What Are Functional Limitations? (And How Do They Affect a Disability Claim?)
When you make a long-term disability claim, it is not enough to say that you cannot work. You must prove it. That means you need to have documentation that identifies your medical diagnoses, your symptoms, and your functional limitations.
But what exactly is a functional limitation? When disability insurance lawyers evaluate your claim, they consider how your health conditions affect your ability to work and perform activities of daily living (ADLs). If these limitations prevent you from working, you might be disabled under your policy.
In this article, we explore functional limitations and their importance during a short-term or long-term disability insurance claim.
Functional Limitation: How a Medical Condition Impact a Person’s Life
You have functional limitations if your medical conditions reduce or eliminate your ability to do certain activities within a normal range of function. For example, if your degenerative disc disease or osteoarthritis makes it difficult to bend, twist, push, and pull, you have functional limitations.
And while we often focus on physical limitations, mental health conditions can also restrict your ADLs and work activities.
Doctors and vocational experts typically break functional limitations into several categories:
- Exertional: physical limitations that affect your ability to perform activities like walking, sitting, standing, bending, twisting, lifting, pushing, and pulling
- Non-Exertional: limitations that do not involve strength or physical effort. You can further break non-exertional limitations into sub-categories:
- Mental: difficulties involving memory, attention span, decision-making, interpersonal skills, stress tolerance, and other cognitive and emotional functions
- Postural: these include difficulties with prolonged sitting, stooping, and the need to elevate your legs or feet throughout the day
- Sensory: problems with your ability to see, hear, touch, smell, and feel
- Environmental: an inability to work or live in areas that expose you to heights, dangerous equipment, respiratory irritants (like dust or fumes), or extreme temperatures.
Typically, your doctor will recommend restrictions that address your functional limitations and help you avoid aggravating the condition.
Why Are Functional Limitations Important to My Disability Insurance Claim?
Simply having a medical diagnosis will not be sufficient to make you eligible for long-term disability benefits. You must meet your disability insurance policy’s definition of disability. Typically, you must show that:
- Your physical and psychological conditions make it impossible to do your existing job, or
- You cannot perform any full-time, competitive work, due to your injuries, illnesses, or chronic conditions
In short, the insurance company will never approve your disability claim unless you have significant functional limitations—and you can prove that they exist.
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How Do I Prove My Functional Limitations?
It is not enough to tell the insurance company that you cannot stand for long periods or struggle with short-term memory loss. Instead, you will need to provide medical evidence that documents and explains your limitations. This might include:
- Medical records from doctors and specialists
- Inpatient hospitalization records
- Diagnostic testing, like x-rays, MRIs, CT scans, and pulmonary function tests
- Assessments from physical and/or occupational therapists
- Functional capacity evaluations
- Testing by neuropsychologists and mental health providers
Your disability insurance attorney will help you compile all this evidence. They might also refer you to specialists who can evaluate your functional abilities and assess how your physical and mental health conditions affect your daily tasks and your ability to care for yourself.
Do Not Put off Your Health Care
When you are unable to work, it is sometimes tempting to postpone “routine” doctor’s appointments or self-medicate when a chronic illness flares up. However, while you might save on co-pays, you also might also seriously damage your disability case.
A consistent, detailed medical history will help you document the severity of your conditions, track the progression of your symptoms, and document each symptomatic flare. This evidence can be invaluable in the hands of a skilled disability lawyer—and can help counteract common insurance company tactics.
- RELATED: How Do You Prove You Are Disabled?
Residual Functional Capacity, Independent Medical Examinations, and Disability
During a disability insurance claim, you might encounter references to “residual functional capacity,” although the term is most commonly associated with Social Security cases. A residual functional capacity (RFC) assessment focused on what you can do physically and mentally, with your existing impairments.
Please note that Bryant Legal Group does not handle standalone Social Security disability claims. Our disability lawyers focus their practice on employer-sponsored and privately purchased disability insurance policies.
The insurance company might ask your doctor to complete a residual functional capacity form that outlines how long you can perform certain activities and movements, including:
- Lifting (both light and heavy objects)
- Reaching (including overhead reaching)
- Handling both small and large objects
- Performing repetitive activities
Then, based on your current abilities, a vocational expert will assess whether you can perform your most recent job or other types of work.
However, different doctors and vocational experts might arrive at dramatically different conclusions. Sometimes, the insurance company will schedule you for an “independent medical examination” or send your records to a “consulting physician” who will issue a report discussing your medical conditions, restrictions, and abilities.
Do not be surprised if the insurance company’s doctors and experts believe that you are capable of much more than your treating physician or your disability lawyer’s team of experts.
Chronic Pain, Self-Reported Limitations, and Functional Impairment
It is relatively easy to prove certain functional limitations. For example, if you have vision problems, testing can document how your reduced visual acuity limits your ability to do household and occupational tasks. The same might apply if you have neuropathy that decreases the function of your hands.
However, most serious health conditions have “softer” symptoms that can affect your ability to perform daily living activities. Fatigue, pain, depression, and anxiety are all very real. But there is not a simple test that unequivocally confirms your self-reported symptoms. This gives insurance company doctors a chance to question your credibility and imply that you are exaggerating the level of your impairment.
If your short-term or long-term disability case is denied because the insurance company overestimated your abilities, you should consult with an experienced disability lawyer right away. An attorney can help you clarify your limitations and refute the adjuster’s assessment of your case.
Bryant Legal Group: Fighting for People With Disabling Conditions
Bryant Legal Group’s disability insurance attorneys have decades of experience helping people with life-changing illnesses, injuries, and health conditions recover the benefits they deserve. Our team regularly works with experts, including physicians, occupational and physical therapists, and vocational consultants, who can help us explain the extent of your limitations and their effect on your life.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.
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