Patients with inflammatory bowel disease may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their inflammatory bowel disease 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.
What Is Inflammatory Bowel Disease (IBD)?
An inflammatory bowel disease is actually a group of disorders that inflame the intestines. Once thought to be an autoimmune disease where the immune system attacked the body, modern research shows that IBD actually happens when the immune system attacks food, bacteria, or a harmless virus in the gut, leading to inflammation and bowel injury.
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:
- 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; and
- Increased risk of colon cancer.
IBD is unpredictable, waxing and waning without warning. When the disease is active, the person will experience severe inflammation, which can make 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 be a good financial solution. Once an individual applies for benefits, the insurance company will decide if they qualify as disabled under the LTD insurance policy.
The insurance company makes its decision based on the information provided on your application and documentation from your medical providers. The following information explains what the long term disability insurance company is looking for when evaluating your LTD claim for IBD.
Disability Evaluation of IBD
Most long term disability companies will refer to the Center for Disease Control (CDC) to evaluate IBD. The CDC defines IBD as two conditions (ulcerative colitis and Crohn’s disease) as characterized by chronic inflammation of the GI tract. Prolonged inflammation leads to gastrointestinal tract damage.
To qualify for LTD, the disease must substantially interfere with school, work, personal, and social activities. 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;
- 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 look to 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 are incapable of performing any position that you would qualify for with your experience, training, and education. A fireman who cannot climb ladders or lift heavy objects would not be approved as disabled under this policy because he is still able to perform other jobs, such as a cashier or clerk.
Proof of IBD
Symptoms alone are not enough to be approved for LTD, though their effects are often taken into consideration. You should also have documentation from medical professionals that back up your claims with laboratory and clinical findings. The insurance company can also base their 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 medical disability examiner, psychologist, or physician review your claim and determine your level of impairment. You may also be required to see a doctor for a functional capacity evaluation or a medical examination. 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 diagnosis. Your disability must be scientifically proven, not just a general guess by your doctor, so be sure that your doctor includes all of their objective findings.
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your inflammatory bowel disease. 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 upfront costs or unexpected bills.
The Ortiz Law Firm has successfully represented people in disability cases across the United States. 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. We would be happy to evaluate your case and to discuss how to help you through the appeal process.