Obtaining disability benefits from your insurer is an uphill battle regardless of your condition. However, it is especially difficult for individuals with rare medical conditions to be awarded long-term disability benefits. Therefore, it is important to consult with an experienced disability attorney to help guide you through this complex process.
Debofsky Law has invaluable experience with a wide array of rare and common medical conditions, including: long-COVID, Ehlers-Danlos Syndrome (EDS), chronic regional pain syndrome (CRPS), postural orthostatic tachycardia syndrome (POTS), trigeminal neuralgia, empty nose syndrome (ENS), amyotrophic lateral sclerosis (ALS), cystic fibrosis, and Huntington’s disease, among others.
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Why Insurers Deny Rare Disease Claims
Insurers deny disability claims for rare conditions for a number of reasons. One of the most common reasons is the insurer’s poor understanding of the condition itself. Insurers often fail to grasp the complexity of rare conditions inevitably leads to a denial of benefits. This often happens from the insurer hiring a medical consultant to assess the condition who is unfamiliar with the nature of the condition.
Another common tactic is the insurer’s belief that a claimant failed to provide objective evidence establishing the existence of or disabling symptoms of the condition. One court recently addressed this issue head on in Waldron v. Unum, a case out of the Western District of Washington. In Waldron v. Unum, the Western District of Washington emphasized that insurers cannot dismiss symptoms solely because they lack objective verification, especially if the policy doesn’t mandate such evidence..
Building a Winning Claim: Proving Limitations and Using the Right Documentation
Whether your disability claim for a rare condition is approved can hinge on having convincing documentation showing how it limits your inability to work. Therefore, it is incredibly important to clearly articulate your rare condition to your disability insurer to help them understand why exactly it prevents you from working. Your diagnosis of the condition alone is not enough to establish your entitlement to disability benefits. Instead, you need to demonstrate how your specific symptoms of that condition prevent you from performing the main duties required of your job. The evidence you can use to do so includes functional capacity evaluations, a detailed symptom diary, neuropsychological evaluations, and expert vocational opinions. Additional important tools you can use include peer review studies and medical journal articles addressing your rare condition. Each of these pieces of evidence can help show which symptoms of your rare condition prevent you from performing your job duties, and why.
Related Article: Clarifying Occupation in Disability Insurance: A Guide to Navigating Your ClaimERISA v. Individual Policies: Legal Strategy Divergence
It is important to acknowledge that rare conditions can be assessed differently depending on whether you are covered under a group disability insurance policy or an individual disability policy. Most individuals fall under the group policy coverage, which is commonly sponsored and administered by your employer. On the other hand, individual disability policies are purchased directly from an insurer to cover you personally. Professionals, such as doctors, lawyers, and C-level executives tend to buy these policies.
One key difference is that the individual disability polities are not subject to ERISA and its regulations. Therefore they are not subject to ERISA’s strict deadlines to appeal, limited claim record, or deferential standard in court.
Consequently, professionals with individual disability claims can generally reap the benefit of broader discovery and bad faith damages in court. They also benefit from a more favorable standard. Individual policies typically require showing only that you can’t perform your own occupation.
Why Debofsky Law is Different
DeBofsky Law’s offices in Chicago and Seattle handle both group and individual disability claims throughout all 50 states. We have also represented many clients who became disabled due to the rare conditions listed above. Our familiarity with rare conditions, combined with our collaborate approach with physicians and vocational experts, strengthens your claim for approval.
Your Rights, Your Timeline
If you are ready to appeal the wrongful denial or termination of your disability benefits, the time to reach out is now. DeBofsky Law can provide a free consultation to review your denial letter and formulate a tailored claim strategy to ensure that your appeal is successful and is submitted prior to ERISA’s 180-day deadline.
Frequently Asked Questions Related to Rare Conditions Claims
How do I get disability insurance benefits for a condition that doesn’t have a clear diagnostic test?
To secure disability benefits for conditions lacking definitive tests, focus on documenting how your symptoms impair your daily functioning and work capabilities. Maintain detailed symptom diaries, obtain evaluations from specialists familiar with your condition, and gather supportive medical literature. Consistent and credible documentation can substantiate your claim even in the absence of objective tests.
What steps should I take if my rare disease long-term disability (LTD) claim is denied?
If your rare disease LTD claim is denied, promptly consult a disability attorney experienced in handling such cases. They can assist in reviewing the denial letter, gathering additional evidence, and guiding you through the appeals process to strengthen your claim.
How do I prove disability when my condition lacks objective tests?
Demonstrate your disability by providing comprehensive documentation of your symptoms and their impact on your work. This includes detailed personal accounts, medical evaluations, and expert opinions. Such evidence can effectively convey the severity of your condition to insurers.
What evidence do insurers really need to approve a rare disease claim?
Insurers typically require consistent and credible evidence demonstrating how your condition impairs your ability to perform occupational duties. This may include medical evaluations, expert testimonies, and relevant medical literature. Providing thorough documentation can enhance the likelihood of claim approval.
How should I respond if my insurer states there’s no ‘objective proof’ of my rare disability?
If your insurer cites a lack of ‘objective proof,’ emphasize that not all conditions can be objectively measured. Highlight the consistency and credibility of your subjective reports, supported by expert opinions and medical literature, to substantiate your claim.
Is it worth hiring a lawyer if my disability benefits were denied for a rare disease?
Yes, hiring a lawyer experienced in disability claims can be highly beneficial. They can navigate the complexities of disability law, assist in gathering necessary evidence, and advocate effectively on your behalf to improve the chances of a successful appeal.
