What Knee Problems Qualify for Disability?
Navigating life with knee pain can present many challenges. Your previously simple day-to-day tasks may now be major obstacles.
Whether it is consistent discomfort or a complete inability to perform common tasks like driving and walking, your knee injury or chronic knee pain may qualify you for short-term disability or long-term disability. But when does a knee problem quality for disability? How do you file a claim for disability benefits? Are there ways you can strengthen or streamline your disability claim?
If you are feeling lost or overwhelmed, Bryant Legal Group’s disability insurance attorneys can help. Our Chicago-based team works with claimants to answer these kinds of questions, explain their policies, and fight for the benefits they deserve.
In this post, we will take a closer look at some common knee issues and how knee-related disability insurance claims work. Then, we will outline some important tips to increase the likelihood of a successful claim.
What Knee Injuries and Conditions Are Disabling?
Knees are complicated structures, and they are a common source of pain. According to recent studies, at least 25% of adults report chronic knee pain, and these numbers are steadily increasing.
While there is plenty of nuance surrounding each of these cases, below are some of the more common disability-qualifying knee issues.
Long-Term Knee Conditions
While these conditions often result in chronic pain and require extended treatment and time off work, you may still qualify for short-term disability in the early stages of your disability claim.
- Osteoarthritis: A common condition among older people and highly active individuals affecting the joints, and very often, the knees. It occurs when the cartilage in the joint is worn down, causing pain, swelling, bone spurs and other issues.
- Rheumatoid arthritis: An autoimmune, inflammatory condition that can affect all joints, including the knee. This leads to stiffness in the joint that can reduce mobility and cause pain.
- Tendinitis: Chronic inflammation within the tendons of your knee. Tendinitis gets worse with time over consistent use of the knee.
- Gout: A form of inflammatory arthritis that occurs when there is a buildup of uric acid in the joint. Gout is often very painful and can lead to stiffness in the affected joint.
Short-Term Knee Injuries and Conditions
- Torn meniscus: A tear in the c-shaped cartilage of the knee (meniscus) that can cause pain and swelling, especially when standing or placing weight on the knee. Meniscus tears are often treated conservatively and may take 6-8 weeks (about 2 months) to heal. However, surgery to repair or trim the meniscus is sometimes necessary.
- Chondromalacia: Sometimes called “runner’s knees,” this condition occurs when the cartilage on your kneecap softens or deteriorates. Sometimes chondromalacia will fully resolve with treatment and rest, while others experience knee pain and grinding for years.
- Bursitis: Bursae are fluid-filled sacs that cushion the knee and other joints. When a bursa becomes inflamed, it can cause pain and limit your mobility. With rest and treatment, it often resolves within a few months.
- ACL and MCL tears: Ligament tears in the knee can destabilize your knee, causing extreme pain, discomfort, and a lack of mobility. An MCL (medial collateral ligament) tear takes approximately 8 weeks to heal, while an ACL (anterior cruciate ligament) tear is more critical, taking 6-9 months to heal.
Most knee replacement surgeries are due to knee osteoarthritis. They are often a treatment of last resort, and are used after less invasive care, such as physical therapy and medication, are unsuccessful.
During your knee surgery, doctors will remove damaged bone and cartilage, replacing them with an implant or artificial knee joint. If only one compartment of your knee is damaged, the doctors might suggest a partial knee replacement. However, if you have widespread degenerative changes, you will likely need a total knee replacement.
After either a total or partial knee replacement, you will have to limit your activity for at least a few months. While many knee replacements are successful, not everyone experiences a full recovery—and there is always a risk of complications. If you and your doctors believe that you cannot work after knee replacement surgery, you might qualify for disability benefits.
Do I Qualify for Knee-Related Disability Benefits?
1: Consult With Your Doctors
Before filing a long-term disability claim, you should first receive a medical diagnosis from your doctor. Having accurate medical documentation is essential to your case, and the insurance company will not approve your claim solely based on self-reported symptoms.
Ideally, your doctors would base their diagnosis and treatment plan on imaging studies, like MRIs and CT scans, which identify objective findings that are causing your knee pain and dysfunction.
2: Speak With a Disability Insurance Lawyer
Before you file a disability claim, you should consult with an experienced long-term disability attorney. A lawyer can help you translate your policy’s terms and conditions into plain language, evaluate the strength of your claim, and help you collect all the evidence you will need to prove your claim.
And unlike the insurance adjuster, who is protecting the company’s bottom line, a disability lawyer is on your side. Your attorney can give you practical advice and will help you try to maximize your claim. Most disability attorneys, including those at Bryant Legal Group, offer free consultations, and everything you discuss will be confidential. To schedule a free consultation, contact our office today.
3: Review Your Policy or Plan’s Terms and Conditions
Once you have a medical diagnosis, you can assess your eligibility for short-term disability or long-term disability benefits. To do this, you will need to carefully review your insurance policy’s terms and conditions. However, it can be difficult to translate all the fine print.
Unlike Social Security disability benefits, which are a government program, short-term disability and long-term policies are sold and managed by for-profit companies. Their terms and conditions can vary from policy to policy. As you read your plan or policy documents, you need to look out for several things.
First, most insurance policies define disability in one of two ways:
- Own occupation: You cannot perform your regular job due to your knee pain and other health conditions.
- Any occupation: Your knee pain and other conditions make it impossible to do any type of work.
To receive monthly benefits, you will need to convince the insurance company that you meet your policy’s disability definition. Many short-term disability policies use the more lenient “own occupation” definition, while most LTD policies take the more rigorous “any occupation” approach.
Second, look out for elimination or waiting periods. You cannot receive short-term or long-term disability benefits until the elimination period expires. For short-term disability insurance policies, the elimination period might be as short as a few weeks. For LTD policies, you often must wait a year before you can receive benefits.
Finally, make sure you review your policy’s exclusions and limitations.
4. File a Disability Claim With Your Insurance Company
If your lawyer believes that your joint pain qualifies for disability insurance benefits, they will help you file a claim with your insurer. This process involves collecting medical evidence, submitting paperwork to the insurance adjuster, and negotiating on your behalf.
If the insurance company approves your claim, you should receive monthly benefit payments. If it denies your claim, you should consult with your lawyer about an appeal.
Looking for Personalized Advice From an Insurance Lawyer?
How to Strengthen Your Disability Claim
While we will always advocate for hiring a lawyer early on in your claim, there are several additional ways to strengthen your case.
Listen to Your Doctor
As mentioned previously, your doctor will be a key resource. Following a medical professional’s guidance and recommendations or seeing a physical therapist can significantly boost your chances of securing disability.
Consider a Functional Capacity Evaluation
While not always necessary, a functional capacity evaluation can be a strong tool in your claim. These evaluations determine your abilities over a series of tests and can be a strong way to convince your insurance company of the strength of your disability claim. FCEs are not a solid option in every case, however, as a negative result could harm your case.
Start a Disability Journal
While it may seem simple, maintaining an honest, detailed log of your knee symptoms, experiences, and other issues can go a long way. Your disability journal can help you understand which activities of daily living worsen your joint pain and how frequently you experience debilitating pain.
Does My Occupation Affect My Disability Claim?
A common misconception is that only those working physical jobs qualify for disability insurance. The fact is that if your knee prevents you from comfortably standing, moving around, or even sitting for extended periods of time, you might qualify for disability insurance benefits.
And if you have an “own occupation policy,” you might have even more options. If you can do lighter work but cannot do your most recent job, you might still qualify for benefits. Surgeons or dentists, for instance, might be able to qualify if their knee(s) prevented them from staying on their feet, even though they could still work at a desk.
While policies vary, if your business offers short-term or long-term disability insurance and you suffer from a medically diagnosed knee condition or injury that limits your ability to work, a claim may still be possible.
Bryant Legal Group: Helping Disabled Workers Get the Benefits They Deserve
If you are considering filing an application for disability insurance benefits, it is a good idea to consult with an experienced long-term disability lawyer early on.
Bryant Legal Group has guided countless disabled individuals through their insurance claims and has a reputation for exceptional service and sophisticated strategies. You can reach us by calling 312-561-3010 or completing this brief online form.
It is important to note that disability insurance, such as a policy provided by your employer, differs from Social Security Disability Insurance (SSDI). Bryant Legal Group focuses on disability insurance and does not handle standalone Social Security disability benefits claims.
Our Recent Articles
How to Appeal a Unum Disability Denial
Disability Insurance for Small Business Owners: A Quick Primer on Coverage Options and Claims
Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011 Dec 6;155(11):725-32. doi: 10.7326/0003-4819-155-11-201112060-00004. PMID: 22147711; PMCID: PMC3408027.