Patients with poliomyelitis (polio) may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their poliomyelitis 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 Poliomyelitis (Polio)?
Poliomyelitis (polio) is a dangerous, highly infectious disease caused by a virus that attacks the nervous system. Most of the people affected by polio are young children that are under five years old. Transmission of poliomyelitis is through direct contact or contaminated water. Polio is preventable by vaccines, and widespread mandatory vaccinations have made new cases of polio rare in the United States. Although new infections are rare, immigrants and travelers can bring the disease into the United States from developing nations. Because the vaccine is only effective against certain strains of the virus, a person may still be vulnerable to infection even if they have received a polio vaccine. People that were vaccinated with early versions of the vaccine may be particularly vulnerable.
Not all people with polio have symptoms. In cases where there are no symptoms, patients rarely experience lasting side effects. Other symptoms of polio can include stiffness in the neck, fatigue, headaches, nausea, and muscle weakness. Some people also have muscle spasms or loss of muscle mass and strength. While paralysis is usually in the legs, it can affect the rest of the body. If the paralysis affects breathing muscles, polio can lead to death.
Paralytic poliomyelitis, which occurs in less than 1% of poliovirus infections, occurs when the virus enters the spinal cord and multiplies within the central nervous system. Once it has entered the spinal cord, it can attack and destroy the nerves that control the muscular system located in the anterior horns of the spinal column. For this reason, poliomyelitis that affects the motor neurons is sometimes referred to as anterior poliomyelitis. Poliomyelitis can cause loss of muscle function and control, shrinking of the muscle tissue, and contraction of the muscles leading to deformities. The most severe type of polio infection is bulbar polio, in which the virus attacks the brain stem. Because the brain stem is responsible for controlling essential life functions such as swallowing and breathing, bulbar polio requires medical intervention and can be fatal.
People who have polio may develop post-polio syndrome, even decades after their recovery. Post-polio syndrome (PPS) has many similar symptoms to polio infections, but it is not contagious. For many cases, the severity of post-polio syndrome is related to how severe the original polio symptoms were. Post-polio syndrome can be debilitating and may become disabling.
It may be more challenging to get a diagnosis of polio in western countries, where polio has been almost completely eradicated. Doctors may not be familiar with the condition and may look at more common diagnoses instead, delaying treatment. Symptoms such as neck stiffness, abnormal reflexes, and difficulty breathing can make a doctor suspect polio. Some people with polio do not show any visible signs, which can make getting a diagnosis even harder.
Doctors will ask about any recent travel outside of the United States or possible exposure to people from countries that are experiencing polio outbreaks. Medical history, including vaccination schedules, will be taken by the physician as well. Clinical exams can include listening to breathing and testing reflexes.
Medical imaging and tests are required to diagnose polio. These can include:
- Stool samples where the virus is isolated from the stool, the most reliable method
- Blood tests to test for the virus
- Lumbar puncture to test for the virus and signs of infection
Medical imaging tests, such as MRIs, are also usually taken to determine the extent of damage and to rule out other conditions that may cause similar symptoms.
Once a diagnosis of polio is reached, doctors may investigate the virus to determine where it was likely to originate. Patients with polio may be isolated to prevent transmission of the disease to other people. Since polio cases are monitored by the Center for Disease Control, patient information will be sent to the CDC to track and prevent potential outbreaks.
Polio is an incurable condition, but treatment can help prevent complications and make life more comfortable for the patient. Rest and pain relievers can help with pain and fatigue. Physical therapy may be needed for those with muscle weakness or paralysis. If a person is having difficulty breathing, respirators and ventilators may be required to keep the patient alive.
Disability Evaluation of Polio
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 complete the work duties of almost any occupation for the years following the initial 2-year period. Each LTD plan defines disability as slightly different, so look over your plan policy to see how your plan sets “disabled.”
Evaluating Disability for People with Polio
Patients diagnosed with polio may not be considered disabled when they are first diagnosed with the medical condition, but – as the disease progresses – they may be regarded as disabled. Patients seeking disability payments for their poliomyelitis will have to prove that they are impacted in a way that they cannot perform their old job or any job that they could be trained to work.
A disability adjudicator is looking for impairment caused by the underlying medical condition. For example, they may look for evidence of one or more of the following difficulties:
- Speaking intelligibly
- Controlling at the two extremities (arms or legs or a mixture of the two), which leads to difficulty balancing, standing, or using the arms
- Breathing without the use of medical devices, such as a ventilator
- Swallowing or digesting food, leading to the use of feeding tubes or similar devices
- Thinking or following instructions
- Social problems, leading to difficulty interacting with others
- Getting things done because of issues concentrating or moving too slowly to finish a task
Because many polio patients may not have the original records of their polio infection, the insurance company may not necessarily require the original documents to qualify for Long Term Disability benefits. A doctor’s record that describes the extent of the initial polio illness can be enough. To assist in this review process, the claimant may want to provide a Residual Functional Capacity (RFC) form that indicates how their symptoms affect and limit their life activities.
What the Insurance Company Needs From You and Your Medical Providers
You should tell the insurance company about any doctor that has treated you for your polio. The insurance company will need to obtain all relevant medical records to get the full picture of your health. These records include office notes, clinical exams, diagnostic tests, and lab results. Records of hospitalizations and neurological testing, both in-office and diagnostic test results, are particularly important. If the original diagnosis records are no longer available, a current doctor’s description of the initial polio infection is adequate. If for any reason they cannot get these records from your doctors, you should request them and provide them to the insurance company yourself.
You will need to provide proof of your diagnosis and your ongoing symptoms, as well as proof of how you are affected by your symptoms. Providing detailed documentation is key to a successful claim. Functional Capacity Evaluations (FCE) determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform. Make sure that you are as honest as possible with your doctors so that they can complete an accurate RFC for you.
Working with an Experienced Disability Attorney
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your polio. 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 polio 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.