COPD and Disability Insurance: A Claimant’s Guide

Jun 11, 2019 | Blog |

COPD can make even simple activities like walking to your mailbox difficult. While you may be painfully aware of how COPD and other breathing conditions impact your life, many people don’t realize how they impact long-term disability claims.

Below, the disability insurance lawyers at Bryant Legal Group discuss how COPD affects your body, how it’s diagnosed, and how you can strengthen your long-term disability claim.

How Do Lungs Work?

Your pulmonary system delivers oxygen to your body and removes carbon dioxide. While your lungs play a vital role in this process, they are only a part of your complex pulmonary system.

  • Trachea: Sometimes called your windpipe, your trachea is a tube that carries air in and out of your lungs.
  • Lungs: Like a pair of bellows, your lungs take in and expel air. They are also home to your bronchi, alveoli, and other pulmonary structures.
  • Bronchial tubes (bronchi): Located within your lungs, these branching, tube-like structures bring air from the trachea into your lungs.
  • Alveoli: Located at the ends of your bronchi, these tiny air sacs pass oxygen into your body and transfer carbon dioxide out of it.

Because all these parts are interconnected, a single issue or defect in any one of them can cause significant breathing problems. If these issues prevent you from working, you may be eligible for disability insurance benefits.

What Is COPD?

According to the Centers for Disease Control and Prevention, more than 15 million people in the U.S. have COPD, and it is our third leading cause of death. About 6.1% of Illinois residents have a COPD diagnosis, although many are still undiagnosed. Smoking is the most common cause of COPD, but air pollution, industrial chemicals, irritants, and genetics can also contribute to the condition.

You may also be surprised to learn that COPD isn’t a single disease. Instead, it’s a group of progressive lung diseases including:

Emphysema

Sometimes, your alveoli become damaged and don’t absorb oxygen as well. Damage to the alveoli can also cause your lungs to stretch out or overinflate, which traps oxygen in the lungs and causes shortness of breath.

Chronic Bronchitis

Your bronchial tubes can lose their tiny hair-like structures, called cilia, that help clear your lungs of mucus. As you try to cough up the mucus, it further irritates your lungs and causes swelling. All this irritation and mucus buildup can make it hard to breathe.

Refractory Asthma

Also called non-reversible asthma, this type of asthma doesn’t respond to most medications. During an asthma attack, your bronchial tubes tighten and swell, making it hard to breathe.

While each of these conditions is different, they are associated with breathlessness, shortness of breath, wheezing, and frequent coughing.

COPD can present differently in different people, and other medical conditions like heart disease and diabetes can cause complications. For this reason, it’s in your best interest to consistently meet with your doctor and follow their recommendations. If your doctor does not think you can effectively perform your job, you should also consult with an experienced long-term disability insurance lawyer.

While COPD is not curable, there are many ways you can improve your quality of life. For example, giving up smoking, taking certain medications, pulmonary rehabilitation, and oxygen therapy can help you control your symptoms and improve your quality of life. However, as your lung disease progresses, you may have a harder time performing your job.

How Do Doctors Diagnose COPD?

Like most medical conditions, doctors base a COPD diagnosis on a variety of factors, including your health history, reported symptoms, imaging studies, your response to certain medications, and pulmonary functions tests (PFTs). Your doctor will also try to exclude other diseases that are sometimes confused with COPD, such as reactive airway disease (asthma) and congestive heart failure.

Your doctor will also grade your COPD using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) system. This system considers your lung function and risk of flare-ups. Then it assigns an A, B, C, or D grade. Someone with a Group A grading has the fewest symptoms and the lowest risk of a flare-up, while Group D is the most severe.

The severity of your symptoms and the documentation supporting them will affect your eligibility for long-term disability benefits.

What Is a Pulmonary Function Test, and Why Are PFT Results So Important to My LTD Claim?

Pulmonary function tests (PFTs) assess how well your lungs operate. During a PFT, machines measure how much air your lungs can hold, how much oxygen you’re getting into your bloodstream, and your rate of airflow. Typically, you will participate in a series of lung function tests during an exam, including:

  • Spirometry: You will repeatedly breathe through a tube connected to sensors and a computer. This test estimates your lung size and measures airflow.
  • Lung volume: While you breathe through a tube, a machine evaluates how much air is in your lungs at each stage of your breathing cycle.
  • Methacholine challenge: You will incrementally inhale a methacholine vapor, which can trigger an attack in someone with asthma. The pulmonary therapist can reverse your symptoms with a dose of albuterol.
  • Exercise testing: You may walk or ride on a stationary bike while a pulmonary therapist evaluates your heart and lung function.

Based on these tests, your doctors and medical providers will assign a series of values that rate your lungs’ performance. However, other factors, such as your age, sex, race, and height, can also impact your PFT scores.

When you apply for long-term disability benefits, PFT scores can help strengthen your claim. For example, a PFT can show that your lungs are severely damaged and provide evidence related to your shortness of breath, fatigue, and other symptoms.

However, PFTs are not perfect, and the insurance company may still dispute the results of a seemingly valid pulmonary function test. For example, they may argue that you didn’t give a full effort or that the machine was improperly calibrated or outdated. In these cases, you may need to participate in another PFT or assessment.

RELATED ARTICLE: 5 Essential Questions You Should Ask a Disability Insurance Lawyer

Can I Get Disability Benefits for My COPD?

Every disability insurance claim is unique and deserves a personalized analysis from an experienced lawyer. Your eligibility for disability benefits will depend on the severity of your COPD, your response to medications, your occupation, whether you have other complicating health issues, and the terms and conditions of your disability insurance policy.

If your workplace is making your COPD worse or you can no longer adequately perform your job, it’s time to consult with your doctors and a disability lawyer. Together, you can make an educated decision about your ability to work and eligibility for disability benefits.

How Can I Strengthen My COPD Disability Claim?

The strength of your long-term disability claim will depend on a variety of factors. While you cannot control all of these factors, you can do a few things to improve the strength of your disability claim.

Follow Your Doctors’ Orders

Your doctor will probably prescribe medication and suggest lifestyle changes that may help control your COPD. While some of these recommendations may sound difficult, it’s in your best interest to follow them. If you ignore your doctors’ recommendations, the insurance company may try to use this against you and deny your disability claim.

Do Your Best to Stop Smoking

If you are a smoker, your doctor has certainly told you to stop. Smoking not only causes COPD, but makes it worse. You should talk to your doctor about support options like medication and counseling that can ease your transition.

Seek Treatment During a Flare-Up

Many COPD patients self-medicate during a flare-up. They may increase their medications, use an at-home nebulizer, or suffer in silence. However, when you don’t report a flare-up to your doctor, you’re losing an important opportunity to document your symptoms and refine your treatment plan. If you consistently self-treat at home, the disability insurance company may claim that your symptoms are less severe than they really are.

Work With Respected Specialists

While your primary care physician or family doctor is probably a great patient advocate and provider, it’s also in your best interest to consult with a lung or pulmonary specialist. These specialists can help refine your diagnosis; interpret your imaging studies, PFTs, and blood work; and provide a greater level of detail about your capacity to work.

Consult With an Experienced Disability Lawyer

It’s difficult to navigate a disability insurance claim alone. You’ll need to interpret the disability policy and plan documents, analyze your medical records, and negotiate with the insurance company—all while dealing with your COPD symptoms and treatment plan. When you retain a disability lawyer at Bryant Legal Group, we can help alleviate some of that responsibility so you can focus on your health.

RELATED ARTICLE: When Should I Speak With a Disability Insurance Lawyer?

Bryant Legal Group: Experienced Chicago Disability Lawyers

If you or a loved one has COPD, the team at Bryant Legal Group can help you understand your legal options and guide you through the disability claims and appeal processes. We assist clients throughout Illinois with their complex disability insurance claims, and we have built a reputation for our client-focused, practical approach.

To request a consultation, please complete our online form or call us at 312-561-3010. We’ll connect you with one of our experienced disability lawyers.

References

COPD among adults in Illinois (n.d.) National Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/copd/maps/docs/pdf/IL_COPDFactSheet.pdf

Pocket guide to COPD diagnosis, management, and prevention: A guide for health care professionals (2018). Global Initiative for Chronic Obstructive Lung Disease. Retrieved from https://goldcopd.org/wp-content/uploads/2018/02/WMS-GOLD-2018-Feb-Final-to-print-v2.pdf

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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