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If you or a loved one are suffering from pancreatitis and have encountered obstacles with claiming long-term disability insurance, you’re not alone. This article dives into the nuances of how insurance companies evaluate pancreatitis claims, providing valuable insights to help you fight back against unjust denials.
What Is Pancreatitis?
The pancreas is a digestive gland placed behind the stomach and between the small intestine and spleen, which can affect metabolism and digestion functions when inflamed. Pancreatitis is when the pancreatic digestive enzymes that are meant to digest food in the small intestine become active in the pancreas instead, which then attacks itself. The illness can be acute and come on suddenly or chronic, lasting for up to several years and causing serious digestive damage.
Causes of Pancreatitis
The most common causes of pancreatitis are gallstones and excessive alcohol use. Gallstones are crystalline concretions formed of bile in the gallbladder, which often pass through other parts of the biliary tract, including the pancreatic duct. Environmental and genetic reasons, along with other common causes like mumps, scorpion venom, certain medications, steroids, and trauma to the abdomen, have also been known to cause pancreatitis.
Symptoms of Pancreatitis
Pancreatitis usually causes severe pain in the upper abdomen, often stretching to the back. Other symptoms include high fever, nausea, vomiting, abnormally rapid pulse, low blood pressure, dehydration, rapid weight loss, and internal bleeding. Chronic pancreatitis may also lead to signs of diabetes or pancreatic cancer. A diagnosis of pancreatitis can often be easily made with an inexpensive abdomen ultrasound, which can clearly see whether or not the pancreas is inflamed and can also detect gallstones and an alcoholic fatty liver.
Treating Pancreatitis
A pancreatitis attack can be a medical emergency, typically requiring hospitalization. If chronic pancreatitis is contracted, the patient may need to be admitted to an intensive care unit and will require ongoing treatment.
Disability Evaluation of Pancreatitis
You must provide sufficient medical evidence to prove you meet the definition of “disability” as outlined by your plan. Navigating the disability evaluation process for pancreatitis can be complex, but arming yourself with the right information is vital if you want to support your claim.
The Definition of Disability
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 perform almost any job after that. Each LTD plan has a different definition, so you must review your policy to see how your plan defines “disability” or “disabled.”
Evaluating Disability for People with Pancreatitis
You must prove that your pancreatitis keeps you from doing your old job (or—depending on the language of the long-term disability insurance policy—any job that you could be trained to do). Your insurance company will evaluate your symptoms from your pancreatitis and any other conditions you have that affect your ability to work.
What the Insurance Company Needs From You and Your Medical Providers
You should tell the insurance company about any doctors you have seen for your pancreatitis, then request your medical records and provide them to the insurance company yourself. The insurance company needs all the relevant medical records to get the full picture of your health. Important documents to include are:
- Physician notes
- Diagnostic test results
- Blood tests
In addition to providing proof of your diagnosis and ongoing symptoms, you must demonstrate how your symptoms affect your ability to work. A residual functional capacity (RFC) form completed by your treating physician(s) will help the insurance company understand the extent of your symptoms and how they may keep you from working.
A Long-Term Disability Attorney Can Help You Appeal a Denied Claim
Even if your claim was previously denied, that doesn’t mean you’re out of options. It’s common to be denied the first time you apply. You have the right to file an appeal and provide more information to strengthen your case. If necessary, you can also file a lawsuit. Working with a knowledgeable disability lawyer gives you the best chance of getting the disability benefits you deserve for your pancreatitis.
Nick Ortiz and his team at the Ortiz Law Firm have successfully represented people in disability cases across the United States. You don’t have to worry about upfront costs because there are no fees unless we recover your benefits. If you’d like to an experienced disability lawyer about your long-term disability denial, call us at (888) 321-8131. We’ll be happy to evaluate your case and discuss how to help you through the appeal process.
