Pulmonary Fibrosis and Long-Term Disability Claims

Pulmonary fibrosis is a progressive lung disease that can significantly impair a person’s ability to work. If your long-term disability (LTD) claim for pulmonary fibrosis has been denied or terminated, we can help. This article explains evidence used to support LTD claims and how a disability attorney can help you fight back after a denial.

What Is Pulmonary Fibrosis?

Pulmonary fibrosis is a chronic lung disease marked by the scarring and thickening of lung tissue. This scarring, often irreversible, gradually makes it harder for the lungs to deliver oxygen to the bloodstream. Causes include autoimmune diseases (like rheumatoid arthritis), long-term exposure to environmental toxins, certain medications, or radiation therapy. In some cases, there is no known cause.

Common symptoms include:

• Persistent dry cough
• Shortness of breath, especially during physical activity
• Fatigue and weakness
• Unexplained weight loss

As it progresses, you may develop complications such as respiratory failure, pulmonary hypertension, or heart failure. Many patients eventually require supplemental oxygen and experience increasing limitations in daily activities.

Functional Limitations That Impact Work

Pulmonary fibrosis affects people differently, but for many, the hallmark symptom is exertional breathlessness. This can make even light physical tasks exhausting. For example:

• A construction worker may no longer be able to climb, lift, or operate heavy machinery.
• Teachers, retail clerks, or anyone who needs to speak frequently or stand for long periods may find their stamina drastically reduced.

Even sedentary jobs can be difficult due to fatigue, brain fog from low oxygen levels, and frequent medical appointments.

Medical Evidence That Supports an LTD Claim

To succeed in a long-term disability appeal, your claim must be backed by thorough and ongoing medical documentation. Evidence might include:

• Pulmonary function tests (PFTs), especially those showing reduced lung capacity or impaired gas exchange.
• High-resolution CT scans confirming lung scarring.
• Arterial blood gas studies or oxygen saturation readings.
• Physician notes documenting symptoms, treatment response, and functional limitations.
• A detailed statement from your pulmonologist explaining why you are unable to work.
• Records showing use of supplemental oxygen or medications like corticosteroids or antifibrotic agents.

Consistent treatment and documentation are critical. An insurer will use gaps in care or vague medical notes to question the legitimacy of your claim.

Common Challenges in LTD Claims for Pulmonary Fibrosis

Insurance companies often deny pulmonary fibrosis claims due to the “invisible” nature of the disease. Claimants may look normal despite suffering severe breathlessness and fatigue. Other common challenges include:

• Lack of Objective Evidence: Insurers may argue that symptoms are subjective if pulmonary function tests don’t show severe impairment.
• Surveillance and Social Media: Videos or posts showing a claimant walking short distances or attending a family event can be misinterpreted as proof of ability to work.
• Biased Medical Reviews: Insurers often rely on doctors who never examine the patient and minimize symptoms based on cherry-picked records.

Consider this: A 58-year-old former warehouse supervisor with pulmonary fibrosis had his LTD benefits terminated after two years. The insurer claimed that his medical records showed “stable” disease and normal oxygen levels at rest. However, his pulmonologist had documented significant desaturation with minimal exertion and prescribed continuous oxygen.

The insurer’s reviewer never addressed these notes. The claimant appealed with legal support, submitting updated test results and a vocational expert opinion. The appeal ultimately resulted in a reinstatement of benefits.

RELATED POST: Objective vs. Subjective Evidence In Long-Term Disability Claims

How an Attorney Can Help After a Denial

If your LTD claim for pulmonary fibrosis has been denied or terminated, it’s important to act quickly and strategically. An experienced long-term disability attorney can help you:

• Review the denial letter and insurance policy to identify weak points in the insurer’s argument.
• Gather stronger medical evidence and get detailed statements from treating physicians.
• Coordinate expert opinions, including vocational assessments.
• Prepare a comprehensive appeal package that addresses both medical and legal standards.
• File a lawsuit if the appeal is denied.

Legal help is especially important for ERISA-governed group policies, where strict deadlines and procedural rules apply.

Contact the Ortiz Law Firm for Help with Your LTD Appeal

If your long-term disability claim for pulmonary fibrosis has been denied, don’t give up. The Ortiz Law Firm offers nationwide representation for LTD appeals and lawsuits. We provide personalized support backed by decades of experience. Call us today at (888) 321-8131 to schedule your free case review and get the help you need to move forward.