Bringing Your Vision-Based Disability Claim Into Focus, Part 2

Today, we’re going to finish our blog series on vision-based disability claims. Last week, we covered Glaucoma and how individuals suffering from this condition can make sure they get the benefits they deserve. The second half of this series focuses on a couple of lesser known conditions that can also affect the quality of life of sufferers and prevent them from continuing in their occupations. If you suffer from one of the these conditions, following the tips below may help you get the benefits you deserve.

Macular Degeneration

Age-related macular degeneration is a condition which usually affects individuals over the age of 50, although rare cases have been reported in younger patients. Due to damage to the retina, macular degeneration can cause loss of vision in the center of your vision field, called the macula. This central loss of vision makes it difficult to do such activities as reading or recognizing faces, although enough peripheral vision is often present to allow the patient to participate in activities of daily life. The initial symptom is often yellow deposits, called drusen, in the retina. The larger and more prevalent the drusen are in the eye, the more likely an individual is to develop macular degeneration. Although it affects the central vision, macular degeneration doesn’t usually lead to complete blindness. The macula compromises only 2% of the retina, leaving the remaining 98% of the vision field unaffected. However, almost 50% of the visual cortex is devoted to processing macular information. In addition, losing central vision is extremely detrimental to basic visual tasks – reading is almost impossible and the loss of contrast sensitivity makes it more difficult to differentiate between colors, contours, and shadows.

There are several tests to determine if you have macular degeneration. These tests measure the presence and size of several different objects in the eye to tell if a patient has the symptoms of the disease. If these issues are present, then there are several different vision tests that can confirm the diagnosis. Once the diagnosis has been determined, the treatment usually consists of injection directly into the eye on a monthly or bimonthly basis. There is no permanent cure for macular degeneration at this time, so controlling the disease is the best choice at this time. In addition to the injections, adaptive devices such as special eyeglass lenses, computer screen readers, and accessible publishing options for books can make the daily life of sufferers easier.

There are several issues that insureds may face when filing a disability claim resulting from macular degeneration. The main issue is the fact that patients can still use their peripheral vision to see certain objects and continue basic daily life activities. Claims examiners can twist this ability into an argument that the insured is still able to perform their job duties. In cases where the insurance company uses surveillance,  the activities on video can be taken out of context if the insured is going into public and completing tasks that may require some vision, but not the detailed abilities that a healthy macula provides. Anyone who is applying for disability benefits based upon macular degeneration should make sure to show how their job functions include tasks that require detailed vision to complete.  Otherwise, this can result in an example of the disconnect between a diagnosis and a disability, discussed in one of our prior blog posts.

Retinitis Pigmentosa

Retinitis pigmentosa is an inherited, degenerative eye disease that can cause severe vision impairment and often leads to blindness. It’s a very unpredictable disease, with some sufferers exhibiting symptoms from birth while others may not notice the condition until much later in life. It can also cause tunnel vision, night blindness, and a loss of central vision. Retinitis pigmentosa is caused by abnormalities in the retina, centered in either the photoreceptors or retinal pigment epithelium. There are no visual symptoms of the disease and sufferers must constantly adapt to less and less vision, eventually causing major issues with the activities of daily living.

Testing for retinitis pigmentosa relies on documentation showing the continual loss of photoreceptor function through visual field testing. In addition, DNA testing is available to detect the presence of a number of different gene indicators that can give advance warning of the condition. After a patient is diagnosed with retinitis pigmentosa, there is little they can do. At this time, there is no cure for the condition, although some new treatments hold promise but aren’t yet widely accepted. Using vitamin A supplements can postpone blindness by years in some cases, and a retinal prosthesis is being tested in several European countries with promising results. Many sufferers  of this condition maintain some form of central vision for a period of time. Some insurance companies have delayed (or denied) disability claims on this fact, asserting that claimants are still able to do sedentary work and work in conditions that don’t require seeing in low light. If you’re suffering from this condition, make sure that the diagnosis and evolution of your condition is well documented and substantiates how you’re prevented from performing your job duties even with “reasonable accommodations.”

Losing your vision is a scary though but is a reality for many people. The last thing someone who is losing or lost their normal vision to differentiate between light and shapes should have to worry about is their ability to collect the disability benefits they deserve. Some insurance companies use the uncertainty in many vision conditions to cast doubt on the claim and find reasons to delay or deny paying benefits. They will say that accommodations can be made even when they’re bordering being unreasonable. The ability of many low-vision claimants to continue doing things like going to the store and completing yard work makes insurance companies suspicious and surveillance videos seem like indictments.

If you’re considering filing a disability claim based off of a vision based disability or are being treated unfairly by the insurance company, please visit our website to sign up for a free consultation or call our offices toll-free at (855) 828-4100.

Bringing Your Vision-Based Disability Claim Into Focus

Vision is a sense that many people take for granted. Although many individuals wear glasses and contacts to correct their vision or may even get LASIK, not may people consider the consequences of having a chronic disease that limits your ability to see clearly even with corrective measures. There are three specific conditions that our firm sees on a recurring basis involving vision losses: glaucoma, macular degeneration, and retinitis pigmentosa. A disability claim based upon loss of vision can be surprisingly difficult, as many insurance companies demand a high level of vision loss before being considered to be eligible for benefits. This, however, does not mean that such people are still able to perform their job. If there is strong medical evidence to back up your claims and an accurate and complete job description to show how you are no longer able to the material and substantial duties of your occupation due to these limitations,  insurance companies will have little choice but to approve you for the disability benefits you deserve. Each of these conditions has different tests and treatments that will be necessary to identify and treat the disease.

Glaucoma

Glaucoma is not a specific disease itself but is the name for a group of diseases that affect the optic nerves and can cause blindness. In fact, glaucoma is the second-leading cause of blindness worldwide. It affects 1 out of every 200 people under the age of 50 and rarely exhibits any symptoms. The two main types of glaucoma are “open-angle” and “closed-angle,” referring to the area between the iris and cornea. Closed-angle glaucoma often has a sudden, painful onset and can cause a sudden loss of vision. However, the amount of discomfort involved usually leads sufferers to pursue treatment before damage becomes permanent. Open-angle, chronic glaucoma on the other hand progresses at a slower rate and doesn’t cause the same level of discomfort. Because of this, many sufferers don’t realize they have lost vision until the disease has progressed significantly. This is the type of glaucoma that causes the most disability issues. Because of the lack of clear symptoms, many sufferers don’t realize their deteriorating condition until it’s too late to restore their eyesight, leading to permanent losses of ability.

Qualifying for short term disability benefits based upon a diagnosis of glaucoma is much more common than qualifying for long term disability. There are a number of effective treatments for the condition, and insurance companies often assume (and/or insist) that anyone who suffers from this condition will soon return to their former health – even though some cases of glaucoma are permanently impairing. This is why it’s so important to follow the proper medical protocols for testing and for treatment during the course of the condition. Testing for glaucoma is a part of most standard eye examinations and include measurements of the pressure in the eye, changes in the size of the eye, and examination of the optical nerve for visible damage. If glaucoma is detected early enough, it can be treated a number of different ways. There are surgical remedies, medications, medicinal eye drops, and even medical marijuana (depending on where you live) that have been proven effective in controlling and even reversing the symptoms of glaucoma.  The best outcome is to successfully treat the glaucoma and recover your eyesight.  But if someone suffers from glaucoma that has permanently damaged their eyesight, then it’s critical to have substantial testing and medical proof for the medical condition, its symptoms, as well as documentation tying the occupational duties to the person’s eyesight. If you’ve been accurately diagnosed with the condition, continue with proper care and treatment, and prove that you can’t perform the occupational duties, you should be able to maintain the disability benefits you deserve.

We’ll go into the other vision conditions that often result in disability claims in our next posting.

Losing your vision can be a terrifying event, and many people expect that their disability insurance company will not question their claim.  But not only are many of these claims questioned – they’re denied using a variety of policy defenses. If you’re considering filing a disability claim due to your loss of vision or feel like you’re being unfairly hassled by the claims process, please visit our website to sign up for a free consultation or call our offices toll-free at (855) 828-4100.

The Different Definitions of Disability

Deciphering the different definitions of disability is a surprisingly complicated process. Some of these definitions can be found in almost every policy, while some use attachments or riders to tweak the policy language. While the exact terminology may be different, there are five basic definitions of disability that are important to understand if you’re considering filing a claim for benefits or even if you’re just trying to decide what type of coverage to purchase.

1. Own Occupation. Simply put, this definition defines you as totally disabled if you can no longer perform the material and substantial duties of your occupation. Some policies will even consider you totally disabled if you are unable to perform just one of the material and substantial duties of your occupation. If you are being paid benefits under an own occupation disability policy, you may be able to go back to work in a different type of job and still be entitled to benefits as long as you’re unable to perform the job from which you were declared totally disabled. Because of this liberal definition, these policies are usually more expensive and harder to obtain.  
2. Any Occupation. This definition is almost the opposite of Own Occupation. You’re only considered totally disabled if you cannot perform the duties of any occupation. Usually, the policy will include language that takes into consideration your education, training, experience, and earnings level as well.  This prevents the insurance company from trying to envision you in a job for which you’re under-qualified or over-paid just to end your claim. This definition is often found in cheaper, group policies and can be challenging to collect benefits without strong medical evidence and very debilitating conditions.
3. Split Definition Coverage. While this isn’t a definition of disability in and of itself, this definition is very common in disability insurance policies so it’s worth discussing. Many policies have definitions of disability that switch from Own Occupation to Any Occupation after a period of time that can range from 6 months to 5 years. Anyone receiving disability benefits under this type of coverage should be extremely wary leading up to this transition date, as insurance companies often plan for how to stop paying benefits around that time.
4. Presumptive Total Disability. Regardless of your policy definition of disability, certain catastrophic injuries or illnesses are automatically considered totally disabling. These often let you skip some of the requirements that must be met to be considered totally disabled. You’re allowed to receive benefits immediately after the elimination period that will continue even if you return to work. The medical events that fall under this definition include the loss of sight in both eyes, loss of hearing, loss of speech, the use of both hands, the use of both feet, or the use of one hand and one foot. These losses must be complete. Different policies can have slightly different qualifications for Presumptive Disability and not all of the ailments listed above will qualify under every policy.
5. Residual Disability. The first four definitions have been about Total Disability, but this isn’t the only way to qualify for benefits. Some policies include definitions of disability that will pay you a portion (or all) of your benefits if your work level and/or earnings are reduced. Under Residual Disability, claimants are paid benefits based on the relative amount of income they’ve lost due to their disability. This is calculated through a formula that takes into account the disabling condition and the percentage of pre-disability income the claimant continues to earn. Be aware – some cheaper policies include a clause that requires the claimant to have been totally disabled for a while before they’re able to collect residual disability benefits. There are two ways to purchase Residual Disability coverage: you can either purchase a Total Disability policy with a Residual Disability rider or you may purchase what is often called an income replacement policy. Income replacement is another term for residual coverage and can be the cheaper of the two option since it lacks specific Total Disability coverage.
6. Partial Disability. This definition is very similar to but slightly different from Residual Disability. The main difference is that Partial Disability does not consider the loss of income calculations when determining the benefit amounts. Rather, if you’re considered partially disabled, the policy will pay you 50% of the total disability benefit amount. Partial Disability is also not offered as a standalone policy and is either included as a rider to a policy or as the base coverage in some rare policies. Benefits periods for Partial Disability are often much shorter, usually not extending beyond 6 to 12 months.

Even if your injury or illness may fit into one of these policy definitions, it doesn’t always mean you will receive benefits. There are many other policy considerations, such as appropriate care or diagnosis limitations, that can decide whether or not you’ll be able to collect your benefits. If you’re considering filing a disability claim and are not sure of the definitions in your policy, or if you’re not sure if you qualify for benefits under your policy’s definition, please call our firm toll-free at (855) 828-4100 or sign up for a free consultation on our website. We can help you get the answers you need to get the benefits you deserve.

Medical Disability Durations & The Effect on Return to Work Guidelines

We have encountered several cases where claimants have been denied their benefits not because of incomplete or inconclusive evidence of their medical conditions but solely because their conditions kept them from working longer than the guidelines used by disability insurance claim departments. When evaluating disability claims, claims examiners rely on industry developed resources to determine the expected duration of the claim, regardless of the specific circumstances. Based on these claim management practices that have been put into place by most insurance companies, we’d like to shed some light on the process used to assign expected return to work dates for claims and the extra steps that claimants need to take to protect their benefits if they’re disabled beyond these arbitrary dates.  

Lyme Disease Diagnosis and Treatment: How These Issues Affect Your Disability Claim

With summer and the outdoor season upon us, there can be different causes of disability to deal with. One of the more common conditions we see during this time of year, especially in the Northeast, is Lyme disease. Although there is evidence that Lyme may be spread through multiple sources, the primary method of infection is a blacklegged or deer tick bite. Lyme is a complex multisystem inflammatory disease that can affect all of the major organ systems in your body and cause a wide range of symptoms including fever, headaches, rash, pain, vertigo, speech impairments, mood swings, depression, and hallucinations. In addition, these symptoms don’t always develop immediately. It can take days, weeks, or even years before the onset of symptoms due to Lyme disease, making it extremely difficult to pinpoint the causal event of the symptoms. 

The Doctor’s Corner: Diabetes, Complications, and Disability

Diabetes is a growing health problem in America with over 26 million people suffering from the condition and another 79 million individuals suffering from pre-diabetes such as insulin resistance and Metabolic Syndrome. Only approximately 5 percent of diabetics suffer from Type 1 diabetes with the overwhelming majority suffering from Type 2 diabetes. While many of these individuals are able to work long and fulfilling careers, there are increasing numbers of people whose disease prevents them from continuing in their jobs and are forced to file claims for disability insurance benefits.

Insurance companies will often dispute and deny a disability claim based solely on a diabetic condition even if it’s shown that the condition was the root cause of the inability to work.  It’s important to understand that technically, they may be correct.  It’s not usually the diabetes that disables someone but one or more of the many complications that are caused by this disease. If you’re receiving regular care and treatment and are following the plan of your treating physician, being diabetic in and of itself is generally not disabling.  If you find you’re unable to work and are filing a disability claim, you’ll want to document the nature and extent of the complications and the severity of their impacts on your work abilities.  

The Disconnects Between Diagnosis and Disability

One of the biggest issues our clients face when filing their disability claim is the lack of clear medical opinions explicitly linking their condition to their disabling restrictions and limitations.  Physicians are skilled at diagnosing a disease or illness, but they may not be the best at explaining why the condition is disabling for the claimant.  This can especially be problematic with mental illnesses or other types of invisible disabilities.  Any ambiguities cause increased scrutiny and in-house referrals by claim examiners and are often used as a basis for a disability claim denial.  Helping your doctor connect the dots between your condition and your inability to work smooths the disability claims process and fosters a quicker claim approval with fewer questions.  We’d like to discuss two perspectives to this issue: the claimant’s and the physician’s.  We’re going to discuss what each party can do to make the disability clearer and the claims process smoother.  

Defending Your Claim Against the Insurance Company IME

The most important piece of evidence in a disability claim is the medical basis for the disability.  If there is strong medical proof of the severity and continuation of your disabling condition, then there’s a good chance of your claim getting approved.  However, this may not always be the case.  Many conditions don’t have clear cut tests to prove their existence, and other conditions have testing protocols that either aren’t generally accepted or aren’t always accurate.  Even if appropriate testing exists, claims examiners may try to dispute the opinion of the attending physician.

When these and other issues are noticed in the claim file and want to be explored, claims examiners will often demand that the claimant undergo an IME.  

Our Top 3 Alternative Treatments for Chronic Pain

Chronic pain is a condition that presents a challenging claim scenario because of the difficult nature of the diagnosis, the many testing options, and the wide variety of treatment plans prescribed by physicians.  Each of these factors relate to one another in a disability, and all need to be well documented in a disability claim.  However, this does not mean that you have to blindly follow a physician’s treatment plan.  There are many alternative treatments that are safe to use in conjunction with your recommended care and treatment and will help reduce the stress and suffering caused by chronic pain syndrome.  Alternative treatments are common among our clients, so we’d like to mention the three most often used alternative treatments.  Therapies and results vary from person to person, and what works for one individual may not work for another.  Before starting any alternative course of therapy, please do prudent research to allow you to discuss it with your treating physician.  Most importantly, never abandon a treatment plan prescribed by your doctors.  Research and discuss alternatives to be an engaged patient but don’t abandon it.  

3 Reasons Your Invisible Disability Benefit Claim Was Denied

When many people think of a claimant who is receiving disability benefits, they picture someone who is visibly and physically unable to work.  Although many claimants suffer from conditions of this nature, some of the most painful and devastating conditions include categories often referred to as “invisible disabilities.”  Invisible disabilities include such conditions as CFIDS, Fibromyalgia, chronic pain and mental illnesses, such as anxiety or depression.  These conditions can be every bit as severe and debilitating as outwardly obvious conditions but are often met with skepticism and distrust by disability claim professionals.  Many claimants who suffer from invisible diseases encounter seemingly unending questions and problems with their long term disability claims and the claims process.  We have seen people make inadvertent errors in how they’re presented their disability claims and simply give up, surrendering their rights to the disability benefits they actually deserve.  Here are the three common reasons that disability claims based on one of these invisible diseases are denied.