If you suffer from a cardiological condition, you may consider filing for short or long term disability insurance benefits to provide financial support during your recovery period, or on a permanent basis if your condition is chronic. However, filing a disability insurance claim for cardiological conditions can be a complicated and overwhelming process, especially when you’re still dealing with the physical and emotional toll of your condition.
Working with an experienced disability insurance attorney can help ensure that you receive the benefits you deserve so you can focus on your recuperation without worrying about financial stress. In this article, we will explore what cardiological conditions cause disability, how insurance companies evaluate disability claims for cardiological conditions, what types of evidence you can submit in support of your claim, and how The Maddox Firm can help prove your cardiological condition disability claim.
What Cardiological Conditions Cause Disability?
There are several cardiological conditions that can cause short or long term disability. A few examples of disabling cardiological conditions include:
Congestive heart failure: This is a condition where the heart is unable to pump enough blood to meet the body’s needs. It can cause shortness of breath, fatigue, and swelling in the legs and feet. In severe cases, it can lead to disability and decreased quality of life.
Coronary artery disease: This is a condition where the arteries that supply blood to the heart become narrowed or blocked, which can cause chest pain, shortness of breath, and heart attacks. In some cases, it can lead to heart failure and disability.
Arrhythmias: These are abnormal heart rhythms that can cause dizziness, fainting, and fatigue. In severe cases, they can lead to disability and decreased quality of life.
Cardiomyopathy: This is a condition where the heart muscle becomes enlarged, thickened, or stiff. It can cause shortness of breath, fatigue, and swelling in the legs and feet. In severe cases, it can lead to heart failure and disability.
Valve disease: This is a condition where the heart’s valves become narrowed or leaky, which can cause shortness of breath, fatigue, and chest pain. In severe cases, it can lead to heart failure and disability.
Any cardiological condition may result in short or long term disability, depending on the nature of your symptoms. Generally speaking, disability insurance policies define disability as any medical condition that impairs you from performing the material duties of your occupation. If your cardiological condition causes symptoms severe and frequent enough to prevent you from working, you may qualify for short or long term disability benefits.
How Do Insurance Companies Evaluate Disability Claims for Cardiological Conditions?
Insurance companies evaluate disability claims for cardiological conditions using a variety of methods.
The evaluation process typically involves a review of medical records, including diagnostic tests, treatment plans, and physician notes. Most insurance companies require claim paperwork which includes a questionnaire for your attending physician. The questionnaire, commonly known as an Attending Physician Statement, is meant for your treating doctor to certify you cannot work.
During the claim evaluation process, your insurance company will consider the impact of your cardiological condition on your ability to perform your job duties. This includes an assessment of physical limitations, such as the ability to sit, stand, or lift. Your insurance company will also consider the nature of your occupation and your regular responsibilities. For example, if you work as an accountant in a mostly sedentary position, your insurance company may be skeptical of your disability claim unless you provide evidence demonstrating that your cardiological condition interferes with your ability to sit for extended periods.
Your insurance company will also consider whether you have complied with all treatment recommendations from your doctors. Typically, disability insurance policies require that you be receiving “appropriate treatment” for your condition, and if you are not visiting with doctors regularly and treating with recommended medications (or other options such as surgery), your insurance company may deny your claim on the basis that you are not in compliance with your policy.
Your insurance company may also use other tactics when scrutinizing your claim. This could include requiring you to undergo an independent medical examination (“IME”) to verify the severity of your cardiological condition. These doctors are paid by your insurance company and often will write reports alleging you are not disabled, regardless of your treating doctor’s opinions and any supportive medical evidence. Sometimes insurance companies will also hire private investigators to surveil you with video footage. The hope for your insurance company is that they will catch you performing activities that could indicate you have high enough physical functioning to work, such as walking, carrying, or lifting. This surveillance can then be used as “proof” you are not disabled, and your insurance company may use it to deny your claim.
What Should I Submit with My Cardiological Condition Disability Claim?
Proving that you are disabled due to a cardiological condition can be a challenging process, as insurance companies often require extensive documentation and evidence to support a disability claim. Your insurance company will require proof of your medical disability and how your cardiological symptoms interfere with your ability to work in your occupation.
Below we’ll discuss different types of evidence to prove your medical disability and your inability to work.
Proving Medical Disability Due to Your Cardiological Condition
Here are some types of medical evidence that may help prove your cardiological condition disability to your insurance company:
Diagnostic Tests: Diagnostic tests such as electrocardiograms (ECGs), echocardiograms, stress tests, and angiograms can provide important information about the severity of your cardiological condition.
Physician Notes: Physician notes from your treating cardiologist can provide detailed information about your condition and the treatment you have received. These notes should include information about your symptoms, test results, and any limitations on your ability to work.
Treatment Plans: Your treatment plan should detail the medications, procedures, and other therapies you have received for your cardiological condition. This can help to show that you have been actively seeking treatment and that your condition is severe enough to require ongoing treatment.
Hospital Records: If you have been hospitalized due to your cardiological condition, your hospital records can provide important information about your condition and treatment.
Functional Capacity Evaluation (FCE): An FCE is an objective test that evaluates your physical abilities. The FCE measures your ability to perform tasks such as lifting, bending, and standing for extended periods of time. FCEs can be particularly useful in demonstrating the extent of your limitations and how they impact your ability to work.
Neuropsychological Evaluation: A neuropsychological evaluation is an objective test that evaluates your cognitive abilities. This type of testing can be useful if your cardiological condition has affected your memory, decision-making, mental stamina, or ability to focus.
Proving Inability to Work Due to Your Cardiological Condition
In addition to medical evidence, vocational evidence can also be important in supporting a cardiological condition disability insurance claim. Here are some examples of vocational evidence that can be submitted to support such a claim:
Job Description: An official job description of your current occupation can provide important information about the physical and cognitive demands of your work. This can help to show how your cardiological condition limits your ability to perform your job duties.
Personal Affidavit: Your resume and official job description may not explain the full depth of your job tasks and responsibilities. You may consider writing a personal affidavit that attests to your education, background, job duties and the level of physical and cognitive functioning required, the onset of your cardiological condition, and how your symptoms interfere with your ability to work.
Statement from Your Employer and/or Co-Worker: You may consider asking your employer and/or a co-worker to write a statement on your behalf. Their statement should include what functions your job entailed and whether they witnessed any decline in your performance due to your cardiological symptoms.
Vocational Assessment: An occupational analysis can be performed by a vocational expert to evaluate the physical and cognitive demands of your work. The analysis will examine the essential functions of your job and determine if your cardiological condition prevents you from performing those functions. The vocational expert can evaluate your medical evidence and vocational evidence and provide an informed opinion on your ability to perform your job duties.
Proving disability due to a cardiological condition can be a complex and challenging process. It is important to gather as much evidence as possible and work with an experienced disability insurance attorney to ensure that your claim is well-supported.
How Can The Maddox Firm Prove My Cardiological Disability?
An ERISA attorney can help you navigate the confusing disability claim process. The experienced team at The Maddox Firm has successfully filed disability claims for many clients due to cardiological conditions. We understand what your insurance company looks for when evaluating your claim and how to get your claim approved.
Here are a few key ways The Maddox Firm can prove your cardiological condition short or long term disability claim to your insurance company:
Examine Your Policy: The Maddox Firm will examine your disability insurance policy and provide you guidance on your insurance company’s specific requirements. This includes what conditions are covered and excluded under the policy, the definition of disability you must meet, the elimination period, and the benefit amount. In examining your policy, The Maddox Firm can identify any potential issues that may arise with your claim, such as limitations or exclusions that could affect your ability to receive benefits.
Assist with Gathering and Organizing Medical Evidence: One of the most important aspects of proving your cardiological condition disability claim is providing medical evidence that supports your condition. The Maddox Firm can assist you in gathering and organizing your medical records, ensuring that all necessary documents are obtained and presented to the insurer. We will also coordinate with your treating doctors for supplemental statements in support of your claim, and review any questionnaires your doctor completes to ensure accuracy and completeness.
Help You Obtain Additional Evidence: The Maddox Firm can recommend you for additional testing if needed, such as a Functional Capacity Evaluation or Neuropsychological Evaluation. We can also refer you to trusted vocational experts to conduct a vocational assessment that may be used to further support your claim.
Represent You in Appeals and Litigation: If your short or long term disability claim is denied or terminated, The Maddox Firm can represent you in the appeals process and, if necessary, litigation. We can prepare a strong appeal that addresses the reasons for the denial and presents new evidence that supports your claim. In litigation, The Maddox Firm can file a lawsuit against your insurer and represent you in court.
An experienced ERISA attorney can be a valuable asset in proving your cardiological condition disability claim to your insurer. 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. The team at The Maddox Firm will look over 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 short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.