Insomnia can be more than just an occasional sleepless night—it can become a debilitating condition that interferes with your ability to work and live fully. When insomnia prevents you from performing your job, qualifying for disability benefits might seem like a solution, but the process can be challenging. Insurers often set high standards for evidence and use tactics to make approval difficult. This guide provides essential information on how to document your claim, navigate common insurance obstacles, and strengthen your case to increase your chances of success.
Table of Contents
What Is Insomnia?
Insomnia is a common sleep disorder that makes it hard to fall asleep, stay asleep, or get a good night’s sleep. It can also cause you to wake up too early and not be able to go back to sleep. These sleep problems persist even when your environment is ideal for rest and sleep.
Insomnia can be both short-term and long-term. Short-term insomnia may last from few days to several weeks. Causes of short-term insomnia can include stress, changes in your schedule or environmental factors. Most adults will experience short-term insomnia in their lifetime.
On the other hand, long-term insomnia (a.k.a. chronic insomnia) can last for multiple months or longer. It typically occurs three or more nights per week and isn’t fully explained by another health problem.
Insomnia can also be comorbid, meaning that it occurs alongside other conditions. These can include psychiatric disorders, type II diabetes, neurological diseases, chronic pain, restless leg syndrome, obstructive sleep apnea, and gastroesophageal reflux disease (“GERD”).
How Can Insomnia Qualify for Disability Insurance Benefits?
Insomnia symptoms, like extreme daytime sleepiness and difficulty focusing, can make it challenging to keep up with work demands. For example, an individual who suffers from extreme daytime sleepiness will be unable to concentrate or even stay awake during normal ‘9-5’ work hours. In addition, slowed cognitive function from insomnia can make it hard to perform essential mental tasks required in many jobs.
These impacts go beyond inconvenience – they can make consistent job performance nearly impossible.
Common Challenges Faced by Insomnia Disability Claimants
There are several tactics insurance companies may use that can make it difficult to approve your insomnia disability claim. For example, some private disability policies require that claimants provide ‘objective evidence’ of the disabling condition. This means that you will need to provide evidence that objectively confirms the limitations caused by your insomnia.
There are several forms of objective evidence within the context of insomnia. One such form is a polysomnography, more commonly known as a ‘sleep study.’ This testing performed while sleeping helps diagnose sleep disorders by recording brain waves, blood oxygen levels, and heart rate and breathing while sleeping. The test also measures eye and leg movement.
Another form of objective evidence is the Epworth Sleepiness Scale. This is a self-evaluation that assesses and scores the severity of your daytime sleepiness.
Relatedly, some disability policies limit the pay period for disabilities based on self-reported symptoms to 12 or 24 months. Thus, it is important to provide your insurer with objective evidence of insomnia to avoid this limitation of benefits.
Another tactic insurance companies use is to classify insomnia as a mental disorder. This is important, because virtually all private disability policies limit payment for mental illness to 12 or 24 months total. Therefore, you will need to make clear that your insomnia is not the result of depression, anxiety, or any other mental illness.
The Application Process: Strengthening Your Insomnia Disability Benefits Claim
Your insurer will require several things of you to provide along with your application for disability. The most important of those requirements is ‘proof of loss.’ This is evidence that establishes your inability to perform the material duties of your occupation.
In practice, proof of loss can take the form of your objective testing results (discussed above), treatment records, treating physician assessments and resulting work restrictions, and your explanation in your own words why your insomnia prevents you from performing your job. Your close relatives or friends can also prepare statements that document their observations of you regarding your insomnia. Essentially, you need to provide your insurer with documented evidence of your insomnia symptoms and their impact on your ability to work.
You will also need to demonstrate to your insurer that you have undergone and complied with appropriate treatment for insomnia. This includes regular visits to a sleep specialist or another qualified medical professional and trying various treatment measures or medications to manage your symptoms.
What Steps Should I Take if My Insomnia Disability Claim Is Denied?
You are entitled to at least one appeal of an insurer’s denial of your disability claim. It is important that you understand the strategies and compelling evidence to succeed on appeal. Your insurer should indicate in its denial letter what evidence you can provide to perfect your claim. You should therefore provide that evidence with your appeal submission.
You should also obtain any evidence that demonstrates why the insurer’s decision was wrong and why you are unable to work due to insomnia. This evidence can take the form of treating physicians’ statements, treatment records, objective testing measures, and your personal reports regarding why you cannot work through your insomnia symptoms.
Legal Considerations for Insomnia Disability Benefits Claims
The law governing most private group disability claims is the Employee Retirement Income Security Act of 1974 (“ERISA”). After exhausting your appeals to your disability insurer, you are entitled to file a lawsuit seeking benefits under ERISA.
DeBofsky Law recently won an appellate-level case that directly addressed this issue. In Scanlon v. LINA, the Court found that disability insurers must consider an individual’s sleep disorders and their impact on an that person’s ability to perform the cognitive duties of their job.
Key Takeaways and Next Steps
Securing disability benefits for insomnia can be a complex journey, but understanding the requirements and preparing your claim thoughtfully can improve your chances. Here are the key points to remember:
- Document Everything: Strong evidence, including sleep studies and physician statements, can make your claim more compelling.
- Anticipate Insurance Tactics: Insurers may limit benefits for self-reported symptoms or classify insomnia as a mental disorder. Prepare to address these challenges.
- Consider Legal Support: An ERISA disability lawyer can help you overcome claim denials, navigate appeals, and advocate for your rights.
If you’re ready to take the next step or need assistance with a denied claim, DeBofsky Law is here to support you. Contact us today for a free consultation and guidance on how to secure the benefits you deserve.
