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Social Security Disability Benefits for Major Joint Dysfunction

Published on August 27, 2014 by

Social Security Disability Benefits for Major Joint Dysfunction

There are essentially two ways to get disability through Social Security: you can work to prove that your health issue prevents you from working at any job you’re qualified for in the country using the SSA’s “Five Step Sequential Evaluation Process”, or you can show that your condition meets or equals one of their Listings of Impairments.

What are the SSA’s Listing of Impairments? It’s the set of standards or medical criteria that the SSA has defined for an individual condition that will automatically qualify someone for disability if they can show that they meet them.

Of the two options, showing that you meet a disability listing is more straightforward but frequently it is a difficult standard to meet because it requires precise objective medical documentation. The SSA requires that anyone trying to qualify for disability benefits be out of work for 12 months (or at least be expected to be without a job for at least that long) regardless of their theory of disability.

Standards and Medical Criteria for Listing 1.02

To meet listing 1.02 – Major Dysfunction of a Joint, the SSA demands claimants to prove one of the following:

  • If the issue is in the lower half of your body, the condition must involve “one peripheral weight-bearing joint” (ankle, knee, hip, etc.) and make it difficult for you to walk and get around. It’s called “ineffective ambulation” and typically involves things like needing a walker or other assistive device, struggling to climb stairs, and being unable to walk for a block or more at a reasonable pace.
  • If the issue is in the upper half of your body, it has to involve “one peripheral joint in each upper extremity” (wrist, elbow, shoulder, etc.) and limit your ability to engage in gross or fine movements. These people tend to struggle with activities such as handling and sorting paper, performing personal hygiene tasks, and preparing meals.

What does the SSA need to see as objective proof? Positive findings on any of the following are helpful:

  1. X-ray
  2. Apley grinding test
  3. Arthrocentesis
  4. Arthrography
  5. Bone biopsy (needle)
  6. Bone scan
  7. Cross-body adduction test
  8. Drawer sign (anterior and posterior)
  9. Elbow extension test
  10. Facial bones (x-ray)
  11. Kellgren-Lawrence score
  12. Magnetic Resonance Imaging (MRI) of bone
  13. McMurray’s Test
  14. Musculoskeletal ultrasound
  15. Patrick’s Test (Fabere Test)
  16. Range of Motion (ROM) tests
  17. Thomas Test
  18. Erythrocyte Sedimentation Rate (ESR)
  19. White Blood Cell scan (WBC)

Keep in mind that it isn’t the end just because you don’t meet a specific disability listing. Many who don’t are still able to prove to the SSA that their issues prevent them from doing any other work using the Five Step Sequential Equalization mentioned earlier.

To learn more about what you can do to have your claim approved and start getting the benefits you need, contact a Social Security disability lawyer today. For even more information on Social Security Disability, download our free e-book and be sure to visit our blog weekly!

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Disability Laws: More Long Term Disability Provisions to Meet

Published on August 22, 2014 by

Last time, we talked about how just having long term disability insurance isn’t enough; your condition has to meet the requirements outlined in your specific policy. The provision we detailed in part one of this series is the definition of disability included in your paperwork. If you can’t meet your policy’s disability definition, you’re not going to qualify for benefits.

But that isn’t the only common provision out there, and today we’re going to delve into the elimination period, earnings caps, and other requirements.

Beyond the Definition of Disability – More Long Term Disability Provisions

Minimum time disabled or elimination periods. This is one of the most common requirements in addition to the disability definition. In order to qualify for benefits, many insurers put a clause in your policy that says you have to remain disabled for a certain amount of time (often 180 days) before your eligibility for long term benefits begins. It is vital that you pay attention to this provision, because in order to get the benefits you need, you’ll have to provide medical documentation proving that you were disabled for this amount of time. Additionally, you need to know the length of the elimination period because your insurer will not provide you with long term benefits until you reach the end of it.

Earnings caps. Another typical provision that can be both good and bad for those with long term disabilities is an earnings cap. An example of an earnings cap may state that you can continue to receive long term disability benefits if you work part-time, but only if the money you earn doesn’t exceed 60% of your previous earnings. It’s nice to be able to make some extra money, but go over that amount and you can lose your benefits.

Ongoing treatment. Certain policies demand that those getting benefits continue to receive regular treatment from doctors. If you stop getting medical help, your benefits stop coming.

Medical or administrative proof. It’s common that a long term disability claimant will need to prove their disability by showing medical documentation, but some policies are very specific in what they will accept – x-rays, blood tests, MRIs, and so on. There are even policies that require claimants to become approved for disability benefits by Social Security before the insurer will pay out.

As you can see, disability laws can be quite complex, and knowing all of these things ahead of time will save you head- and heartache. Next time we’ll continue with more common provisions by discussing policy limitations and appeals, but you can learn more now in our free eBook.

 

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ERISA Plans: How to Understand Your Long Term Disability Policy

Published on August 20, 2014 by

If you know that you have long term disability benefits as part of your insurance policy, you might think that getting those benefits is as simple as completing an application. Unfortunately, as part of an experienced long term disability law firm, I can tell you that is decidedly not the case.

There are specific terms that you have to meet in order to qualify, and those terms differ depending on the policy itself. However, there are a number of provisions that are typical to most long term disability policies. Today, we’re going to cover one of those provisions – meeting your insurer’s definition of disability.

You’ll Only Receive Long Term Disability if You Meet the Included Definition

If you look through your policy, you will see a definition for Disability or Total Disability. Frequently, these are broken into two parts – the first describing disability as an illness or injury that keeps you from doing your own occupation, and the second part saying that this same condition doesn’t allow you to work in any occupation. Generally speaking, the second part doesn’t really come into play until after 24 months. Someone suffering from the same ongoing disability that is preventing them from obtaining gainful employment should qualify for this second part, which is essentially just saying that you’re not able to work at all, regardless of the job.

Pay careful attention to the words used in this definition. Often your insurer will provide definitions for those, too, and you have to meet every part of the definition to qualify. Some common ones to watch out for include:

Own occupation. This refers to the job that you currently hold or held before your disability interfered. If you’re an accountant, you have to be able to show that your condition prevents you from doing that kind of work to meet the “own occupation” clause.

Any occupation. The word “any” tends to throw people off here, because it doesn’t literally mean that your disability keeps you from doing anything at all. Under most definitions, it means that you can’t do any job for which you have training and experience. A trained lawyer, for example, probably has experience that would allow them to work in a number of other fields, but a construction worker’s experience could limit them to physical labor.

Injury or illness. Many insurers refuse to pay disability if the injury you’re suffering from was self-inflicted or your illness involves drugs or alcohol. And these are only two of the most common conditions excluded. Look carefully at your policy to make sure your disability is covered.

Next time, we’ll talk about another provision you need to meet to quality for long term disability in ERISA plans – the elimination period.

If you’d like to learn more about long term disability in general, check out our free resources!

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Proving Neuropathy in a Long Term Disability Claim Under ERISA

Published on August 8, 2014 by

Almost 26 million children and adults in the US have Type 2 diabetes, according to the American Diabetes Association, and many of these people also suffer from peripheral neuropathy as a result of diabetes-related nerve damage. Neuropathy may become increasingly severe over time, causing pain, numbness, and weakness in the hands, feet, or other parts of the body, and eventually compromise an individual’s ability to work and complete normal daily activities.

If neuropathy makes it impossible for you to continue completing the normal functions of your job, you will likely need to apply for disability benefits and prove that this disability is legitimately preventing you from working. The following forms of documentation will help you prove your case and receive the benefits that you need to support yourself.

Medical records. The most obvious evidence you will need is your complete medical history, including a neurologist’s diagnosis of your peripheral neuropathy based on testing such as MRIs, a nerve biopsy, blood tests, nerve conduction tests, or a spinal tap.

Documentation of treatment. Presenting an initial diagnosis of your peripheral neuropathy is generally not enough in a long term disability case; you need to prove that you’ve continued the recommended course of treatment. If you cannot prove that you’ve received regular treatment from a neurologist or other medical provider, your claim may be denied.

Log of daily activities. In order to prove that you can no longer work in the capacity that you used to, you need to prove that your neuropathy hinders your completion of basic day-to-day activities. The most straightforward way to do this is tracking how long it takes you and what type of pain and other symptoms you experience while completing daily activities like showering, dressing, and performing household chores. If you write all this down in an activity log, you can use that log as evidence.

Written statement from neurologist.  To make your claim even stronger, you should have your neurologist write and sign a detailed statement explaining the symptoms you experience, how those symptoms are disabling you, and what he or she recommends for your course of treatment.

If you need more advice about how to file a long term disability claim, contact us and be sure check out our free eBook  for even more information!

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