Copy of your LTD policy;
• Copies of all letters from your insurance company and you to the insurance company;
• Why you can not perform your job duties (this will require medical documentation);
• A list of all medical providers that you have seen for this condition and a letter from each provider stating that your condition prevents you from working;
• Letters that summarize all conversations (by phone or in-person) between you and the insurance company representatives, nurses, doctors, and your employer. Send copies to all parties involved in the communication via certified mail as proof it was received; and
• Keep everything chronological so that if your claim is denied you have a complete record of how your claim was handled.

Since two-thirds of all claims are denied the first time, help yourself by staying organized from the beginning. You may need this documentation for court later. However, it is crucial to note that an initial denial of benefits isn’t the end of your journey. Many claimants are initially denied the benefits they deserve and the insurance carrier is hoping they will abandon their claims. Remember that you have the right to appeal, and that many claimants successfully recover benefits during the appeal stage.