Patients with temporomandibular joint disorder may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their temporomandibular joint disorder 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 Temporomandibular Joint Disorder (TMJ)?
Temporomandibular joint disorder is a common disorder that affects temporomandibular joint, which connects the jaw to the skull and allows the jaw to move. Temporomandibular disorders are frequently called TMJ after the joint that is affected, though some doctors may refer to it as TMD instead.
Symptoms of temporomandibular joint disorder include jaw pain and swelling, difficulty moving the jaw to speak or chew, and locking of the jaw joint in the open or closed position. Frequently people experience a clicking or grinding sound when moving the jaw. Patients can also experience muscle spasms in the face and neck, headaches, and difficulty sleeping because of discomfort.
Temporomandibular joint disorder has several known causes, though it may be impossible to determine what is causing a specific patient’s condition. Bruxism, or clenching and grinding the teeth, is a common cause. Other causes of TMJ include arthritis, jaw injuries, and connective tissue disorders. TMJ tends to run in families, so a close relative that suffers from the disorder can be a good indication that a person may be likely to develop TMJ themselves.
Diagnosing Temporomandibular Joint Disorder
Diagnosis of temporomandibular joint disorder (TMJ) begins by an examination by a dentist or physician. A medical history, including the location and duration of pain and other symptoms, will be collected. The patient’s bite and jaw will be examined, as well.
If the physician suspects TMJ, further diagnostic testing may be needed to understand the extent of deformity and inflammation, including:
- X-rays of the teeth and jaw;
- CT scans; and
- MRI scans.
Treating Temporomandibular Joint Disorder
Temporomandibular joint disorder (TMJ) is often a temporary, although painful, experience that goes away on its own. Many people with TMJ find relief through conservative home treatments such as non-steroid anti-inflammatory drugs such as ibuprofen, mouth guards or splints, or stress-relieving therapies. Other prescription medication options include antidepressants and muscle relaxers. Botox injections into the muscles surrounding the joint can ease the pain for severe cases. As a last resort, surgery might be an option. Alternative therapies such as acupuncture and biofeedback can be used by themselves or with traditional treatments.
Disability Evaluation of Temporomandibular Joint Disorder (TMJ)
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 Temporomandibular Joint Disorder (TMJ)
Most patients with temporomandibular joint disorder (TMJ) are not considered disabled as the condition does not limit their life activities and resolves quickly. Others may not be so fortunate. Patients seeking disability payments for their TMJ 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.
To qualify for disability benefits, the condition must prevent the person from working for a least one full year. They will need a Residual Functional Capacity (RFC) assessment that indicates how their symptoms affect and limit their life activities. Severe TMJ may leave a patient unable to open or close their jaw, leaving simple tasks such as eating or speaking difficult if not impossible.
Even if a person does not qualify for disability benefits for their TMJ alone, they may be eligible under their other conditions. It is essential to consider and convey the entire health of the patient when applying for disability.
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 TMJ. 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. 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. Residual Functional Capacity (RFC) assessments 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 a Long Term Disability Attorney
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your temporomandibular joint disorder (TMJ). 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 expert 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 long term disability lawyer about your TMJ 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.