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.

3 Major Questions of a Total and Permanent Disability Claim

While most sufferers of chronic back pain are able to recover and return to work in varying capacities, there are many people who experience such severe and debilitating pain that they will never be able to hold a normal job again. Claimants who suffer from such severe conditions are initially approved for their disability benefits, but this may be just the beginning of a long and winding road for claim investigations that can be opened and reopened for years on end. Insurance companies won’t acknowledge what total and permanent represents and require regular and appropriate care for the conditions causing the pain throughout the duration of the claim and can also require other documents ranging from tax returns to activity logs. Insurance companies can also reopen investigations at any time and restart the review process all over again. If you have been approved for benefits and don’t expect to return to work anytime soon, there are several issues you should consider to help reduce the stress going forward in the claims process.

Three of the most common issues we hear about from claimants in this situation are surveillance, settlements, and what the insurance company considers to be appropriate care for the condition. I will touch on each of these topics as well as a few other key issues prevalent in these types of claims. 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

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

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.   Continue reading

6 Potential Pitfalls of Your Chronic Back Pain Disability Claim

Almost everyone will experience some sort of back pain during the course of their lives.  This can extend from the cervical to thoracic to lumbar, not to mention shooting into arms and legs, and range in severity from a minor, short-term twinge to protracted, excruciating pains that last for months.  For people who deal with chronic back pain on a daily basis, performing what used to be simple tasks and normal work functions can become difficult and sometimes unbearable.  Even with surgical intervention, the pain may prove too overwhelming for many people.  In addition, this pain can lead to a host of other conditions such as depression and anxiety.  When this occurs, sufferers of chronic back pain may need to consider applying for their disability benefits.

The claim process is full of unexpected pitfalls and hurdles that may weaken the claim and cause benefits to either be delayed or denied, preventing you from having the money you were counting on to pay the many bills that crop up when you become disabled.  These following six tips represent some of the most common problems our clients have experienced when filing their claim for benefits based upon conditions that cause chronic back pain and the ways to avoid these problems, helping you receive your benefits as soon as possible when you need them most.   Continue reading

Dealing With an Aggressive Claims Examiner

When you file a disability claim, your main point of contact with the insurance company is usually a claims examiner who has been assigned to your claim.  These individuals are trained to act as your lifesaver during your time of need, but they’re specifically trained (and sometimes even rewarded) to search for reasons to deny claims and goad claimants into making statements that are not representative of the truth and can be twisted to the insurance company’s advantage.  There are many different ways that the insurance companies try to reach their profit goals, but one of the most obnoxious techniques seems to use aggressive and pushy tactics in the claim departments to force mistakes or cause anxiety and fear that cause claimants to reconsider whether they should even pursue their benefits.  Knowing the fragile state of many claimants when they file for disability benefits, some claims departments capitalize on these weaknesses and manipulate LTD claims process to their advantage. Continue reading

Uncovering the Secrets of Insurance Company Surveillance

Surveillance is an issue that has been mentioned in several past blogs and creates tension and stress for claimants and insurance companies.  Disability claim examiners are trained to recognize certain “red flags,” ranging from incorrect statements on claims forms, to inconsistencies with medical information, to the experiences of a claims handler, that can trigger different types of surveillance.  In response to several questions about specific surveillance techniques and how to handle them, I’d like to explain some of the more common tactics used on a regular basis by insurance companies.   Continue reading

Watch Out for Your Social Media Presence

Post on Facebook!  Tweet on Twitter!  Re-pin on Pinterest! 

Social media is breathlessly changing the way our world communicates, shares news and pictures, and forms relationships with other people.  Recently, there have been several articles in the news about how social media has been used by insurance companies to accuse people of committing disability claim fraud.  Many people do not think about what they put on Facebook, Twitter, or LinkedIn, but claims examiners, field representatives, and private investigators sure do.  These sites are some of the first (and best) sources of information used to delay or decline paying a disability claim.  While Internet searches are not always misused in a claim investigation, the possibility for abuse is there by misconstruing what’s posted or putting information in a wrong or misleading context.  This is why we educate our clients on how to be clear and careful about what they put online and how to have a consistent social media footprint when filing a disability claim.

It might sound funny, but Google yourself.  Get an idea of what may be floating around the Internet about you.  For another example, try Dirt Search and you might be surprised what one free, simple, quick public record search is able to find. Continue reading

Insurance Company Manipulation of Herniated and Degenerative Disc Claims

Many people have some form of degenerative back condition, ranging in severity.  Certain activities and professions can aggravate these symptoms into a condition that makes working almost impossible.  Several types of doctors, such as interventional cardiologists and radiologists, are susceptible to back injuries and herniated discs from wearing heavy lead aprons.  While there are several types of surgeries that may help relieve symptoms, including discectomies, insertion of rods and pins, and spinal fusions, these surgeries do not always work.  Before and even after such surgeries, patients can suffer from numbness, weakness, and loss of sensation in their extremities.  When the conditions become unbearable, many people decide to stop working and file for their disability insurance benefits.  However, getting your disability claim paid is not as simple and easy as it was promised.  Here are a few ways insurance companies defend against these claims to delay or not pay benefits. Continue reading