Unfortunately, many people who file claims for long-term disability insurance benefits – LTD – because of multiple sclerosis (MS) have their claims denied by the insurance company.
MS is a complex, progressive condition, which by its nature may be difficult to document and establish consistent deficits in functionality, sometimes due to the waxing or waning of symptoms. Engaging an experienced LTD lawyer early on in the claims process can greatly enhance the chances of timely and seamless claim approval.
A lawyer can put pressure on the LTD insurer to review the medical evidence in light of the claimant’s symptoms and restrictions. They can compel the insurer to act more fairly, as tactics employed by long-term disability insurance companies to deny MS claims have been seen before.
Because symptoms of MS can come and go (wax and wane), and since many of the manifestations of MS are difficult to connect to consistent functional deficits, legal counsel can work with the patient’s treating physician to carefully create medical support within the record that thoroughly and accurately documents the disease and its affect on the claimant’s ability to work. This can be both from a cognitive and physical standpoint. No one test diagnoses MS (and nor is a diagnosis enough for a disability claim), and many of its symptoms are subjective, so it is crucially important that the claimant’s doctor carefully document his or her observations of symptoms and associated limitations caused by the disease.
The insurance company (or a third-party claim administrator hired by the insurer) is likely to deny a claim that is not thoroughly documented in the medical records. A carefully documented claim that sheds light on the nature of MS can help a claim examiner without much knowledge of the disease to understand what the claimant is actually facing. Thus, even if not well understood by the examiner, if well explained in the record, it can overcome that challenge.
What exactly is MS?
According to the Mayo Clinic, MS is a degenerative, incurable disease of the central nervous system in which the patient’s immune system wreaks havoc on the protective tissue that surrounds individual nerves. This intrusion interrupts the flow of communication circulating in the body through nerves, which can themselves sustain permanent damage.
MS manifests in different ways and in varying intensity. Some people have times of remission, while others experience ongoing, permanent and catastrophic disability such as inability to walk. Even if symptoms become relatively stable, the stress of work can negatively exacerbate the disease, so the job itself can cause the medical condition to worsen.
Symptoms may include:
- Severe fatigue
- Stiffness and numbness
- Depression and anxiety
- Bladder infections requiring frequent access to the bathroom and limiting travel
- Tremors and weakness
- Paralysis in varying degrees
- Vision problems, including blindness and eye pain
- Mobility problems
- Movement problems such as in the hands
- Speech impairments
- Cognitive impairment, including confusion, trouble concentrating and memory problems
- Compromised immune system
- And others
Keeping a diary or log that tracks in detail the claimant’s symptoms and how they limit functioning can provide important evidence for the insurance claim as well as documentation to assist treating and examining doctors in understanding the extent of the diagnosis, suggests the National Multiple Sclerosis Society. The Society also advises claimants to make lists of the “physical and cognitive demands of … [a] typical workday” so that the link between work requirements and the impact of symptoms on the ability to complete them is clearer.
Independent medical exams
The insurance company may have the right to send a claimant for an independent medical examination or IME. The claimant’s lawyer can negotiate with the insurer to get a neutral doctor who is an MS specialist for the IME, ideally one who is not on the insurance company’s payroll.
Legal guidance and advocacy
An attorney can get involved at any step of the way. Ideally, counsel could assist with the initial claim application, but disability attorneys are also brought in after denial on review or appeal within the insurance company or in a lawsuit. Sometimes MS claimants find themselves terminated from LTD benefits if their symptoms vary in intensity (which can be part of the disease’s presentation). A lawyer can also help fight wrongful benefit termination. Whatever the circumstances, do not hesitate to speak with an attorney as soon as possible, as there are likely tight deadlines for the various stages of a claim or lawsuit.