Disability insurance companies don’t always make it easy for policyholders who have osteoarthritis to get the disability benefits they deserve.
Severe pain associated with osteoarthritis is one of the most common reasons for filing a disability claim. Carriers are notorious for denying and terminating osteoarthritis claims because they just don’t understand them.
How Do Disability Carriers View Osteoarthritis Disability Claims?
Many claims are denied because the disability insurance company says:
(1) There is no objective basis of the diagnosis,
(2) There is no objective basis for the restrictions and limitations assigned by your physician because of your osteoarthritis,
(3) There is no causal relationship between your osteoarthritis diagnosis and/or restrictions and limitations, and your inability to do your own or any occupation.
The carrier has a laundry list of other reasons to deny your claim:
- Coverage is excluded because of the pre-existing condition clause in your disability policy.
- Benefits are limited under the subjective limitation clause. Osteoarthritic pain is disabling, but carriers routinely dispute the impact of your pain.
- You have had osteoarthritis for years and have not been disabled before now. You will have to overcome the carrier’s argument that you have been working with these problems for years and nothing has changed. It is crucial that your medical records develop the progression of your symptoms. After all, osteoarthritis is a chronic degenerative condition.
- The MRI, CT-Scan, EMG/NCT are normal or consistent with your age.
- Your symptoms are intermittent.
- Your pain is a subjective complaint, and your diagnostic studies don’t support the level of pain you say you have.
- You haven’t had a Functional Capacity Evaluation that documents the basis of the restrictions and limitations assigned by your physician.
- Your physician is relying on your subjective complaints, which aren’t supported by your medical records, the Activity of Daily Living forms you completed, what your employer has told us or the surveillance we have.
The surveillance shows that you can do more than you or your doctor say you can.
Nancy Cavey, who has 35 years experience handling disability cases, has successfully represented many policyholders with osteoarthritis. She overcomes a claims denial by working closely with you and your physician.
Nancy Cavey offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.
What Are The Disabling Symptoms of Osteoarthritis?
Osteoarthritis symptoms can include:
- Sore and stiff hips, knees and low back,
- Stiffness after resting that goes away after movement, and
- Pain that is worse after activity or toward the end of the day.
It’s not uncommon for osteoarthritis also to affect your neck, small finger joints and even your feet. The pain can be excruciating and unrelieved with medication.
How Do I Get The Disability Insurance Benefits I Deserve?
Osteoarthritis can interfere with your daily activities and with your ability to work. If you no longer can work or your doctor has told you to apply for disability benefits, you should take steps before you apply:
- Obtain a copy of your disability policy. See how it defines “disability,” “occupation” and “self-reported conditions.” You’ll need to understand what you have to prove and if there are limitations in your coverage.
Some policies consider pain without objective findings to be a subjective condition; benefits are limited to just two years. You need to know about any applicable policy limits before you apply for benefits.
- Obtain a copy of your medical records. Review them to see if there is an objective basis for your diagnosis, what your records say about your report of symptoms and your restrictions and limitations.
One of the most common reasons given for a claims denial is that there is “no objective evidence to support your subjective complaints of pain.’’
Often there just are no objective findings on x-rays, CT scans or MRIs to explain someone’s pain. Carriers make a leap of logic and conclude the policyholder either is exaggerating or faking their pain. Nancy, who has had spine surgery herself, knows what proof is necessary to meet the policy definition of disability.
- Obtain a copy of your personnel file to see if your osteoarthritic pain has affected your work performance.
- Obtain a copy of your job description. Create your own description of your physical duties with an explanation of how your symptoms impact your ability to do your occupation.
- Provide your doctor with the occupational description. Ask your doctor to prepare a report that explains the objective basis for your diagnosis, the objective basis of your restrictions and limitations, and the objective reasons you can’t perform some or all of the material and substantial duties of your occupation.
- Prepare a pain diary that explains your pain and any side effects of medication. Don’t forget to give examples of how your pain and symptoms interfere with your ability to do things on a daily basis. Your pain may give you problems with sleep or with concentration.
- Hire Nancy Cavey to help you file your initial application. The application process is confusing and designed so you and your physician make mistakes that can result in a delay or even a denial of your benefits. Ms. Cavey knows how to prepare and file a winning shock and awe disability application that leaves the carrier little reason to question your claim.
- Hire Nancy Cavey to help you appeal a wrongful denial or termination of your disability benefits. Disability carriers are in the business of collecting premiums and not paying disability benefits. They’ll use any reason to deny your osteoarthritis claim. The odds of getting your benefits on appeal are greater when you are represented by an experienced ERISA/private ID policy disability attorney.
Contact Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live
Osteoarthritis can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Nancy Cavey can review your policy and your medical records, and explain to you what your policy says and how to get your disability benefits. Call today for a free consultation at 727-894-3188.
