HIV, AIDS, and Disability Insurance: A Claimant’s Guide

If you’re one of the estimated 1.1 million people living with HIV and AIDS in the United States, you know that medical advances have significantly improved your treatment options and quality of life. However, even “manageable” HIV can seriously limit your ability to work and do the things you love.

At Bryant Legal Group, we help people living with AIDS and HIV apply for disability insurance benefits. In this article, we discuss the essentials of HIV-related claims and suggest some simple ways you can strengthen your application for benefits.

What Is the Difference Between HIV and AIDS?

Human immunodeficiency virus (HIV) attacks your CD4 cells (sometimes called T-cells), which limits your body’s ability to fight off infection. HIV is a complicated disease that has three main stages.

Stage 1: Acute HIV

Soon after you contract the virus, you may have flu-like symptoms. Because your viral loads are very high, you are highly contagious during the acute phase.

Stage 2: Dormant HIV

During this phase, you may not have significant symptoms since your viral load is relatively low and your CD4 cell levels are high. However, you still may experience severe fatigue, diarrhea, and other disabling symptoms. For some people, treatment can prolong Stage 2 for decades.

To monitor your HIV’s progression, your medical team will frequently test your CD4 and viral loads, assessing your body’s T-cell and HIV levels. If your CD4 levels drop and your HIV loads increase, it may be a sign that you’re entering Stage 3 of the disease.

Stage 3: Acquired immunodeficiency syndrome (AIDS)

As your viral loads increase and CD4 levels drop, your body struggles to fight off opportunistic illnesses like fungal infections, cancers, pneumonia, and tuberculosis. You may also experience HIV-associated dementia and wasting syndrome.

Today, people can live for years with AIDS thanks to improved treatments. However, AIDS is still a potentially disabling chronic condition that can produce severe symptoms.

Antiretroviral Therapy Can Slow HIV but Has Serious Side Effects

In 1996, a 20-year old with an HIV diagnosis had a 39-year life expectancy. By 2011, the average person who actively managed their HIV had a life expectancy of 70. We can thank antiretroviral therapy for this remarkable improvement. Many people with HIV can live long, happy lives if they receive a quick diagnosis and quick treatment. Some people with HIV can even reduce their viral loads to undetectable levels for years.

However, antiretroviral can still cause significant side effects, including:

  • Nausea and vomiting
  • Diarrhea
  • Fatigue and insomnia
  • Dizzy spells
  • Headache
  • Skin rashes
  • Dry mouth
  • Pain

If you’re struggling with serious medication side effects, you should immediately talk with your doctor. But some people with HIV find that even after they consult their doctor, they suffer from antiretroviral therapy side effects that are unavoidable and disabling.

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Can I Get Long-Term Disability for HIV or AIDS?

HIV and AIDS can be disabling. However, you’ll need to carefully evaluate your LTD policy and circumstances before you apply for benefits.

You’ll Need to Prove You Cannot Work

While you may be eligible for government benefits if you have specific opportunistic infections or a very low CD4 count, long-term and short-term disability insurance plans will only pay benefits if you’re unable to work. Depending on the language in your disability insurance plan, you’ll either need to convince an adjuster that you’re unable to perform your current job or that you can’t perform any full-time job.

To prove this, you’ll need strong evidence supporting your disability claim, including:

  • Medical records that document your diagnosis and the disease’s progression
  • Statements from your doctors about your ability to work
  • Opinions from vocational experts
  • Functional capacity assessments

Compiling all this information is a work-intensive and detailed process. Fortunately, when you work with an experienced disability lawyer, they should help you collect your evidence and may even consult with their own medical and vocational experts about your case.

RELATED: Own Occupation vs. Any Occupation Definitions of Disability

The Insurance Company Will Scrutinize Your Medical Records for Inconsistencies

Because HIV now has a reputation as a manageable chronic condition, insurance adjusters approach HIV-related LTD claims with skepticism. If anything in your medical records indicates that you’ve been noncompliant with treatment or that your condition is not as severe as you allege, you’ll struggle to receive benefits.

For example, insurance adjusters frequently take physician comments, like a doctor’s note that you’re “clinically stable,” out of context. However, you can be clinically stable and still have significant symptoms and limitations; stability just means your condition has not worsened. Nevertheless, the insurance adjuster may argue that because you’re “stable,” you are doing well and can work.

To give your disability claim the best chance of success, we suggest that you always:

  • Clearly and accurately report your symptoms and concerns at your medical appointments
  • Consistently take your medications
  • Follow up with your doctors and attend all scheduled appointments

While some of this advice may seem like common sense, people often minimize their own symptoms. For example, some HIV patients become so accustomed to chronic fatigue, diarrhea, or dizziness that they stop mentioning it to their doctors. However, the disability insurance company may use the fact that you didn’t mention these symptoms to argue that you no longer experience them at all.

Pre-Existing Condition Limitations Clauses May Apply to Your Claim

Most long-term disability insurance policies limit coverage for pre-existing conditions. While your plan’s limitations may vary, employer-sponsored LTD plans typically will reject your claim if you received treatment shortly before getting coverage and make a claim within 12 months of obtaining coverage.

However, most long-term disability policies do not include a blanket exclusion for pre-existing conditions. If you have worked for your employer for an extended time, it is likely that your LTD plan’s pre-existing condition clauses do not apply to your claim.

RELATED: Pre-Existing Conditions and LTD: 4 Things You Need to Know

Bryant Legal Group: Chicago’s Disability Insurance Team

At Bryant Legal Group, we focus on complex disability insurance claims and guide our clients through their applications for benefits and appeals. If you have questions about an HIV- or AIDS-related disability insurance claim, contact our office today. We’ll help you understand your legal options and treat you with the respect you deserve.

To schedule your consultation, either complete our online form or call us at (312) 561-3010.

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

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