Patients with multiple sclerosis may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their multiple sclerosis 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.
Applying for LTD Benefits With Multiple Sclerosis
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, including the brain, spinal cord, and optic nerves. Generally speaking, MS is a progressive disease. Over time the patient’s symptoms will worsen and become more debilitating. MS patients may eventually functional abilities even in periods with few to no symptoms.
Types of MS
There are several types of MS, including:
- Relapsing-remitting multiple sclerosis (RRMS);
- Primary-progressive MS;
- Secondary-progressive MS; and
- Progressive-relapsing MS.
The symptoms of each type vary depending on the progression of the disease and whether the patient has periods of exacerbations and remissions.
Qualifying for Disability With MS
If your multiple sclerosis is advanced, you have a high chance of being approved for long term disability insurance benefits. In order to qualify for LTD benefits for MS you must prove that your MS has limited your functioning so much that you can no longer work.
To qualify for long term disability insurance benefits, you must satisfy the definition of disability under your policy. The definition of disability is specific to each LTD policy. However, under most long term disability insurance plans, “totally disabled” means the inability to perform the material duties of your regular occupation for the first two years under the policy; after the first two years of disability, the definition usually changes to the inability to perform the material duties of any occupation for which you are reasonably suited by education, training or experience.
Demonstrating the inability to work can be an issue for patients with MS because most forms of MS are episodic, which meaning there are periods when the patient is very sick and periods when the patient has few to no symptoms. The periods of sickness may be referred to as episodes, exacerbations, or relapses, and can vary in duration and severity. The periods of time with few symptoms are called remissions. If you are symptom-free for months at a time, it may be difficult to prove disability. Most insurance companies do recognize that MS is episodic in nature, so the adjuster assigned to your claim will evaluate the frequency and length of your episodes, the time between your episodes, and the presence of permanent impairments even in periods of little to no symptoms, to determine if you are disabled.
Disabling Symptoms of MS
Multiple sclerosis can have significant effects on the body, and MS can affect multiple parts of the body at the same. Some symptoms include:
- Balance problems;
- Difficulty with walking and coordination;
- Tremors or weakness in the extremities (arms and legs);
- Bowel and bladder issues, including constipation and the need to urinate frequently;
- Vision problems, including double vision or a loss of vision;
- Numbness, tingling, or pain in the face, arms, or legs;
- Loss of hearing;
- Difficulty with memory and concentration;
- Mental problems such as depression;
- Speech problems, including slurred speech;
- Difficulty chewing and swallowing food, and
- Extreme fatigue.
Medical Evidence to Support a Claim for MS Disability
To qualify for benefits with MS, you should have objective medical evidence to demonstrate the severity of your condition. The test most used to diagnose MS is a magnetic resonance imaging (MRI). This test can provide objective medical proof of demyelination caused by multiple sclerosis. An MRI is so sensitive that it can detect even the smallest evidence of demyelination or plaque. A medical study has shown that 96% of those individuals diagnosed with MS have an abnormal MRI result.
Another test medical providers use to assist with the diagnosis of multiple sclerosis is a spinal tap, or lumbar puncture. This test is about 85% effective in accurately diagnosing MS cases. This test is often used to rule out other conditions such as Lyme disease, HIV, or syphilis. When an individual has MS, the myelin basic proteins are usually elevated as well as other antibodies.
There are also a few other tests used to help diagnose MS, which include the electroencephalograph (EEG), computerized axial tomography (“CAT scans”), x-rays, and evoked potentials (exposing the patient to various stimuli). These are usually assessed simultaneously with MRI scans and spinal taps, though they are not conclusive tests for MS in their own right.
Medical records used to prove MS-related impairments include medical reports from treating physicians and tests related to the alleged impairment. For example, if the patient has vision loss, specific eye test results demonstrating a loss of visual acuity, peripheral vision, or visual efficiency are imperative to prove a severe decrease in vision. For most claimants with MS, the most significant visual impairment is a loss of visual acuity.
The claimant’s medical history, the findings of mental examinations, and the results of other tests may provide proof of organic mental abnormalities and their etiological link.
If you are trying to argue you have severe fatigue and weakness caused by MS, you should provide a physician’s notes that show a diagnosis of MS and that your fatigue and weakness are a result of the MS.
How MS Limits One’s Ability to Work
The long term disability insurance company will evaluate your ability to perform work activities. In doing so, the carrier will assess your physical, mental, and sensory limitations to determine your Residual Functional Capacity (RFC). You can also download free RFC forms for your doctors to complete in support of your claim.
A physical RFC may include any physical and sensory limitations you have. The adjuster assigned to your claim will review your medical records and consider any independent medical examination reports to evaluate your ability to sit, stand, and walk, as well as your capacity to lift, carry, and push or pull items. For those with MS, some of the primary physical impairments that could appear on an RFC are difficulty with balance and walking, numbness and weakness in the arms and legs, and tremors or involuntary movements. Other problems that are common in MS include partial hearing loss, low vision, and speech problems, which may also be included in the RFC.
The insurance company may also create a mental RFC for you that identifies any limitations you have in your ability to understand, remember, and carry out instructions. Individuals with MS often suffer from memory loss and may have difficulty concentrating or staying on task. If you have such impairments you will want to make sure they appear in your medical record so the LTD insurance company can include them in your mental RFC. Any of these mental impairments may prevent a return to work if they are severe enough.
Work With an Experienced Long Term Disability Attorney
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your multiple sclerosis. 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 multiple sclerosis 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.