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Do I Qualify For Disability Insurance Benefits If I Have Rheumatoid Arthritis?

CaveyLaw.com > Practice Areas  > Long Term Disability & ERISA Lawyer  > Long Term Disability Disabling Conditions > Do I Qualify For Disability Insurance Benefits If I Have Rheumatoid Arthritis?

1.3 million Americans have rheumatoid arthritis, RA. Nearly three times as many women have the disease as men.

Not everyone with rheumatoid arthritis (RA) is entitled to disability benefits. Disability insurance companies don’t always make it easy for policyholders who are disabled because of rheumatoid arthritis to get the benefits they deserve.

What Is Rheumatoid Arthritis and What Are The Symptoms?

An autoimmune disease, rheumatoid arthritis can cause chronic inflammation of the joints and other areas of the body.

The immune system attacks the protective lining that surrounds a joint called the synovium. The inflammation thickens the synovium and can invade the cartilage and bone. The tendons and ligaments that hold the joint together are weakened and stretched. The joint loses shape and alignment, resulting in joint deformity and dysfunction.

RA initially affects the small joints in the hands, wrist, feet and ankles. As the disease progresses in can involve the shoulders, elbows, knees, hips, jaw and even the neck. It affects the same joints on both sides of the body.

Patients with autoimmune diseases have antibodies and immune cells in the blood that target other body tissue. RA is a systemic illness. The symptoms can include:

  • Joint pain and Stiffness

Joint pain and stiffness commonly occur in the feet, knees, and hands. This can cause permanent joint destruction and deformity. You joint pain can be debilitating, and the damage to your joints can make it difficult to do your activities of daily living. Something as simple as buttoning a button becomes impossible.

  • Swollen and Tender Joints

Swollen joints and painful tenderness limit your ability to do any work activity that requires use of your feet, knees and hands.

  • Fatigue

Debilitating fatigue can limit activity.

RA is characterized by periods of disease flares and remissions. This plays into the carrier’s view that RA is not disabling.

What Is The Treatment for Rheumatoid Arthritis and How Does That Impact My Claim?

The hallmark symptoms of rheumatoid arthritis are swelling, stiffness and painful inflammation. The severity of the symptoms can differ from person to person.

Treatment for rheumatoid arthritis often includes nonsteroidal anti-inflammatory drugs, known as NSAIDs, steroids, disease modifying antirheumatic drugs and immunosuppressant drugs. These drugs can have significant side effects, including gastrointestinal problems, anemia and fatigue.

It is important that your physician document the side effects and how they impact your ability to work.

If medication doesn’t prevent or slow the joint damage, you may have to undergo surgery, such as:

  1. Synovectomy, to remove the inflamed and painful lining of the joint;
  2. Tendon repair surgery, to repair the tendons that loosened or ruptured as a result of inflammation and joint damage;
  3. Joint fusion surgery, arthrodesis, to stabilize or realign a deformed joint; and
  4. Joint replacement surgery, arthroplasty, to remove the damaged joint and replace it with a prosthesis made of metal and plastic.

These surgeries also can be the basis of a disability claim.

How Disability Carriers Handle Rheumatoid Arthritis Claims

Disability carriers are notorious for denying and terminating many claims. Common arguments disability carriers make include:

  1. Coverage is excluded by the pre-existing condition clause of your disability policy.
  2. Benefits are limited under the subjective limitation clause. Pain and fatigue can be your most disabling symptoms, but carriers routinely dispute their impact.
  3. You’ve had RA 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.
  4. Your symptoms are in remission and just flare up temporarily so you can work.
  5. Your complaints are really coming from your back; there is no objective testing that supports the severity your back complaints.

As a result, many disability claims are denied. Other reasons carriers give to deny claims:

(1) There is no objective basis of the rheumatoid arthritis diagnosis, as x-rays often are normal in the early stages,

(2) There is no objective basis for the restrictions and limitations assigned by your physician, or

(3) There is no causal relationship between your rheumatoid arthritis diagnosis and/or your restrictions and limitations, and your inability to do your own or any occupation,

(4) There is no reason you can’t work in a sedentary capacity, or

(5) There is no reason you can’t work with accommodation.

Why You Need Nancy Cavey

Nancy Cavey, who has 35 years experience handling disability cases, has successfully represented many rheumatoid arthritis policyholders. She overcomes a claims denial by working closely with you and your physician.

She obtains, as needed, a Functional Capacity Evaluation to objectively document the limits you have using your fingers and hands, and your difficulty walking, standing and sitting. She even hires a Vocational Evaluator to explain why your symptoms prevent you from doing your occupation or any occupation.

Nancy Cavey offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.

How Do I Get The Disability Insurance Benefits I Deserve?

Rheumatoid arthritis can interfere not only with your daily activities but 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:

  1. 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. Your policy might limit conditions that are based on subjective complaints without objective evidence of a diagnosis.
  1. 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.
  1. Obtain a copy of your personnel file to see if your rheumatoid arthritis has affected your work performance. Your productivity may have suffered because you may have limited ability to use your hands, walk, stand or sit for any length of time.
  1. 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.
  2. 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.
  1. Prepare a pain diary that explains your pain and the side effects of medication. Give examples of how your rheumatoid arthritis symptoms interfere with your ability to do things on a daily basis. Document the flare-ups and your dysfunction even when you are not flared.
  1. Take pictures of your affected joints to document the swelling, disfigurement and dysfunction.
  1. 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.
  1. 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 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

Rheumatoid arthritis 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.