Arthritis: Common Claim Mistakes and How to Get Approved for Benefits

If I were to ask you the number one cause of disability in the United States, what would you say? It may surprise you that the answer is…arthritis.  Arthritis is a very common condition that affects the ability of more than 20 million Americans to work in their chosen careers on a daily basis. It manifests itself in many different forms, but the main type is osteoarthritis followed by rheumatoid arthritis and psoriatic arthritis. In the case of individuals who try and continue their careers, their work abilities can be marred by absenteeism and frequent doctor appointments to deal with the pain and difficulties of movement. It’s estimated that over $60 billion dollars a year in earnings are lost due to this degenerative disease. Disability insurance is a very important consideration in the treatment and recovery of an arthritis patient, so it’s critical to remember several key points when applying for disability benefits from an insurance company.

To understand the do’s and don’ts of the disability approval process, you should first make sure you can tell the differences between the main forms of the disease so that you can understand and anticipate what the insurance companies and their doctors will be looking for to prove your claim.

  • Osteoarthritis Also known as degenerative arthritis, this type is usually caused by the degeneration of the cartilage between joints.  The most common form of arthritis, osteoarthritis can result from many different causes.  Symptoms usually include joint pain, tenderness, stiffness, weakness, and locking of the joint.
  • Rheumatoid Arthritis:  Considered a systemic autoimmune disease, rheumatoid arthritis is an inflammatory disorder that focuses on the flexible joints in the body.  It affects women at three times the rate of men and is recognized through the swelling and tenderness of affected joints.  It affects nearly 70,000,000 people – or 1% of the world’s population.
  • Psoriatic Arthritis:  Another type of inflammatory arthritis, more than 30% of people who experience psoriasis will develop this form of arthritis.  The main symptoms of this form of arthritis include pain and swelling in affected joints as well as joints that are warm to the touch with extreme exhaustion.

After reading the main symptoms of these debilitating conditions, it’s easy to see how the symptoms prevent many people from being productive at their jobs.  However, disability insurance companies don’t always see things this way.  By picking and choosing individual events and abilities, claims examiners try and paint arthritis as a condition that doesn’t prevent your ability to work and may dismiss many of the symptoms as self reported conditions or as general aches and pains.  We’ve had many claimants come to us when their disability insurer has denied their legitimate claim for benefits due to their arthritis.  Here are some of the helpful advice and tips we’ve garnered through these claims.

First and foremost, it’s important to get your condition diagnosed by a doctor (preferably by a specialist) as soon as possible – and then stop working.  We see many clients who realize their arthritic conditions are worsening but only begin to wind down their work responsibilities or stop working entirely before beginning the process of formal medical diagnosis.  Waiting to go to the doctor until after you’ve stopped working or have reduced your job duties to a sedentary level makes proving your condition and effect on your job much more difficult.  Insurance companies will try and label your inability to work as a simple lack of available work in your field or try to label your as an administrative role, especially if you’re a business owner.  For example, take a surgeon who owns his or her practice and performs operations on a regular basis.  As the arthritic symptoms progress, the surgeon may change the focus of his practice to less demanding procedures or assume more of an administrative role in the practice, not out of desire but rather out of necessity.  When that surgeon chooses to file a disability claim due to the inability to perform surgeries, many claims examiners will try and evaluate his job based on the less demanding procedures or administrative duties “as of the claimed date of disability” instead of the actual occupational duties that had been performed by the surgeon.

Like many other chronic conditions, arthritis symptoms may come and go over time.  It’s almost never going to be instantly and completely disabling, so the claim forms need to clearly reflect this.  Many claimants make the mistake of overstating their disability to make sure the insurance company approves their claim.  This isn’t to say they lie, but the restrictions and limitations may be amplified.  For example, if you say you’re unable to use your right hand due to the effects of rheumatoid arthritis, this needs to be true.  But if your hand is usable and functional only 30% of the time, your claim forms should reflect this as well.  Insurance companies will use these blanket statements by an insured to conduct surveillance and develop avenues to deny an otherwise valid claim.  If you report that your right hand is unusable, but a private investigator videotapes you using it, you may have placed your claim at risk of denial due to misstatements on the claim form – no matter your true inability to work.  If your restrictions and limitations stop you for working and qualifies you for benefits under the terms and conditions of your disability policy, there is no need to exaggerate your symptoms.

One last tip for arthritis disability claims involves the treatment you’re receiving for your claim and whether the insurance company will consider your course of treatment “appropriate.”  I’ve touched on this subject several times in prior blog posts, but it cannot be stressed enough.  Alternative medicines and doctors are common (and often quite useful) in chronic conditions that have no known cures, just treatments for the symptoms.  Although you may feel these alternative treatments are beneficial to your condition, the insurer will often not recognize your treatment unless it is by a board-certified physician, experienced and credentialed to treat your condition.  Alternative options are acceptable as long as they are a supplement to conventional medications and treatment.  Do not give the insurance company an easy way to deny your claim by refusing certain types of commonly expected treatments.

Arthritis is a condition that not only affects the health of a claimant but their personal and professional lives as well.  Studies have shown that this disease can take years off of your life, and it is important to keep stress levels as low as possible.  Dealing with an aggressive, intimidating insurance company on your own is not a good way to reduce stress.  Having a team of expert consultants who’ve handled thousands of disability claims and are prepared to help you preserve your rights can help ensure that your claim process is as smooth and easy as possible.  Call Royal Claims Advocates now at (855) 828-4100 or visit our website for a free consultation if you would like more information on how we can help you navigate the tough process of getting the benefits you deserve.

2 thoughts on “Arthritis: Common Claim Mistakes and How to Get Approved for Benefits

  1. Pingback: Uncovering the Secrets of Insurance Company Surveillance « Royal Claims Advocates

  2. Pingback: 6 Tips To Keep Your Disability Claim Moving | Royal Claims Advocates

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