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If you are one of the estimated 12 percent of Americans who get migraine headaches at least occasionally, you know exactly how painful, debilitating, and frustrating they can be. Health experts, including those at the World Health Organization, have ranked migraine headaches as one of the most disabling medical conditions.

The statistics are grim. Most people (90% to be exact) living with migraine headaches say that they interfere with their daily activities, work, and social life. There are millions of Americans with chronic migraine headaches who are unable to work consistently and need to apply for long-term disability (LTD) benefits to help them meet their financial needs.

Unfortunately, like many people with “invisible injuries” and self-reported symptoms, chronic migraine sufferers often have a difficult time proving their disability to insurance companies that misunderstand or minimize the significance of their symptoms.

In this article, we will explain the basics of how migraine-related long-term disability claims work. Keep reading to learn more.

What Is a Migraine?

Migraines are recurrent headaches that often cause severe, debilitating symptoms, such as throbbing pain, nausea, and hypersensitivity to light and sound. While the good news is that most migraine sufferers only deal with a severe headache a few times per month to a few times per year, sufferers with chronic migraines experience headaches and other migraine symptoms for at least 15 days out of every month.

A migraine headache can involve up to four different stages:

1. Prodrome

Sometimes called the “preheadache” phase, the prodrome stage warns you that a migraine attack is developing. You may notice increased irritability, uncontrolled yawning, food cravings, sensitivity to light and sound, nausea, fatigue, and other symptoms during prodrome.

While not everyone experiences prodrome consistently, preventative measures during prodrome, like avoiding known triggers and taking medications, can reduce the severity of a migraine. The prodrome phase can last for a few hours to a few days.

2. Aura

Immediately before a migraine, many people experience dramatic symptoms, including visual disturbances. You may see dots, zigzags, and bright lights. You may also experience blurred vision during the aura phase of a migraine.

However, the aura phase can also involve more than just vision problems. You may also experience muscle weakness, numbness, and tingling. Aura symptoms can continue into the active headache phase.

For many migraine sufferers, the aura phase is a frightening and disabling experience. People sometimes confuse aura symptoms with a stroke.

3. Headache

The headache phase of a migraine may last for anywhere from a few hours to several days. Common symptoms include a sharp or throbbing headache, nausea, vomiting, sensitivity to light and sound, neck pain, nasal congestion, and dizziness. Pain is often more severe on one side of the head than the other.

4. Postdrome

Most people feel exhausted and sore during the postdrome phase, which is also called the post-headache or recovery phase. You may also have problems concentrating and processing information for a day or two.

Symptoms Can Vary

Again, not all migraines are the same, and not all people will experience all four stages during a typical migraine. Only an estimated 25% of migraine sufferers experience an aura, for example. Others deal with silent or acephalgic migraines where they experience all the symptoms of a migraine other than pain.

A migraine sufferer discussing disability options with a lawyer

Can I Get Long-Term Disability Benefits for Migraine Headaches?

It is possible, although not always easy, to get long-term disability benefits for migraine headaches—particularly chronic migraines. To win a long-term disability claim, you must prove that you will be unable to work full-time for an extended period (typically beyond 90-180 days, depending on your policy) under your policy’s definition of disability.

While some LTD plans define disability as an inability to perform your regular job (sometimes called “own occupation” disability), most use a broader definition of an inability to perform any occupation (called “any occupation” disability).

If your long-term disability plan uses the “any occupation” standard, you will have to show that your migraines and other conditions are so debilitating that they prevent you from working full-time at any job—not just the one you are currently performing. This is a much higher bar to clear.

However, even if you think your migraine headaches are severe enough to qualify for long-term disability benefits under your policy, that still does not guarantee that your insurance company will approve your claim.

The Biggest Challenge to Long-Term Disability Claims for Migraine Headaches: Medical Evidence

Insurance adjusters are often skeptical of medical conditions that cannot be easily explained or proven.

While migraine attacks can sometimes be linked to an identifiable cause, such as TMJ dysfunction or a brain tumor, most migraines are idiopathic—meaning the cause is unknown. Although migraine research is ongoing, and there is some evidence suggesting that genetics and environmental factors play a role, there probably are not any diagnostic studies or tests that can pinpoint the precise cause of your migraines, nor are there any brain scans that could conclusively prove that you even had one.

Due to the lack of “objective” tests, insurance companies will often try to minimize your symptoms and argue you are still capable of working, unless you back up your claim with substantial medical documentation.

Furthermore, many disability policies include provisions limiting benefits for migraine headaches and other “self-reported conditions” for a certain period of time. So, even if you are diagnosed with migraine headaches, and your insurance company approves your claim, your benefits may be cut off after 24 months regardless of whether you are able to work.

For these and other reasons, we highly recommend working with an experienced long-term disability attorney. They can help you understand your policy and gather the medical evidence you will need to build a comprehensive and detailed record that supports your claim.

What About Other Primary Headache Disorders?

Migraines are a kind of primary headache disorder, meaning that in most cases the cause is unknown, and it is not a secondary symptom of a separate underlying medical condition. Other examples of primary headache disorders include:

  • Cluster headaches. People with cluster headaches tend to experience brief, painful headaches that occur repeatedly over a “cluster” of a few weeks to a few months, then go into remission for a few months to a few years. Symptoms tend to be fairly like migraines in the headache phase.
  • Tension headaches. This is the most common type of headache, typically marked by steady, dull pain (as opposed to throbbing or pulsing), and usually lacking the nausea, light sensitivity, aura, and other secondary symptoms common to migraines. Everyone gets tension headaches every now and then, but some people with chronic headaches experience them almost every

Although these headache conditions may share many overlapping symptoms and can sometimes be confused for one another, they may require significantly different treatment methods and even medications to manage successfully.

If you struggle with chronic headaches of any sort, we strongly urge you to seek out a healthcare professional who can properly diagnose and help you manage your medical condition. This will not only help you improve your overall health, but will be beneficial for any disability claim you make as well.

People making long-term disability claims for other primary headache disorders typically face similar obstacles as those with migraines. In particular, cluster headaches can be challenging because they are by nature intermittent. During a cluster period you may be completely disabled and unable to work for weeks or months at a time, but during a remission period you have no head pain whatsoever.

Again, working with an experienced disability attorney can determine whether your condition is covered by either short-term disability or long-term disability, and help build your case.

Long-Term vs Short-Term Disability for Migraines

Because long-term disability policies typically have long “elimination periods” (often at least 180 days) before benefits kick in, you may need to file for short-term disability as well to fill in the gap in coverage. Many disability insurance plans are structured so that long-term disability kicks in as soon as short-term disability expires (often after 26 weeks, which is 180 days).

However, it is important to understand that just because your short-term disability claim was approved does not mean that your long-term disability claim will be. In most cases, short-term disability plans have more relaxed qualifications.

For example, your short-term policies will have an “own occupation” definition of disability, while your long-term policy will have an “any occupation” policy. If you find yourself in this common scenario and want your benefits to continue past the short-term window, you will need to ensure that your long-term disability claim meets this higher standard.

What About Social Security Disability Benefits for Migraine Headaches?

It is challenging, though not impossible, to get Social Security Disability Insurance (SSDI) for migraines.

Migraines are not listed as a qualifying disability by the Social Security Administration (SSA), so claimants will need to show evidence that their symptoms are severe enough to keep them from working for at least 12 months. The fact that migraine severity is determined by self-reported symptoms rather than diagnostic testing is a significant obstacle to approval, though this can sometimes be overcome with a well-prepared case and relevant statements from medical professionals.

It is highly recommended that you work with an attorney if you are considering applying for SSDI benefits. Please note that, while we sometimes handle SSDI cases for clients who are also making a long-term disability claim against private insurance, Bryant Legal Group does not handle standalone SSDI cases.

 

How Do I Prove the Severity of My Migraines and Build My Case?

Consistency is key to a migraine-related disability claim. While it is tempting to self-treat your migraines and try to ignore how severe your symptoms are, you will be much better off if you speak honestly with your doctors and take an active role in your treatment plan.

Get Medical Care for Your Migraines

At the peak of a migraine, you probably just want to curl up in a dark and quiet room and rest. Indeed, many people with regular migraines are accustomed to self-treating their symptoms, and may have never seen a doctor about their condition. So, booking an appointment with a healthcare provider now may seem like a lot of unnecessary hassle.

However, if you have not been to the doctor about your migraines yet, or if you are having a very severe migraine or exhibiting new symptoms, it is a good idea to consult a doctor as soon as possible. Moreover, if you want to have any shot at securing disability benefits, you will need to.

Your medical team may be able to alleviate your symptoms with medications and other treatments, and they will document the migraine diagnosis, symptoms, and treatments in their records. These medical records will become valuable evidence in an LTD claim.

In addition to seeing your primary care physician, you should also build relationships with specialists who treat headaches and chronic pain. These doctors could have insight into your condition and may be able to suggest innovative ways to control your symptoms. Visiting a specialist can also help strengthen your LTD claim since insurance adjusters tend to value opinions from a specialist more than those from a general physician.

Create a Migraine Journal or Diary

A migraine journal offers many benefits. For example, identifying your triggers can help you better control your migraines. However, a journal can also improve your long-term disability claim.

It is easy to ignore everyday migraine symptoms. When you create a diary, you may discover that your migraines are more frequent or disabling than you thought. For example, you may realize that it takes you days to fully recover from a migraine. You and your doctors can use this information to refine your treatment plan and adjust your work restrictions.

Your migraine diary can also help you complete your LTD application. During the application and claim process, insurance company representatives may ask you for details about your daily activities and the frequency of your migraine symptoms. Your diary can help you provide accurate answers that are backed by documentation.

Follow Your Doctor’s Recommendations

Many factors can contribute to a migraine, including stress, hormones, changes in the weather, caffeine, tobacco, and diet. If your doctor has suggested that you change your lifestyle, you should take this advice seriously.

This is doubly true when it comes to medication. If your doctor is recommending a specific medication protocol, you should follow it to the best of your abilities. Do not under or over-use your medications.

Insurance adjusters are constantly looking for reasons to question your credibility and deny your LTD claim. When you refuse to follow your doctors’ orders, the insurance company will almost certainly use it against you.

Consult an Experienced Disability Insurance Lawyer

At Bryant Legal Group, we know from experience how migraine symptoms, especially fatigue, nausea, and visual disturbances, can complicate the disability insurance claim process. It is easy to make mistakes and miss deadlines when you are battling a migraine.

If you are unable to work due to severe migraines, you do not have to navigate your long-term disability claim alone. A disability insurance lawyer can provide guidance and ensure you do not make errors that lead to a denial of benefits.

Also, stress is one of the top contributors to a migraine. When you work with one of our LTD lawyers, you get peace of mind, which might even help reduce the frequency of your headaches or ease symptoms.

Bryant Legal Group: We Understand Migraine Disability Claims

Our team of disability insurance lawyers at Bryant Legal Group has earned an outstanding reputation based on our attention to detail, practical strategies, and real-world results. Bryant Legal Group assists disability insurance claimants in Chicago and beyond with complex LTD claims to give them peace of mind and help them get the benefits they are entitled to.

To schedule your free consultation, contact us at 312-634-6160 or complete our online contact form.

Unlike some states, Illinois law requires that federal courts apply a de novo standard of review in long-term disability (LTD) claims if the coverage was issued or offered in Illinois. Judges can weigh all the evidence in your claim and do not have to defer to the insurance company’s past decisions. However, that doesn’t mean that your appeal will be easy.

If an insurance company has denied your long-term disability (LTD) benefits in Illinois, you need to understand how the courts will assess your legal and factual arguments. To learn the essentials, keep reading this article. To find out how these laws apply to your insurance claims, contact Bryant Legal Group.

What Is a Standard of Review?

Lawyers are obsessed with standards of review, but most clients don’t understand the concept. A standard of review can deeply impact your chances of winning your lawsuit. These standards set the rules of the game and determine how much flexibility and discretion a judge has when reviewing a case.

There are two possible standards of review in long-term disability claims.

  • De novo: The judge approaches the case with fresh eyes, and weighs all of the available evidence. De novo means “from the beginning” in Latin.
  • Abuse of discretion: The judge gives some deference to the insurance company’s decision and will only overturn a denial of benefits if the company’s decision violates the law, is irrational, or is completely unsupported by the evidence.

Insurance companies prefer the abuse of discretion standard since judges are more likely to uphold a denial of benefits. To make sure this lenient standard of review gets applied, most insurance companies insert special “discretionary clauses” into their plans.

RELATED: Zaccone v. Standard: Court Rules That De Novo Standard of Review Applies

Thankfully, while some states still permit these clauses, Illinois made discretionary clauses in insurance plans illegal in 2005. Federal courts upheld this law in 2015. Today, almost all insurance disputes in Illinois involve a de novo standard of review.

What Do Standards of Review Mean for My LTD Claim?

Today, thanks to the de novo standard of review, you have a better chance of winning your LTD appeal in Illinois than you did in the past. Judges in cases where the Illinois law applies now have broad powers to review long-term disability claims and can freely consider all of the evidence available to them. If the insurance company’s decision is inconsistent with the law or the evidence, the judge can grant your disability insurance benefits.

However, that doesn’t mean your long-term disability appeal will be successful. ERISA, the federal law that governs employer-sponsored benefits, may apply to your claim. This law sets strict limitations and procedures on employer-sponsored LTD claims. That’s why it’s in your best interest to consult an experienced LTD lawyer at Bryant Legal Group if you have an LTD claim in Illinois.

For decades, our team has helped people with disabilities get their disability insurance benefits. When you work with Bryant Legal Group, we will:

  • Explain in plain language the complex array of laws and regulations that impact LTD claims
  • Interpret your disability insurance plan documents and apply them to your situation
  • Collect evidence, including medical records and expert opinions, that can strengthen your legal claims
  • Help you navigate all the levels of the ERISA appeal process
  • Meet the tight filing deadlines and other procedures associated with an LTD claim

We take a client-centered approach, building strategies that focus on both your long-term and short-term goals.

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

 

Can I Submit New Evidence During a Long-Term Disability Lawsuit?

Even though Illinois adopted a more lenient standard of review, it doesn’t mean judges have access to all your information and documents. Instead, your ability to submit new evidence will depend on whether your appeal involves an ERISA or private disability plan.

  • Employer-sponsored (ERISA): Your only chance to submit evidence is during the insurance company appeal process. The judge will only consider evidence that was available to the insurer at that time.
  • Private: You can submit admissible evidence and information throughout the claim, as long as you follow Illinois’ rules of evidence.

If you’re unsure whether you have an ERISA or private LTD plan, it’s a good idea to consult an attorney. We can help you understand the exact procedures that apply to your long-term disability claim and then build a compelling record of evidence that clearly explains your situation and your eligibility for benefits.

Bryant Legal Group: Trusted Illinois Disability Insurance Lawyers

We were at the forefront of the fight for de novo review in LTD claims. Today, we continue to stand up to insurance companies using a sophisticated and practical approach to ERISA and private long-term disability insurance appeals. Bryant Legal Group is based in Chicago but serves all of Illinois.

To schedule a consultation with one of our experienced attorneys, either fill out our online contact form or call us at (312) 561-3010.