Many different medical and psychiatric conditions can serve as the basis for a short-term or long-term disability claim. One such group of conditions is known as blood clotting disorders. Let’s delve into the intricacies of clotting disorders and disability claims.

What Are Clotting Disorders?

A blood clot refers to a mass of coagulated blood that forms within a blood vessel. These clots can cause significant health concerns, including stroke, pulmonary emboli, loss of limb, and even death if not treated properly.

There are several different classifications of blood clotting disorders, the most prevalent of which are deep vein thrombosis (“DVT”), pulmonary embolism (“PE”), arterial thrombosis, and lymphedema. DVT refers to blood clots that form in deep veins, typically in the legs, pelvis, or arms. DVT can cause swelling and pain; and they can cause heart attack, stroke, or lung problems if the clot fragments break off and travel to another area of the body. Relatedly, PE is a specific type of DVT that travels to the lungs and results in lung damage, organ damage, or death. Arterial thrombosis refers to blood clots that form specifically within an artery. These can also cause organ damage. Lymphedema refers to the buildup of lymph fluid in tissues that causes swelling and aching.

Many individuals who experience those conditions have a medical tendency to form blood clots, also known as thrombophilia. That tendency can be inherited genetically or acquired. One such thrombophilia that can be acquired is known as antiphospholipid antibody syndrome (“APLS”), which refers to an autoimmune disease where the body produces antibodies against certain proteins in the blood, in turn leading to a greater likelihood of clotting. APLS is common in pregnant women. Other acquired risk factors include smoking, cancer, obesity, and autoimmune disorders.

On the other hand, inherited thrombophilia includes factor V Leiden, prothrombin gene mutation, and deficiencies in protein C, protein S, and ATIII. Factor V, the most commonly inherited thrombophilia, causes an abnormal coagulant protein that increases risk for clotting. Likewise, prothrombin gene mutation produces too much of a coagulant protein, whereas protein deficiencies cause a risk of clotting due to a lack of protein.

What Are the Typical Challenges for Claimants Seeking Disability Benefits for Clotting Disorders?

Claimants seeking disability insurance benefits for clotting disorders face both general and condition-specific challenges after filing a disability claim. More specifically, one of the most common issues arises where an insurer’s reviewing doctor opines that that claimant’s reported symptoms are not consistent with the information available in their treatment records. Since the aforementioned conditions can cause pain that could prevent an individual from working, it is important to objectively verify and document those symptoms to the fullest extent possible.

One issue that is more specific to clotting disorder-based disability claims involves the level of risk associated with an attempt to work through the condition. An individual with a clotting disorder is more prone to stroke, heart attack, and death. Thus, while the individual may otherwise be able to physically perform their occupation, they could still establish an entitlement to disability benefits simply due to the risk that working would pose in light of their condition.

How Can Individuals With Clotting Disorders Navigate the Claims Process?

As one can imagine, the claims process established by disability insurance companies can be quite confusing and overwhelming. Fortunately, the attorneys at DeBofsky Law possess years of experience applying for, managing, maintaining, and appealing denied disability benefit claims. In order to maximize your chances of getting your disability claim approved, it is critical that you consult with an attorney who has experience in this field. Hiring a disability attorney can often be the difference between whether your insurer approves or denies your claim.

What Legal Rights Are Available to Individuals With Clotting Disorders Whose Disability Claims Are Wrongfully Denied?

Most private disability benefit claims are governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). This law requires that disability claimants exhaust their administrative remedies prior to filing a lawsuit seeking payment of benefits. In practice, this means that if a disability insurer denies your initial claim, then you must appeal that denial to the insurer. Most disability policies require that you appeal at least once prior to filing suit.

Once you have exhausted your disability policy’s appeal process, you are entitled to file a lawsuit against your insurer requesting that the court award your disability benefits. However, the challenges you face do not end there. If your disability policy affords your insurer discretion in deciding entitlement to benefits, then your lawsuit will be subject to a heightened standard of review. This means that the court must afford deference to the insurer’s denial of benefits and overturn its denial only if it was unreasonable. And, even if you win your lawsuit, the court may remand your claim to your disability insurer. This means that the insurer gets to take a fresh look at your claim and once again decide whether to approve or deny it, as opposed to the court simply ordering the insurer to pay you the benefits you deserve.

In light of those obstacles, it is highly important to retain disability benefit attorneys who have successfully navigated the disability benefit appeals and judicial processes. The attorneys at DeBofsky Law are ready, willing, and able to guide you.

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