You may have purchased a disability policy through your employer or are covered under an employer-sponsored disability plan and never thought you would have to file a claim for your disability benefits for mast cell disease. You probably never even heard of mast cell disease when you got your disability coverage.
If you have been diagnosed with mast cell disease you may be entitled to disability benefits if you meet the policy or plan definition of disability. There is no uniform definition of disability, and each policy or plan is different. How does your policy or plan define disability and occupation? What is a disability carrier or plan looking for in deciding to pay or deny your claim?
What is Mast Cell Disease in ERISA Claims?
The term “mast cell disease” is a broad term used for the many allergy-like symptoms caused by the abnormal stimulation of mast cells.
Let’s talk about the biology of mast cells.
Mast cells are found in loose connective tissue throughout your body. They are immune cells that activate an inflammatory response that protects us from pathogens and foreign substances.
When triggered, mast cells cause allergy like symptoms that release mediators. Mast cells help maintain the equilibrium of the immune system. Unfortunately, when mast cells don’t function properly or are abnormally stimulated to release mediators the immune system goes out of sync.
The result can be frequent episodes of allergic reaction which can vary in intensity and length and severe anaphylactic reactions.
Mast cell disease can impact a number of organs, including.
- Lungs,
- Heart,
- Kidney,
- Gastrointestinal tract,
- Brain,
- Spleen,
- Bone marrow,
- Liver,
- Bladder,
- Lymph nodes and even the
- Skin.
The Definition of Disability and Occupation In Your Policy or Plan
You must prove that you are disabled, as that term is defined in the policy or plan. You generally have to prove that you can’t perform your own occupation due to an illness or medical condition caused by mast cell disease.
The definition of occupation can vary. You may have to prove that you can’t perform your occupation as you perform it for your employer, how it is performed in the local economy, the national economy or pursuant to the Dictionary of Occupational Titles.
Generally, after two years the definition of disability changes from an inability to do your own occupation to an inability to do any occupation. Mast cell disease disability claims are often denied when the definition of disability changes because the carrier or plan takes the position that you can do sedentary work.
What Symptoms Are a Disability Carrier or Plan Looking for In Your Medical Records
Because mast cell disease is caused by many different triggers and impact different body systems, the disability carrier or plan will closely review your records for a history of what triggers your symptoms, what symptoms you have, how long they last, your respond to treatment and how those symptoms impact your ability to do your own or any occupation.
I think the best way to document this information is with a log or spreadsheet that you can give to your physician at each visit to be made part of your medical chart.. Be sure to keep a copy for your records.
What is also key is to document the nature of any “remissions” and the problems you might have during these “remissions.”
This is crucial because the disability carrier or plan will seize these periods when you have no allergy symptoms or minimal symptoms as evidence that you are not disabled and can work.
They may also argue that if you avoid triggers you wouldn’t be disabled.
Unfortunately, disability carriers or plans treat everyone with mast cell disease the same. They don’t understand triggers or the different types of mast cell disease. Worse yet, they don’t get mast cell disease symptoms which is problematic since the severity of the symptoms and impact on functionality vary from person to person. That is why we think a thorough and detailed medical history and symptom log are key.
ERISA Disability Insurance Claim and Mast Cell Disease
It’s safe to assume that most disability insurance carriers and plans don’t understand the diagnosis, symptoms, and how mast cell disease symptoms impact a person’s ability to perform their own occupation or any occupation.
It is crucial that you have your policy or plan and medical records reviewed by an experienced mast cell ERISA disability attorney, before you stop work and apply for benefits, so you know what you need to prove to win and keep your benefits.
If the disability carrier or plan is making noise about your medical records, suggesting that your mast cell disease is psychologically based or that your disability benefits are limited, it’s time to call Cavey Law.
Why Cavey Law for your Mast Cell Disability Claim?
We have the experience when it comes to filing claims for disability with Mast Cell diseases and conditions. Do not wait to give us a call to schedule your free consultation with our law firm at 727-894-3188 today.
