Short and Long Term Disability Due to Clotting Disorders
- Matthew Maddox
- 14 minutes ago
- 12 min read
Navigating the complexities of short term and long term disability claims can be particularly challenging for individuals living with clotting disorders. These conditions, which affect the blood’s ability to clot properly, can result in significant physical and cognitive impairments. If your clotting disorder prevents you from working, you may be considering filing for disability insurance benefits.
This article aims to provide comprehensive information on securing short and long term disability benefits for your clotting disorder. We’ll answer common questions about the process, including the critical evidence required to support your claim and what strategies you can utilize to effectively navigate the claims process.
How Can Clotting Disorders Impact My Ability to Work?
Clotting disorders are medical conditions that affect the blood’s ability to clot properly, which can lead to either excessive clotting or excessive bleeding. These disorders can significantly impact your ability to work, depending on the severity and the nature of your job.
Common clotting disorders include:
Hemophilia: A genetic disorder primarily affecting males where the blood lacks sufficient clotting factors, leading to prolonged bleeding after injury or surgery.
Von Willebrand Disease: The most common hereditary clotting condition, characterized by a deficiency in or impairment of a protein critical for blood clotting.
Deep Vein Thrombosis (“DVT”): Involves clots forming in the deep veins of the legs, which can dislodge and lead to life-threatening conditions like pulmonary embolism.
Thrombophilia: Excessive clotting disorders that increase the risk of blood clots in veins and arteries, which can impair circulation and lead to complications like strokes or heart attacks.
The potentially disabling symptoms of clotting disorders can vary but often include:
Physical symptoms: Easy bruising, frequent nosebleeds, excessive bleeding from cuts, swelling and pain in the limbs (indicative of clots), and chronic fatigue which can be debilitating.
Cognitive symptoms: In cases where blood clots form in the brain or when severe bleeding occurs, symptoms could include headaches, dizziness, and in severe cases, strokes, which can affect cognitive functions and physical mobility.
Can I Get Short or Long Term Disability Benefits for Clotting Disorders?
Yes, you can qualify for short term or long term disability benefits for clotting disorders if your condition significantly impacts your ability to perform your job. However, your eligibility for benefits will depend on the terms of your disability insurance policy. Policies can vary, but they typically define disability in one of two ways:
Own Occupation: You are considered disabled if your condition prevents you from performing the duties of your own occupation.
Any Occupation: You are considered disabled if your condition prevents you from performing the duties of any occupation for which you are reasonably suited by education, experience, and training.
Many policies will first assess your claim under the “own occupation” standard before transitioning to the “any occupation” definition at a later date (typically 24 months).
In order to approve your claim, your insurance company will require you demonstrate that your clotting disorder causes symptoms that prevent you from working and meet the definition of disability as laid out in your policy. Thoroughly understanding the definitions of disability in your policy and providing detailed, accurate documentation to support your claim will enhance your chances of receiving disability benefits for your clotting disorder.
How Do Insurance Companies Evaluate Clotting Disorder Disability Claims?
Insurance companies evaluate clotting disorder disability claims with a focus on medical evidence and the impact of the disorder on your ability to work. Your insurance company assesses how your clotting disorder affects your daily functions, especially in relation to your job tasks.
Clotting disorder disability claims can face additional scrutiny from insurance companies due to the nature of the condition. Here are a few common challenges you may face when filing a clotting disorder short or long term disability claim:
Fluctuating Symptoms: Clotting disorders can have symptoms that vary significantly over time, making it difficult to consistently demonstrate your condition’s impact on your ability to work. This variability can lead insurance companies to question the frequency and severity of your condition.
Subjectivity of Symptoms: Symptoms like pain or fatigue are subjective and difficult to measure objectively, which can lead insurers to challenge these as bases for disability.
Lack of Specific Guidelines: Unlike some other conditions, there may be a lack of specific guidelines on how clotting disorders should be managed and evaluated for disability purposes, leading to inconsistencies in how claims are assessed.
Pre-Existing Condition Clauses: Some policies have clauses that limit coverage for conditions deemed pre-existing, which can complicate claims if your clotting disorder was diagnosed before your disability insurance policy was in effect.
Understanding these evaluation processes and preparing for potential challenges can help you better navigate the complexities of filing a disability claim for a clotting disorder. When filing a short or long term disability claim for a clotting disorder, consider consulting with an experienced disability insurance attorney. They can strategize how to best substantiate your claim for benefits to your insurance company and avoid common pitfalls during the process.
What Evidence Is Necessary to Support a Short or Long Term Disability Claim for a Clotting Disorder?
To support a short term or long term disability claim for a clotting disorder, comprehensive evidence is crucial to demonstrate both the medical severity of the condition and its impact on your ability to work.
Medical and vocational evidence is key to substantiating your clotting disorder disability insurance claim. Examples of documentation to support your claim include:
Detailed Medical Records: These should cover all aspects of your diagnosis, treatment, and response to treatment, including blood tests, imaging studies, and medical notes from your treating physicians, particularly hematologists.
Specialist Evaluations: Reports from specialists who treat clotting disorders can provide insights into the complexity and severity of your condition.
Neuropsychological Evaluation: If there are any cognitive impairments suspected, such as issues stemming from microbleeds or medication side effects, a neuropsychological evaluation can document these impairments in detail.
Functional Capacity Evaluation (“FCE”): An FCE provides a comprehensive assessment of your ability to perform various physical tasks. For clotting disorders, this evaluation can help illustrate how symptoms like pain, fatigue, or mobility restrictions impact your functional capabilities at work.
Ongoing Treatment Records: Continuous updates on your condition and treatment show the persistency of your disorder and its impacts, which is vital for claims that require proof of ongoing disability.
Official Job Descriptions: An official job description from your employer should include details of your job duties and physical and cognitive requirements, illustrating the specific tasks that your clotting disorder prevents you from performing.
Statements from Employer and/or Co-Workers: Written statements from your employer and co-workers can provide firsthand accounts of how your condition affects your work performance and overall ability to carry out your job responsibilities.
Vocational Assessment: A vocational expert can assess your work capacity relative to your condition and the labor market. This report can provide a detailed analysis of your occupational demands, both physical and cognitive, and render an opinion on your inability to perform these duties due to your clotting disorder symptoms.
By compiling this robust array of evidence, you significantly strengthen your disability claim, illustrating not just the presence of a medical condition but its tangible effects on your daily living and employment capabilities.
What Role Do Medical Experts Play in the Disability Claims Process for Clotting Disorders?
Medical experts play a crucial role in the disability claims process for clotting disorders, providing essential insights and evidence that can influence the outcome of your claim.
Here’s how they contribute:
Diagnosis and Treatment Documentation: Specialists in fields related to clotting disorders, such as hematologists, are vital for accurately diagnosing the condition and outlining effective treatment plans. Their detailed medical reports and treatment records serve as the foundation of your disability claim, demonstrating the legitimacy and severity of your condition.
Expert Testimony on Functional Limitations: Medical experts assess and document how your clotting disorder impacts your physical and possibly cognitive functions. They provide detailed explanations of your limitations and how these impairments affect your ability to perform work-related tasks. This might include limitations on standing, lifting, or concentrating, which are critical in determining your eligibility for disability benefits.
Neuropsychological Evaluation: If you experience cognitive impairments due to your clotting disorder or related treatments, neuropsychologists play a key role. They conduct comprehensive cognitive assessments that measure impacts on memory, problem-solving abilities, and other cognitive functions. These evaluations provide objective data to support claims that involve cognitive deficits.
Functional Capacity Evaluations (“FCE”): Medical experts who specialize in physical medicine and rehabilitation can conduct an FCE to objectively assess your ability to perform various work-related physical tasks. This evaluation helps to establish a clear link between your medical condition and your functional capacity, offering concrete evidence to support your claim.
Ongoing Assessment and Monitoring: Medical experts also provide continuous monitoring and periodic re-evaluation of your condition. This is crucial, as disability insurance providers require ongoing proof of disability. Regular updates from medical experts help to substantiate that your clotting disorder continues to be disabling.
Interpretation of Medical Data to Insurers: Medical experts often need to communicate complex medical information in a way that insurance companies can understand. Their ability to clearly articulate the impact of a clotting disorder on your daily life and work duties is essential in navigating the often complex language and requirements of insurance policies.
The involvement of medical experts adds a layer of credibility and authority to your disability claim, ensuring that all medical aspects are thoroughly documented and effectively communicated to the insurance company. This professional support is integral to overcoming the challenges of proving disability due to a clotting disorder.
Can My Employer Terminate My Employment If I Am on Disability Due to a Clotting Disorder?
Yes, under certain circumstances, your employer may terminate your employment even if you are on disability due to a clotting disorder. However, there are specific legal protections and considerations that apply:
Family and Medical Leave Act (“FMLA”): If eligible, you can take up to 12 weeks of unpaid, job-protected leave under the FMLA each year for serious health conditions, which would include a clotting disorder. Your job or an equivalent position must be available to you upon your return unless specific exceptions apply (such as if you are a key employee or if significant economic hardship to the employer can be demonstrated).
Employment Contracts and Union Agreements: If you have an employment contract or are covered by a union agreement, there may be additional protections against termination. These agreements often contain specific provisions regarding medical leave and disability.
State Laws: Some states have additional protections that go beyond federal laws, offering greater coverage or requiring accommodations for smaller employers not covered by the ADA.
Despite these protections, there are conditions under which employment might still be terminated legally. For example, if there are documented performance issues that are unrelated to your disability, your employer may have grounds for termination. Layoffs due to economic reasons or organizational changes that would have occurred regardless of your disability status may still legally affect your employment.
It’s essential to consult with a legal professional specializing in employment or disability law to understand fully your rights and protections in your specific situation. They can provide guidance tailored to your circumstances and help ensure that your legal rights are preserved during your period of disability.
How Long Can I Receive Disability Insurance Benefits for a Clotting Disorder?
The duration of disability insurance benefits for a clotting disorder can vary based on several factors, including the specifics of your insurance policy and the severity and progression of your disorder. Here’s a general overview of how long you might receive benefits:
Short Term Disability (“STD”) Benefits: These are typically designed to cover a period of temporary disability ranging from a few weeks to several months. STD policies often provide benefits for a maximum of 3 to 6 months, but this can vary depending on the specific terms of your policy.
Long Term Disability (“LTD”) Benefits: If your clotting disorder continues to impair your ability to work beyond the coverage period of your STD benefits, LTD benefits may kick in. LTD benefits can last for a more extended period—often ranging from a few years to up until you reach retirement age, depending on your policy. Common durations for LTD benefits include until age 65 or for 5 to 10 years.
Policy Definitions: The specifics of how disability is defined in your insurance policy play a crucial role. Many LTD policies transition from an “own occupation” definition (where you’re considered disabled if you can’t perform your specific job) to an “any occupation” definition (where you’re considered disabled if you can’t perform any job for which you’re qualified) after a certain period, usually around 24 months. This change can affect your eligibility for continued benefits.
Medical Reviews: Insurance companies regularly conduct medical reviews to assess whether the criteria for disability are still being met. Continued receipt of benefits typically requires ongoing proof of disability through updated medical records and sometimes additional assessments or evaluations.
State and Federal Regulations: Some regulations, particularly those related to employer-provided disability insurance plans, may influence the duration of benefits. For example, the Employee Retirement Income Security Act (“ERISA”) governs many employer-sponsored disability plans and can impact how claims and appeals are handled.
To understand precisely how long you might receive disability benefits for a clotting disorder, you should review the terms of your specific insurance policy and consult with a disability insurance lawyer with experience in ERISA who can help clarify your rights and the provisions of your coverage. This professional guidance is crucial in navigating the complexities of disability insurance and ensuring that you receive the full benefits to which you are entitled.
What Should I Do if My Clotting Disorder Short or Long Term Disability Claim Is Denied?
If your short term or long term disability claim for a clotting disorder is denied, taking the following steps can help you effectively address the denial and pursue the benefits you need:
Consult with an Attorney: This should be your top priority. A disability insurance attorney with experience in the Employee Retirement Income Security Act (“ERISA”) can provide crucial guidance, as many disability insurance policies offered by employers are governed by ERISA. These attorneys understand the complex rules and strict timelines involved in ERISA claims and can help you navigate the appeal process effectively.
Review the Denial Letter Carefully: Understand the reasons for your claim’s denial. The denial letter must specify why the claim was denied, what information is needed to reconsider the decision, and how to appeal. This information will be critical for your attorney to formulate a strategy for your appeal.
Gather Additional Medical Evidence: Collect more detailed medical documentation that addresses the deficiencies pointed out in the denial letter. This might include more comprehensive medical records, new evaluations from medical specialists, and results from recent medical tests. Your attorney will be able to identify what evidence is needed for your appeal and help you with obtaining the needed documentation.
Obtain Written Support from Your Healthcare Providers: Secure detailed statements from your doctors that explain how your clotting disorder impacts your ability to work. These statements should directly address any issues raised in the denial of your claim.
Consider a Vocational Assessment: It may be beneficial to include an assessment from a vocational expert who can attest to your inability to work in your specific profession or any occupation, depending on your policy’s definition of disability.
Prepare for a Timely Appeal: Be aware of the timeline for submitting an appeal, which is typically very strict under ERISA. Missing a deadline can permanently affect your right to benefits. Your attorney will ensure that all necessary paperwork and additional evidence are submitted correctly and on time.
Document Everything: Keep detailed records of all communications with your insurance company, as well as copies of all documents submitted and received during the claims and appeals process. This documentation can be vital in case of further disputes or legal proceedings.
By taking these steps, especially consultation with an experienced disability attorney, you can strengthen your position to secure the disability benefits you deserve.
How Can The Maddox Firm Prove My Short or Long Term Disability Claim?
The Maddox Firm is dedicated to helping our clients navigate the complex process of filing for short term or long term disability benefits. With a thorough understanding of disability law and a commitment to personalized legal support, we can effectively manage and prove your disability claim.
Here’s how The Maddox Firm can help:
We Examine Your Policy and Assess Your Claim: Our first step is to carefully review the details of your disability insurance policy. This allows us to understand the specific provisions, limitations, and definitions within your policy that are crucial for building a solid claim based on your clotting disorder.
We Handle All Communications with Your Insurance Company: We take over all interactions with your insurance provider, ensuring that all communications are timely, documented, and strategically crafted to advocate for your interests. This includes responding to requests for information and negotiating with the insurance company on your behalf.
We Help You Obtain Evidence to Support Your Claim: We guide you in gathering comprehensive medical evidence, including detailed doctor’s statements, medical records, and personal statements. We may also coordinate with medical and vocational experts to obtain additional evaluations to strengthen your claim.
We Handle Appeals and Litigation: If your claim is denied, we are prepared to handle the appeals process and, if necessary, pursue litigation to seek the benefits you deserve. We are skilled in managing both ERISA and non-ERISA claims, providing adept representation through every stage of the appeal and court proceedings.
A short term disability or long term disability claim can be a complicated process. If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse short term or long term disability decision, The Maddox Firm can help. The experienced 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 short and/or long term disability claim. Our New Jersey and New York long term disability attorneys help clients nationwide.
