Lupus and Disability Insurance: A Claimant’s Guide
An estimated 1.5 million people live with lupus in the United States, and roughly 16,000 more are diagnosed each year. If you’re living with this complicated disease, you know its challenges first-hand. Lupus is hard to diagnose and treat, and many people won’t understand how this “invisible” condition affects your life.
At Bryant Legal Group, we’re here to help. Our lawyers assist people living with lupus and other autoimmune disorders through their disability insurance claims.
In this article, we discuss the essentials of lupus-related claims and suggest some simple ways you can strengthen your application for benefits. (Please note that this article focuses on long-term disability (LTD) insurance and lupus, not Social Security disability insurance or SSI benefits.)
What Is Lupus?
Lupus is an autoimmune disorder. When you have lupus, your body’s immune system attacks healthy tissues. There are four types of lupus:
- Systemic lupus erythematosus (SLE): You experience inflammation throughout your body, which can affect your organs, joints, skin, and nervous system.
- Cutaneous lupus: Sometimes called “chronic cutaneous lupus” or “discoid lupus,” you only experience symptoms and inflammation in your skin tissues.
- Drug-induced lupus: Some medications can cause lupus, although in these cases, the disease typically resolves once you stop using the drug.
- Neonatal and childhood lupus: These conditions develop in utero or during childhood.
SLE is the most common form of lupus. When most people say “lupus,” they really mean systemic lupus erythematosus.
While women are more often diagnosed with lupus, the disease can affect anyone. Common symptoms associated with systemic lupus include:
- Extreme, chronic fatigue
- Fever with no identifiable cause
- Pain and swelling in your joints, hands, feet, and around the eyes
- Chest pain, especially when you breathe deeply
- Sensitivity to both natural and fluorescent light
- A red, butterfly-shaped rash on your cheeks and nose
- Raynaud’s disease, which can cause your fingers and toes to feel numb and turn white or blue
- Mouth ulcers or sores
- Unexplained weight loss or sudden weight gain
Over time, lupus can also damage your organs, cause inflammatory arthritis, and contribute to depression and anxiety.
Lupus symptoms tend to wax and wane. During a flare, you may experience very dramatic inflammation, fatigue, and other symptoms. When the disease is in remission, you may be relatively asymptomatic. You may even be able to perform your daily activities without any difficulty.
How Is Lupus Diagnosed and Treated?
Because lupus shares symptoms with many other conditions, it usually takes a long time to diagnose the disease. There is no single test that conclusively diagnoses lupus. Instead, you’ll probably undergo many blood tests, x-rays, and even biopsies. It can be an incredibly frustrating process.
There is no known cure for lupus, but there are many ways you can manage your condition. Depending on your unique symptoms, your doctors may prescribe various medications, like steroids, anti-malarial drugs like Plaquenil, and immune-suppressing drugs. Many doctors also recommend lifestyle changes such as quitting smoking, following a healthy diet, and getting regular exercise.
Long-Term Disability Benefits for Lupus
Like any chronic condition, lupus can be disabling. However, you’ll need to carefully evaluate your LTD policy and circumstances before you apply for benefits. Because lupus symptoms vary from person to person, it’s a good idea to have a well-prepared application for benefits. Otherwise, you may face significant delays and difficulties in your long-term disability claim.
Identify Your Insurance Policy’s Disability Definition
Long-term and short-term disability plans will only pay benefits if you’re unable to work. Before you apply for disability benefits, you should carefully read your Plan Document or Summary Plan Description and identify your policy’s definition of disability. You may have an “own occupation” plan that will pay disability insurance benefits if you’re unable to do your current job. Alternatively, you may have an “any occupation” policy that only pays LTD benefits if you’re unable to perform any type of work.
Most long-term disability policies use an “any occupation” definition of disability, which makes disability harder to prove. However, if you a private disability insurance policy, you may have selected the more lenient “own occupation” standard. If you need help understanding your plan’s terms and conditions, contact an experienced disability insurance lawyer for help.
Watch Out for Limitations on “Self-Reported” Conditions
Most long-term disability insurance policies limit coverage for “self-reported condition” that cannot be substantiated by a diagnostic test. If your condition falls within this limitation, the insurance company may only pay your benefits for a limited period, often two years.
Unfortunately, many lupus symptoms, like fatigue, chronic pain, depression, and concentration difficulties, are “self-reported.” There is no MRI, CT scan, or blood test that can detect these symptoms and prove they are real.
To fight back against insurance company tactics, your long-term disability lawyer may consult with experts and specialists who can link your symptoms to your lupus diagnosis and other related health conditions.
Get Consistent Medical Care for Your Lupus
You’ll need clear and consistent medical records as well as strong testimony from your doctors and other experts to win your disability insurance claim. Our disability insurance lawyers always suggest that you follow up with your doctors during a flare and clearly explain your symptoms. This way, you’ll have an accurate record of your disease’s progression and the frequency of your flares.
Unfortunately, many people with lupus become so used to their chronic fatigue, joint pain, and inflammation that they stop mentioning it to their doctors. When this happens, the disability insurance company may argue that because your medical records do not consistently document your ongoing issues, you no longer experience these symptoms.
You may also want to keep a disability journal that tracks your daily activities, symptoms associated with your medical conditions, and side effects from your treatment.
Don’t Forget to Mention Medication Side Effects
Many lupus medications cause severe side effects, including an increased risk of infection, headaches, nausea, and blurred vision. When the insurance company evaluates your application for benefits, it should consider how these negative side effects limit your ability to work.
However, it’s also a good idea to report these issues to your medical team. Your doctors can help document your side effects and may be able to identify other treatment options.
Bryant Legal Group: Chicago’s Lupus Disability Lawyers
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 lupus or another autoimmune-related disability insurance claim, contact our office today. We’ll help you understand your legal options and treat you with the respect you deserve.
Lupus facts and statistics. (2016, October 6). Lupus Foundation of America. Retrieved from https://www.lupus.org/resources/lupus-facts-and-statistics
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.