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Do I Qualify For Disability Insurance Benefits If I Have A Shoulder Problem?

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

Disability insurance companies don’t always make it easy for policyholders who have shoulder problems to get the disability benefits they deserve.

Your shoulder joint is made up of the collarbone (clavicle), shoulder blade (scapula) and the upper arm bone (humerus). It is anchored by muscles, tendons and ligaments that keep the ball of your arm in the socket and allow the shoulder to move.

The shoulder can become unstable and painful as a result of degenerative changes, overuse or injury.

However, not all shoulder problems are disabling.

What Are The Common Disabling Shoulder Problems?

According to the American Academy of Orthopedic Surgeons, shoulder problems are commonly caused by:

  • Tendon inflammation, including bursitis or tendinitis or a tendon tear,
  • Instability,
  • Arthritis, and
  • Facture or broken bone.

Disabling shoulder problems include:

  1. Bursitis, an inflammation of the bursa, which is the cushion between your bones and soft tissue, including tendons.
  2. Tendinitis, caused by an inflammation of the tendons of the rotator cuff or biceps, which become inflamed and irritated.
  3. Calcific tendonitis, caused by calcium deposits in the shoulder tendons.
  4. Frozen shoulder or adhesive capsulitis, causes stiffness and immobility of the shoulder joint. Generally requires surgery.
  5. Labral tear, makes it difficult to rotate your shoulder. Requires surgery.
  6. Rotator cuff tear, which occurs when the tendons of the rotator cuff separate from the bone. Generally requires surgery.
  7. Shoulder dislocation, which occurs when the top of your arm bone disconnects from the scapula. In the case of recurrent dislocations, requires surgery.
  8. Shoulder instability, caused by a loosed joint. Can result in surgery.
  9. Shoulder separation, the result of a separation of the acromioclavicular joint. May require surgery.
  10. Shoulder arthritis, can limit motion as a result of changes in the joint. Can, in turn, lead to shoulder replacement surgery.

Sometimes these problems also involve the neck, arm and even the hand, which significantly impacts use of the arm.

How Disability Carriers View Shoulder Claims

Many shoulder claims are denied or terminated 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 shoulder problems,

(3) There is no causal relationship between your shoulder problems and/or restrictions and limitations, and your inability to do your own or any occupation.

(4) Ergonomic changes in your workplace will allow you to work.

Nancy Cavey, who has 35 years experience handling disability cases, has successfully represented many policyholders with shoulder problems. She had shoulder surgery herself. Ms. Cavey overcomes a claims denial by working closely with you and your physician.

If necessary, she will have a Functional Capacity Evaluation performed to document the functional problems you have with your shoulder and arm.

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?

Shoulder problems can interfere with your daily activities and 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.

Some policies consider shoulder conditions without objective findings consistent with the level of dysfunction to be a subjective condition and limit benefits to just two years. Before you apply for benefits, discover your policy’s applicable limits.

  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.

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.’’  The carrier often makes a leap of logic and says the policyholder either is exaggerating or faking their pain or dysfunction. Nancy Cavey, who knows how shoulder problems can cause pain and limit use of the arm, knows what proof is necessary to meet the policy definition of disability.

  1. Obtain a copy of your personnel file to see if your shoulder problems have affected your work performance.
  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. Don’t forget to explain what activities increase your pain.
  1. 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 diary that explains and gives examples of how your symptoms interfere with your ability to do things on a daily basis and the side effects of your medication.
  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 shoulder problem 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

Shoulder problems and complications 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.