When faced with the challenges of amyotrophic lateral sclerosis (“ALS”), also known as motor neurone disease ("MND") or Lou Gehrig's disease, you may find yourself grappling with physical, emotional, and financial burdens. Short and long term disability benefits can provide vital support to help manage the impact of this progressive disease. However, understanding and obtaining these benefits can be a complex and overwhelming process.
In this article, we’ll discuss the essential steps involved in securing short and long term disability benefits for ALS and how an experienced ERISA attorney can help guide you through the process.
How Does ALS Cause Disability?
Amyotrophic lateral sclerosis (also known as “ALS”) causes disability through its progressive degeneration of motor neurons, which are responsible for transmitting signals between the brain and the muscles. As the disease advances, the motor neurons deteriorate, leading to a loss of muscle control and function. This results in various forms of disability, including physical and cognitive symptoms.
Physical Disability Due to ALS
Motor impairment: ALS affects voluntary muscle movements, leading to muscle weakness, twitching, and eventually paralysis. This can impact the ability to walk, use your hands and arms, speak, swallow, and perform everyday tasks.
Respiratory dysfunction: As ALS progresses, it can affect the muscles involved in breathing, leading to respiratory difficulties. This may result in the need for assistance with breathing, such as through a ventilator.
Speech and communication difficulties: ALS can impair the muscles involved in speech production, making it challenging to articulate words and communicate verbally.
Swallowing difficulties: ALS can affect the muscles involved in swallowing, causing dysphagia. This can lead to problems with eating and drinking safely, increasing the risk of choking and malnutrition.
Fatigue and weakness: ALS often causes extreme fatigue and weakness, making it difficult to perform even simple physical tasks. This can contribute to reduced mobility and independence.
Cognitive Disability Due to ALS
In some cases, ALS can also lead to cognitive impairment and changes in thinking, cognitive deficits, and altered behavior. This condition, known as ALS-related frontotemporal degeneration (“ALS-FTD”), occurs in a subset of individuals with ALS. The exact causes of cognitive impairment due to ALS are not fully understood, but researchers believe that it may involve a combination of factors, including frontotemporal degeneration, the spread of pathological proteins, and certain genetic mutations.
The cognitive impairments seen in ALS-FTD can manifest in various ways, including:
Changes in executive functioning: ALS-FTD can cause difficulties with executive functioning, such as planning, problem-solving, decision-making, and organizing tasks.
Behavioral changes: ALS-FTD can lead to alterations in behavior, personality, and social interactions. These changes may include apathy, disinhibition, impulsivity, or inappropriate behavior.
Language difficulties: Some individuals may experience language impairments, such as word-finding difficulties, speech comprehension problems, or trouble expressing thoughts.
Memory deficits: Memory impairment, particularly in episodic memory (memory of personal experiences), may occur in some cases.
How Do Insurance Companies Evaluate ALS Disability Claims?
When assessing your ALS disability short or long term disability claim, your insurance company will look to determine whether you meet the eligibility criteria set out in your insurance policy. An ALS diagnosis is very serious, but without evidence demonstrating your symptoms and proof of how they interfere with performing your essential occupational duties, your insurance company is unlikely to approve your claim.
Obtaining approval for ALS disability benefits can be challenging due to various factors.
One significant challenge is the limited treatment options available for ALS. While there are therapies to manage symptoms and slow down disease progression, your insurance company may require documentation of ongoing medical treatment and its impact on functional limitations. The limited treatment options for ALS can make it challenging to meet these requirements and demonstrate the necessary medical evidence for disability benefits.
Documentation is a crucial aspect of the disability benefit application process. Gathering and organizing extensive medical records, test results, and physician statements can be complex and onerous. Ensuring that the documentation clearly showcases the impact of ALS on your daily functioning and meets the specific criteria outlined by the insurance provider can be a challenge for claimants.
Insurance companies often demand objective evidence to support disability claims. However, ALS primarily affects motor neurons, and the progression and impact of the disease may not always be easily measurable through traditional medical tests or imaging. This lack of easily quantifiable objective evidence can make it challenging to meet the requirement set by insurance companies.
Navigating the challenges to obtaining ALS disability benefits involves gathering comprehensive and persuasive medical documentation, establishing the impact of the disease on functional abilities, and working closely with healthcare professionals experienced in ALS. A reputable ERISA attorney can provide valuable guidance throughout the process and maximize your chances of success.
What Evidence Can I Submit for My ALS Disability Claim?
To get your ALS short or long term disability claim approved, you must submit comprehensive evidence to your insurance company that establishes your condition prevents you from working. Insurance companies typically require evidence that proves both your medical disability and your inability to perform the material duties of your occupation.
This means you must provide your insurance company with medical documentation as well as vocational evidence that demonstrates how your ALS impedes you from working.
Proving Medical Disability Due to ALS
When submitting a short or long term disability claim for ALS, it’s essential to provide comprehensive medical evidence demonstrating your diagnosis and the extent of your symptoms. Here are some specific types of medical evidence that can be submitted:
Neurologist Reports: Detailed reports from a neurologist who specializes in ALS are crucial. These reports should include a thorough description of the diagnostic process, clinical findings, and observations related to the progression of your ALS.
Electromyography (“EMG”) and Nerve Conduction Studies: EMG test results can provide objective evidence of motor neuron dysfunction and contribute to the diagnosis of ALS. Submitting EMG reports and nerve conduction studies can help establish the presence and severity of the disease.
Clinical Examinations: Comprehensive clinical examinations conducted by neurologists or other specialists should be included. These examinations typically involve assessing your muscle strength, reflexes, coordination, and other neurological functions affected by ALS.
Imaging Studies: Magnetic Resonance Imaging (“MRI”) or Computed Tomography (“CT”) scans may be used to rule out other potential causes of symptoms and support your ALS diagnosis. These imaging studies can help demonstrate any structural changes in your brain and spinal cord associated with ALS.
Pulmonary Function Tests: ALS can lead to respiratory impairments. Spirometry tests, which measure lung function, can provide objective data on your respiratory decline and the need for ventilatory support.
Swallowing Assessments: Dysphagia (difficulty swallowing) is common in ALS. Submitting reports from swallowing assessments conducted by speech-language pathologists can help illustrate the impact of ALS on your swallowing function.
Functional Capacity Evaluation (“FCE”): The functional capacity evaluation is a thorough evaluation performed by healthcare experts such as physical therapists or occupational therapists. It assesses your physical and cognitive abilities, including strength, endurance, mobility, coordination, and concentration. This evaluation can be used to provide objective evidence of your functional restrictions and limitations.
Neuropsychological Evaluation: If cognitive impairment (ALS-FTD) is present, you may consider undergoing a neuropsychological evaluation to support your claim. The neuropsychological evaluation can assess deficiencies in your cognitive function, behavior, language, and memory, providing evidence of cognitive decline associated with ALS.
Treatment and Medication Records: Providing documentation of the treatments you’ve received and medications your providers have prescribed for ALS can further support your claim. This includes records of medications used to manage symptoms and slow disease progression.
Physician Statements: Detailed statements from your treating physicians or specialists who have been involved in the management of your ALS can offer professional opinions on the impact of the disease on your functional abilities and overall disability.
Proving You Cannot Work Due to ALS Disability
Proving ALS disability with vocational evidence involves demonstrating how the functional limitations imposed by your disease impact your ability to engage in substantial employment.
Here are some examples of vocational evidence you can use to support your ALS disability claim:
Work History: Provide a detailed work history, such as a resume, that outlines your education, training, and previous and current employment.
Job Descriptions and Occupational Information: Gather comprehensive job descriptions and occupational information from your previous and/or current job roles. This documentation helps establish the essential functions, requirements, and skill levels associated with the work you performed.
Vocational Assessment: A vocational expert can evaluate the impact of ALS on your ability to perform substantial gainful activity. The assessment offers an analysis of your functional limitations and whether you are able to work with your ALS symptoms.
Statements from Employers and Colleagues: Former employers, colleagues, or supervisors can provide personal statements attesting to your occupational demands and responsibilities, your declining abilities, and the impact of ALS on your job performance.
How Can The Maddox Firm Prove My ALS Disability Claim?
When filing, appealing, or litigating an ALS disability claim, having the assistance of an experienced ERISA attorney can make all the difference. The experienced team at The Maddox Firm has a deep understanding of the disability claims process, ensuring that your ALS claim is handled effectively and efficiently. With our proven experience, The Maddox Firm will guide you through the complex claims process and increase your chances of benefit approval.
Here are a few ways The Maddox Firm can help prove your ALS short or long term disability claim:
The Maddox Firm examines your policy. We thoroughly review your disability insurance policy to understand its specific requirements for approving short or long term disability benefits. Our team deciphers the policy language, including the definition of disability, elimination period, and benefit amount. We identify any potential challenges, such as pre-existing condition clauses, that may arise and prepare a personalized strategy to overcome any roadblocks to your benefits.
The Maddox Firm gathers and organizes your evidence. It can be time-consuming and difficult to obtain medical records from your various treating providers. The Maddox Firm handles requesting and obtaining your medical records on your behalf, ensuring they provide a comprehensive and accurate portrayal of your ALS condition. We coordinate with your healthcare providers and employer to gather any necessary documentation.
The Maddox Firm makes sure your claim has as much support as possible. Our team scrutinizes your evidence, identifying any weaknesses or red flags that need to be addressed. If needed, we will recommend you for additional testing, such as a neuropsychological evaluation, functional capacity evaluation, or vocational assessment. We will also coordinate with your treating doctors to procure statements of support that detail the nature of your ALS and how your symptoms prevent you from working.
The Maddox Firm represents you in the event of an appeal or litigation. If you are facing a claim denial or termination, The Maddox Firm will represent you for an administrative appeal or litigation with your insurance company.
By partnering with The Maddox Firm, you gain the support of experienced professionals who understand the unique challenges of ALS disability claims. We are dedicated to advocating for your rights and ensuring you receive the disability benefits you deserve.
Whether you are looking for assistance in navigating the claims process, appealing a claim denial, or litigating a final adverse decision, The Maddox Firm can help with your ALS short or long term disability claim. The expert team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your ALS short or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.