Spondylitis & Long-term Disability Insurance

By Sarah Demers
Associate Attorney, Kantor & Kantor, LLP

              Long-term disability (“LTD”) insurance is a common employment benefit many employees do not even realize they have until they suffer from a disabling condition that impacts their ability to work. One in four adults in the U.S. has a disability that impacts their ability to perform normal daily activities.[1] People with chronic or progressive illnesses, like spondylitis, may have a difficult time successfully applying for LTD benefits. Here are some tips on making a claim for long-term disability benefits to help with the process.

• • Make sure you read your policy. Your policy contains the rules of making an LTD claim. It is helpful to review your policy while you are still able to work to understand when you would qualify to receive LTD benefits. The policy will define the term “disability”, tell you how to make a claim, and what to submit with your claim. You should carefully read any policy provisions having to do with limitations or exclusions on your coverage. There may be limitations on how long the insurer will pay benefits for disabling conditions based upon self-reported symptoms like pain and fatigue. Knowing about these limitations before you make a claim will put you in a better position to avoid them if possible.

• • Speak to your treating doctor. It is important to have an ongoing discussion with your doctor about your symptoms and how they impact your life at work and home. Make sure your doctor is recording this information in your medical records so when your insurer reads them, your symptoms and their impact on your life will be documented. Follow up on any suggestions for specialists to see and treatments to try so your doctor can confidently say you have complied with treatment and are not capable of working.Being on disability requires having a doctor who is an advocate for you. She will need to fill out forms describing your symptoms, their frequency and severity, and how they impact your ability to work. Ask your doctor whether she will be willing to offer this type of ongoing support if you become disabled. It is better to know you have a doctor who will not fill out forms from the insurance company before you make a claim rather than afterwards.

• • Contact your insurance company. If you are no longer able to work due to your symptoms, you should contact your disability insurance company and ask to make a claim. There insurer will send forms for you and your treating doctor to fill out. Don’t feel limited to the information requested on the forms or the space available on the forms to describe your situation. You should submit any and all information you think is helpful to understand your condition – articles about spondylitis, a symptom diary[2], a letter from your partner describing your activity limitations around the house, a write-up from work because you were late or absent too many times due to your condition. You can attach extra sheets to continue your answers if you run out of space on the form.It is important to know that it is your burden to prove that you are disabled. You need to explain to the insurance company what specific job duties you are unable to do and why. It’s not enough to describe your symptoms or give your diagnosis – you need to explain the frequency and severity of your symptoms and what they prevent you from doing.
    
    Bad Example: “I have fatigue.”
    
    Better Example: “Because of frequent fatigue, I am often absent from or late to work.”
    
    Best Example: “I have fatigue every day which impacts my ability to attend work. I have been late to work 7 of the last 30 days, and I have been unable to attend work 3 of the last 30 days because I did not have enough energy to leave my house. I am attaching timekeeping records from work to show my poor attendance, as well as a written reprimand I received for absenteeism.”
    
    With a chronic or progressive illness, if you have been working with the illness for some time, the insurance company will want to know why you are disabled now. The insurance company will need an answer as to why you were able to work last week, but you cannot work this week. Chances are you were not diagnosed with spondylitis, and then applied for disability the next day – people often work for years with spondylitis until they are unable to do so. This is another reason to see your doctor regularly and discuss your symptoms so you can document in your medical records if you are getting worse in severity or frequency.

• • If your claim is denied, contact an attorney as soon as possible to help you appeal the denial. There are short time limits on when an appeal can be submitted, and you must appeal the decision to protect your right to pursue these benefits in court.

About Sarah Demers

Sarah Demers, associate attorney, graduated from the University of St. Thomas School of Law. Since graduating, Sarah has devoted her law practice to representing employees in disputes with employers and insurers over employee benefits. She has fought beside employees to obtain health insurance, life insurance, disability, and retirement benefits. She has represented classes of employees against plan fiduciaries who have breached the duties of loyalty and prudence they owe to employees and plan beneficiaries. Sarah currently focuses her practice on health insurance benefits including wrongfully denied medical and surgical benefits and violations of federal and state mental health parity laws.

[1] Per the CDC.

[2] This can be a simple handwritten diary to track things like: what symptoms you experienced on a particular day, how severe the symptoms were, what activity you were unable to do, how much you slept, what medications you needed to take, or what coping strategies you needed to employ.