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.

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.

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

6 Tips To Keep Your Disability Claim Moving

One of the biggest red flags a claimant can inadvertently create in their disability claim is to move.  While there are many legitimate reasons someone can move, claim examiners have been trained to closely scrutinize a case where a claimant moves.  New sets of arguments and investigative avenues are opened for the insurance company to use against you.  As anyone who’s moved can tell you, moving is difficult at best.  And the last thing someone needs, who is already trying to move while dealing with their disability, are new and additional hassles from their disability insurance company, not to mention the added stress of worrying that their benefits will be delayed or stopped.  If you’re currently applying for or receiving disability benefits, there are several issues we think you should understand as well as a few tips on how to keep the disability claim process moving smoothly during this stressful time.   Continue reading

Obesity and Its Effects On Disability Claims

Obesity has become a major health problem in the United States, affecting healthcare providers and insurance companies.  Although obesity is seldom a cause for disability in and of itself, it can cause or complicate a number of different conditions that can cause people to become disabled.  In addition to a declining quality of life, obesity can lead to cardiovascular diseases, stroke, cataracts, diabetes, hypertension, arthritis, cancer, pulmonary diseases, and sleep apnea, among other disorders.  If you’re suffering from any of these conditions and are also obese, curing your condition and regaining your life is an on-going battle.  The fatigue and lack of mobility that often accompany cases of obesity make it more difficult to perform the duties of many careers, even without considering the problems caused by any accompanying complicating medical conditions.  Reducing obesity is one of the best ways to reduce stress on your body and your life, but that’s not always an option due to people’s circumstances.  And our discussion is not going to address the relationships between obesity, certain drug side-effects, and/or mental conditions – that’s a topic for another day.  Today, I’m going to approach the topic of obesity in two ways: offering advice on how to deal with your existing disability claim while suffering from obesity, as well as sharing a few basic tips on how to reduce your weight in ways that can help prevent a disability claim in the future.

Continue reading

10 Ways to Protect Your Disability Claim in 2013

The new year is always a good time to review the events of the past 12 months and see what you can do to improve your life over the next 12 months.  If you’re dealing with health problems and a resulting disability insurance claim, this is also a great time to review the status of your claim and find ways to make the claim process stronger, simpler, and better.  This can be done in whichever stage of the claims process you’re in.  Whether you are still considering filing a claim, are waiting on a decision from the insurance company, are receiving benefits, or are facing a claim denial, it’s important to stay on top of your claim.  Insurance companies are always looking for new strategies to increase profits and reduce claims, so you should always try and stay one step ahead of them.  These 10 ways to protect your claim can help reduce your stress and work required on your disability claim over the next 12 months.  Like most things, maintaining a strong disability claim is easier than rehabilitating a claim when it breaks (or is denied).  Continue reading

Doctor’s Corner: Behind a Carpal Tunnel Syndrome Diagnosis

As many professional jobs become more and more computer-based, disabilities that involve nerve, muscle or tendon damage in the hands have become a major issue.  These conditions prevent people from typing reports, replying to e-mails, and completing the day-to-day tasks of their jobs.  These conditions can range from work modifications to a short-term disability, simply requiring a short period of rest away from the office and the stresses of work, to a total and permanent disability.  One common condition causing such disability claims is carpal tunnel syndrome (CTS).  In today’s blog, I am going to walk through the information many doctors will look for and use in writing a report for your disability insurance company.  Even if you aren’t suffering from carpal tunnel syndrome, this article can be useful to show the steps an examiner follows when diagnosing your condition. 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

The Doctor’s Corner: 9 Tips for Dealing With Chronic Pain Syndrome

Our firm gets many questions from individuals experiencing all different kinds of issues with their disability insurance.  From questions about nuances between companies and policies to what could be considered to be appropriate care, we help with details of disability insurance everyday.  However, these aren’t the only issues facing our clients.  We know that our clients can better help themselves and return to work more successfully if they take care of themselves and follow some simple steps to help improve their recoveries.  In today’s blog, I am going to talk about a few simple techniques to help those suffering from some of the most common condition that reach out for our help: chronic pain syndrome. Continue reading