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Patients with inflammatory bowel disease (IBD) may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their IBD may qualify for long-term disability (LTD) benefits. The insurance company will review claims to see if the claimants qualify under their plan’s terms and conditions. If your claim is denied, a long-term disability attorney can help recover your benefits.
What Is Inflammatory Bowel Disease?
Inflammatory bowel disease is a group of disorders that inflame the intestines. Once thought to be an autoimmune disease in which the immune system attacks the body, modern research shows that the inflammation and bowel injury is actually the result of the immune system attacking food, bacteria, or a harmless virus in the gut.
There are two main types of IBD – Crohn’s disease and ulcerative colitis. Crohn’s disease can affect any portion of the gastrointestinal tract from the mouth to the anus, while ulcerative colitis takes place strictly in the colon or large intestine.
IBD can cause serious complications. These include:
- Malnutrition.
- Toxic megacolon – a life-threatening extreme dilation of the colon.
- Perianal disease and fistulae – diseases that affect the tissue around the anus.
- Obstruction or stricture of the bowel.
- Rupture or perforation of the bowel.
- Heavy intestinal bleeding from the ulcers.
- Arthritis.
- Increased risk of colon cancer.
IBD is unpredictable, waxing and waning without warning. When the disease is active, the person will experience severe inflammation, making it impossible to work. Not knowing when symptoms will hit can make it difficult to hold down a job.
Long-Term Disability and Inflammatory Bowel Disease
While suffering from IBD, a person may not be able to perform their work duties on a full-time basis. In these instances, long-term disability benefits can provide financial support. Once an individual applies for benefits, the insurance company will review the information provided on the application and documentation from treating medical providers to decide if they qualify as disabled under the LTD insurance policy.
Evaluating Disability for Claimants with Inflammatory Bowel Disease
To qualify for LTD, the disease must substantially interfere with your ability to work. When applying for LTD benefits due to IBD, you may want to show that you experience one or more of the following symptoms:
- Iron deficiency anemia caused by blood loss;
- Loss of appetite;
- Weight loss;
- Fever;
- Extreme urgency when having a bowel movement;
- Bloody diarrhea; and
- Abdominal pain and cramps.
You should have documentation from your doctor that evidences the above symptoms.
How Does Your Policy Define Disability?
LTD policies vary, so you must see how the terms “totally disabled” or “disability” are defined in your particular situation. Most policies fall under “own occupation” or “any occupation.”
- For an own occupation policy, you’re considered disabled if you are unable to perform the duties of your own job. For example, if you are a fireman who is unable to meet the mental or physical requirements of that job, you may qualify as “disabled” – even if you could handle a different, less strenuous job.
- An any occupation policy is stricter. You must prove that you cannot perform any position you would qualify for with your experience, training, and education. For example, a fireman who cannot climb ladders or lift heavy objects would not be approved as disabled under this policy because he can still perform other jobs, such as a cashier or clerk.
Providing Poof of Inflammatory Bowel Disease and How If Affects Your Ability to Work
Symptoms alone are not enough to be approved for LTD, though their effects are often considered. You should also have documentation from medical professionals that backs up your claims with laboratory and clinical findings. The insurance company can also base its decision on medical information alone if it clearly shows that you are disabled.
The insurance company will assign an adjudicator to your claim, who may have a nurse consultant, psychologist, or physician review it and determine your level of impairment. You may also be required to see a doctor for a functional capacity evaluation (FCE) or an independent medical examination (IME). The adjudicator will then use that evidence to make a decision. If they feel that they don’t have enough information, you may be asked to provide additional evidence as needed.
Also, medical documentation should report acceptable laboratory and clinical findings, not just symptoms and diagnoses. Your disability must be scientifically proven, not just a general guess by your doctor, so be sure your doctor includes all their objective findings.
Claim Denied? Get a Free Case Review with a National Long-Term Disability Attorney
Many people are denied benefits the first time they apply, but that does not mean the fight is over. You have the right to file an appeal, and working with an experienced disability attorney will give you the best chance of recovering the benefits you deserve for your inflammatory bowel disease. Expert help is often the difference between being denied and being approved for benefits on appeal.
The Ortiz Law Firm has successfully represented people in disability cases across the United States. We do not get an attorney fee unless we win your case, so you can seek help without worrying about upfront costs or unexpected bills. If you would like to talk to an experienced disability lawyer about your inflammatory bowel disease and its impact on your ability to work, call us at (888) 321-8131.
