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

maculardegenAge-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 pigmentosaRetinitis 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

GlaucomaGlaucoma 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 Doctor’s Corner: 5 Recent Medical Study Developments

There have been several studies released in the past few months that offer promises for better understanding and treatment of several different chronic conditions. Today’s post is going to review some of these advances and how they may affect those with these chronic conditions and how they may impact disability claims.

  • Study Shows Antibiotics May Relieve Chronic Lower Back Pain:  This new study shows that 4 in 10 chronic back pain cases may be caused by bacteria and that 80% of these cases may be successfully treated with antibiotics. antibioticIn this double-blind Danish study, patents were treated with either a placebo or antibiotic regiment 3 times a day for 100 days and then re-evaluated. The placebo group showed no noticeable improvement while patients who received the antibiotics were better able to function after one year with less lower back pain, less leg pain, and fewer days off work due to the condition. These new treatment avenues could help some people who suffer from chronic back pain regain more independence and return to more normal activities.
  • Los Angeles Doctor Develops New Fibromyalgia Test:  Individuals who suffer from Fibromyalgia know the frustration and extended time it often takes to reach a conclusive diagnosis of their condition. A new test developed by Dr. Bruce Gillis in Santa Monica, California is the first blood test able to recognize two blood markers for Fibromyalgia that can be found in the immune system. The test measured the levels of two specific proteins produced by white blood cells: chemokines and cytokines. Patients who suffer from Fibromyalgia also lack the production of these two specialized proteins. This test may be able to offer more definitive evidence, or their holy grail of objective proof, for the insurance company claim examiners and consulting doctors who are dubious and skeptical about any and every disability claim involving Fibromyalgia.
  • Long-Term Intake Of Omega-3 Fatty Acids Can Greatly Reduce Risk of Rheumatoid Arthritis:  This is a Swedish study of 32,000 women over a 10-year period. In the study, people who ate certain types of fatty fish at least once per week developed rheumatoid arthritis at only half the rate of women who at little or no fish. The researchers behind the study say that the Omega-3 fatty acids present in these fish have an anti-inflammatory effect on the immune system.  Since rheumatoid arthritis occurs when the immune system mistakenly attacks joints, the anti-inflammatory effects mitigates the body’s inflammation, reducing the pain and cartilage damage caused by arthritis.
  • Study Shows Genetic Relationships Between 5 Major Psychiatric Disorders:  The largest genome-wide study ever conducted on schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorders (ASD), and attention-deficit/hyperactivity disorder (ADHD) has demonstrated that genetic relationships exist among these conditions. The study’s findings show that many of these disorders may be far more connected than manygenome people consider today. The results show that the genetic overlaps are most significant between schizophrenia and bipolar disorder. They’re moderate between bipolar disorder and depression, schizophrenia and depression, and depression and ADHD. The lowest correlation of any significance was found between schizophrenia and autism. These correlations will help researchers find new protocols to treat behavioral patterns as opposed to specific conditions, allowing for more precise and patient-specific treatment therapies.
  • New treatment offers relief for Colitis and Chrohn’s disease:  Two studies show that the same treatment may provide relief for sufferers of both Crohn’s disease and Ulcerative Colitis. These trials took place with nearly 2,000 patients in 34 countries and monitored them for one year of treatment with the intravenous antibody medication, Vedolizumab. This drug works by inhibiting the immune system from releasing cytokines, the same protein coincidentally used as a marker in the new Fibromyalgia test above. The inflammation caused by this protein causes many of the uncomfortable symptoms brought on by these diseases. Not only did the drug work to prevent the symptoms of the conditions but even better more often resulted in remissions. These studies also showed that patients were able to stop using some commonly prescribed drugs and therapies to treat Colitis and Chrohn’s, helping avoid their significant and common side effects such as weight gain, nausea, and headaches. This new treatment gives sufferers the opportunity to regain more of their lives without having to deal with the residual effects of the disease along with the side effects of prescriptions that can prevent claimants from being able to return to work.

As medical research progresses, more sufferers of chronic diseases are able regain their lives and reduce their risks of becoming or remaining permanently disabled. New advances are made every day, and new studies continue to find links that help understand the reasons and factors underlying – and treatments for – many chronic conditions, giving patients and doctors new directions in finding different and more effective treatment protocols for conditions which can be terribly debilitating.

If you are suffering from a chronic condition and need help with your disability insurance claim, please call our firm at (855) 828-4100 or visit our website to sign up for a free consultation.

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.   Continue reading

Insurance Investigators: An Inside Look At Their Techniques

We’ve often mentioned insurance company investigators and their tactics as extremely adept at developing reasons to deny legitimate disability claims. Insurance companies like to hire former FBI agents and police detectives who have been specifically taught to treat their targets as adversaries and be cynical of any answers – which they innocently refer to as being professional. These investigators have undergone specialized training on how to dig up information and how to conduct interviews that can be twisted against claimants and used by claims examiners to deny disability claims. Due to our connections, our firm has seen some of the confidential training materials used by disability claims operations that help provide insight into the investigative techniques and methods used to interview claimants. This information can be invaluable to claimants, allowing them to more properly prepare for the interview, whether it’s a scheduled appointment or an unannounced visit. Today’s blog is going to breakdown and summarize some of the key points to help you handle an interview and understand the underlying purposes for the questions.   Continue reading

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.  Continue reading

Another Success Story!

Every once in a while, we like to feature a story from one of our clients about their personal experiences with the disability claim process. Today’s story is an especially touching one. We spent a lot of time with working with Robert and his wife, and he ended up getting the disability benefits he deserved. The nature of his disability and the circumstances of his claim presented some unique hurdles that we had to work together to overcome, but we were able to provide the level of service he needed to satisfy the demands of his claims examiner and move on with his life. Here’s his story, in his own words:

My consultant, Fred Gosman, really helped with my disability claim! After I suffered a broken ankle, I found myself no longer able to work when the injury took a turn for the worse and turned into Reflex Sympathetic Dystrophy and Complex Regional Pain Syndrome. This is when I decided to file for disability benefits. Being an insurance agent, I thought I’d be able to easily complete the claim forms.  But after attempting it alone, I realized the enormity of my situation and decided to find help.  

I hired a claim consultant who promised lots of help, but instead she became abrasive and overbearing, angering my doctors and not helping my claim.  I had to quickly terminate that relationship and start over.  Once I found Royal Claims Advocates, my experience completely changed.  Fred helped me and my wife from the beginning, making sure I understood what was needed and helping gather all of the information.  He helped make sure my claim forms reflected my situation and worked with my doctors (They loved him!) to ensure they understood what was needed by Reassure America for my claim. 

He has helped make sure Reassure America was treating me fairly.  They asked for lots of records that didn’t apply to me or my claim, but he helped us correct their misunderstandings and provide the information they really needed. 

I’ve struggled through some rough parts of my disability, and Fred was flexible when I needed it.  Everything he’s done helped us move closer to filing my claim with support and documentation. His knowledge of disability insurance and claims helped my claim go smoothly.

Once we submitted my claim, my benefits were approved and paid within weeks, far quicker than I imagined.  Fred and his team at Royal Claims stayed with me to support and guide us through this challenging time.  Their help really has been invaluable to me and my wife.  As a former insurance agent, I appreciate the depth of their knowledge and the quality of their work.  It’s allowed me to focus on my recovery instead of fighting the insurance company for my benefits! 

– Robert S., Philadelphia, Pennsylvania 

Thank you Robert for your kind words!  Stories like these are the purpose we created our firm and the reason we fight so hard to ensure our clients get the disability benefits they deserve.

We’ve helped many others receive their benefits as well. If you or someone you know is in need of help on their disability claim, please contact us. You may call us toll-free at (855) 828-4100 or visit our website to sign up for a free consultation.

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.   Continue reading

March Madness: Our Elite Eight Blog Posts

What a difference a year makes! Where does the time go?

We’ve been writing articles for this blog for over a year, and we’ve learned as many things from our readers as we hope you’ve learned from us. As our topics have grown and more readers have found us, we wanted to make sure that some of our posts don’t get lost in the noise of the Internet and buried deep away where claimants would less likely be able to find help. In the spirit of the NCAA basketball tournament, we’re going to go through our most popular blog posts as well as highlight some posts that we think include topical, valuable information that may be helpful in your disability claim. Thanks again for reading our blog over the past year and making us one of the top-rated destinations for disability claim advice and help.  While we hope you never have any problems with your conditions or your claim, we’ll continue to be here to read, just in case, for years to come!

Continue reading