Do You Have A Case?

What is Long-Term Disability Insurance?

Long-term disability insurance covers you in the event that you suffer from an injury or debilitating condition that limits your ability to work. It is a form of insurance coverage that some businesses offer their employees. It is also something that an individual can seek out for themselves. If you are diagnosed with a debilitating condition, or suffered from a disabling injury, your long-term disability coverage may provide you with benefits. But first, you’ll have to prove that your condition is a disability. Your disability attorney will help you file your claim, and find the specific steps you need to meet the policy conditions. Below, we will discuss some of the more common aspects of a long-term disability claim.

Chiropractor showing spinal cord bones to aged man for orthopedic diagnosis and physical recovery. Chiropractic assistant with human skeleton explaining spine injury to older patient - long-term disability insurance claim concept

Does my Condition Qualify for Long-Term Disability Insurance?

Your insurance policy could cover a plethora of different conditions and injuries. However, it may not cover your specific condition. Your disability attorney will help you find out if you are covered for your condition. However, all hope may not be lost if not. While a specific condition may not be covered, your debilitating symptoms may be enough to get the claim approved. If your symptoms are severe and/or frequent enough, your attorney may be able to prove that you qualify for benefits.

How Do I Document my Disability for Insurance?

There are many ways that you can provide evidence to prove your disability. And the more evidence you provide, the stronger your case will be. There are different avenues for providing evidence, and not all of them may be necessary for your unique situation. Your disability attorney can help you plan out and collect the evidence required to create an objective narrative of your condition.

Diagnosis of your Condition

Having an official recorded diagnosis for your condition is a vital first step in building your case. You may need to undergo various tests or consultations with specialists to receive the proper diagnosis for your condition.

Documenting Symptoms with Your Doctor

Be sure to discuss with your doctors all of the symptoms you are experiencing, including emotional, cognitive, and physical symptoms. Your doctor will take note of these symptoms as part of your medical records. They may also refer you to specialists that can further assist you in caring for those symptoms.

A History Of Treatment for your Symptoms

Whether from your primary care physician or a specialist, it is important to show a history of ongoing care for your condition. In order to receive benefits, and continue receiving them after you are approved, you need to show a history of treatment for your symptoms. This can include doctor visits, physical therapy, psychiatry appointments, prescription medications, and more. Depending on your condition, you may need one or more of these.

Vocational Evidence for Your Disability Insurance Claim

Vocational evidence refers to a report from a vocational expert consultant in your field. The evaluator is brought in to evaluate the functions and duties of your job position. They then check to see if you have the capacity to effectively perform your duties in your current condition. This is often important to establishing a full narrative of the scope of your duties.

Obtaining Objective Medical Evidence for Your Long-Term Disability Insurance Claim

Generally, there are 3 ways of providing objective medical evidence. The first is a confirming diagnostic test. While not every condition has a test that can confirm the diagnosis, many do. Testing such as an MRI, blood test, or CT scan can be considered objective evidence.

Functional Capacity Evaluation

A Functional Capacity Evaluation is a test that helps provide objective evidence of your physical limitations. This can include mobility, hyper flexibility, chronic pain, fatigue, muscle strain, and more. Most attorneys will recommend that you take a 2-day FCE so that there is documentation of your fatigue. It can also show a decrease in productivity over the course of multiple days. Generally, the test is administered at a physical therapy facility, by specialists there. The FCE also has “validity testing” measures, which highlight whether the individual is putting out their maximum effort. This helps provide objectivity to the test and could invalidate an evaluation if the individual does not actively try.

Neuropsychological Evaluation

While the FCE quantifies your physical limitations, a Neuropsychological Evaluation can provide similar evidence for emotional and cognitive limitations. A Neuropsychological Evaluation is one of the most effective ways to prove the extent of your cognitive or psychological disability as a result of your injury or illness. Generally, the test is given by a trained psychologist or neuropsychologist. First, they use the data to help confirm symptoms of your cognitive impairments and make a diagnosis, if necessary. Then, they can quantify the deficits in different areas of cognitive functions. The report can help provide data on how these impairments could impact one’s ability to work. Like the FCE, Neuropsychological evaluations also use “validity testing” procedures.

Are My Pain Symptoms Disabling?

Everyone experiences and tolerates pain differently. There are many factors that can contribute to one’s pain tolerance. The 2 main types of pain are acute and chronic. Acute pain is usually sudden or severe. It often comes and goes, and is relatively short-term. Chronic pain is persistent and lasting. Because pain interferes with your focus, range of motion, and ability to perform some tasks, it could be a disabling symptom.

While pain can’t be objectively measured, there are ways to prove the credibility of the pain you experience. Document pain by talking with your doctor. You may want to seek out more objective evidence of your pain. For example, if you have severe back pain, an MRI may be able to show evidence of spinal stenosis. Keeping a journal of your pain can also be helpful in chronicling your pain. Additionally, be sure to seek out appropriate medical treatment for your pain.

Is My Fatigue Disabling?

Fatigue is more than being tired after a good workout. Fatigue is a feeling of extreme tiredness resulting from mental and/or physical exertion or illness. For some people living with a long-term illness or injury, chronic fatigue can be devastating. It can be hard to achieve even the simplest task on days when you lack the energy to get things done. For some, fatigue from an injury or illness can last weeks or months at a time. Much like pain, it can affect your cognitive ability as well. Mental exhaustion can limit your ability to focus on tasks.

Your chronic fatigue could be disabling if you can prove that it limits your ability to perform at work. Proving that you suffer from chronic fatigue starts with talking to your doctor and documenting your fatigue. Additionally, there are 2 tests you can take to help quantify your fatigue. First is the FCE as mentioned above. The second is a Cardiopulmonary Exercise Test (CPET). These tests help review your stamina, energy, and your ability to meet the physical demands of a professional environment, as well as daily life. Another way to document your fatigue is to keep a journal of our symptoms, including how much fatigue you are feeling. This can be a helpful record for both your doctors and your insurance company.

Are my Cognitive Impairments Disabling?

Cognitive impairments caused by injury, illness, pain, or fatigue can seriously affect your ability to do your job. Cognitive deficits can have a major impact on your job performance. Impairments to your processing speed, memory, and ability to focus can make your daily life much harder. If you are suffering from any cognitive impairments that are affecting your ability to perform work tasks, you may be able to file a long-term disability insurance claim.

A Neuropsychological Evaluation can be helpful in providing an assessment of your cognitive impairment. This type of testing can be a vital resource in building an insurance claim surrounding cognitive disabilities.

Additionally, you may want to seek out a Mental Status Examination. An MSE looks for severe signs of impairment. It assesses your mood, speech, behavior, thought processing, cognition, judgment, and more. However, because the MSE only catches severe symptoms, it may not catch all of your symptoms. Because of this, further testing may be required.

Do my Physical Limitations Count as a Disability?

An illness or injury could cause physical limitations which hinder your job performance. Physical changes to your vision can impair your ability to drive or read from a computer screen. A back injury can prevent you from sitting, standing, or walking. Changes to your hearing, such as tinnitus, can also impair your ability to work. Documenting the cause of your physical impairments or limitations start with a diagnosis from a doctor. Proper documentation and reporting of symptoms can also be important here as well. A few examples of physical limitations may include:

  • limited mobility
  • hyper flexibility
  • joint damage/arthritis
  • back pain/lumbar problems
  • spinal stenosis
  • vision loss/macular degeneration
  • hearing loss/tinnitus

In addition to documenting your physical limitations, you may need to show objective evidence of the limitations you face. This can include a Functional Capacity Evaluation. An FCE helps show the objective limits of your physical capabilities.

Mental Illness Limitations on Your Long-Term Disability Policy

When filing for long-term disability insurance for mental illness, it is important to check if your policy includes a Mental Illness Limitation. While policies may vary, it is common for a Mental Illness Limitation to limit your benefits to 2 years. However, some policies may have an even smaller limit.

If you are disabled solely due to your mental health condition, and no additional physical disability, your benefits may run out when you reach the Mental Illness Limitation. There are some exemptions to MIL’s, but they are generally reserved for specific conditions, such as bipolar disorder. However, if you can demonstrate objective proof of your cognitive limitations, such as with a neuropsychological evaluation, your benefits may extend past the limit.

Discuss with your disability attorney your options regarding your policy.

Can an Attorney Help Me Get My Long-Term Disability Insurance Claim?

If you are looking to file a long-term disability claim for your injury or health condition, you should seek out an experienced attorney. At D’Agostino & Associates, we help people living with disabling conditions file long-term disability claims. We help you through the process step by step to help you build a strong case. Our law team is here for you.

At D’Agostino & Associates, our team of lawyers can help you sort through all the details, understand what you are entitled to, and fight to get what you deserve. D’Agostino & Associates P.C. has offices in New York and New Jersey. Contact us, or call us at 1-888-245-2924 to schedule a free consultation with our attorneys.

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