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Short and Long Term Disability for Crohn’s Disease

Crohn's Disease can cause long term disability

Navigating the path of chronic illness brings its own unique set of challenges, and for those grappling with the complexities of Crohn’s disease, these challenges can be particularly daunting.

If you’re struggling to work while dealing with your Crohn’s disease and have short and/or long term disability insurance, you may consider seeking financial support through disability benefits.

Crohn’s disease affects over a half a million people in the United States. The relentless nature of Crohn’s, with its unpredictable flare-ups and array of debilitating symptoms, often leads individuals to face not only physical discomfort but also considerable disruptions to their daily lives.

In this article, The Maddox Firm will provide insight into the process of applying for short or long term disability benefits for those with Crohn’s disease. We’ll explore how Crohn’s disease causes disability, the challenges unique to Crohn’s disease short and/or long term disability claims, and how The Maddox Firm can help you secure your Crohn’s disease disability benefits.

How Does Crohn’s Disease Cause Disability?

Crohn’s disease is a chronic inflammatory bowel disease (“IBD”) that primarily affects the gastrointestinal tract. It can lead to inflammation and damage in any part of the digestive system, but it most commonly involves the small intestine and the colon (large intestine). The exact cause of Crohn’s disease is not fully understood, but it is believed to involve a combination of genetic, environmental, and immune system factors.

Many symptoms of Crohn’s disease can lead to disability, depending on their severity and how they impact your ability to perform daily activities, including work.

Cramping woman - Cramping is a symptom of Crohn's that can lead to long term disability

Here are some Crohn’s disease symptoms that may cause disability:

  • Severe Abdominal Pain and Cramping: Intense and persistent abdominal pain and cramping can make it difficult for you to perform work-related tasks that require physical exertion or concentration. This pain can also cause limitations on your mobility, cutting short your range of motion. Pain outside of work can interfere with your ability to obtain restful sleep, leading to persistent fatigue.

  • Frequent and Urgent Diarrhea: Frequent and urgent diarrhea, often accompanied by blood, can lead to severe disruptions in daily life. The need to frequently visit the bathroom can hinder you from participating in activities outside the home, including work, and cause you to require excessive breaks throughout the day.

  • Fatigue: Chronic fatigue is a common symptom of Crohn’s disease. Fatigue can impact your cognitive functioning, ability to maintain a regular work schedule, complete tasks, and perform physical activities such as standing, walking, or sitting for extended periods.

  • Weight Loss and Malnutrition: Severe weight loss and malnutrition due to poor nutrient absorption caused by Crohn’s disease can weaken the body and lead to physical weakness and reduced stamina. This can hinder your ability to perform physical tasks and maintain employment.

  • Joint Pain and Inflammation: Crohn’s disease may cause inflammation in joints, leading to pain, stiffness, and limited mobility. Joint pain can affect your ability to move around comfortably and perform work-related tasks that involve physical effort.

  • Anemia: Crohn’s disease may cause chronic inflammation and blood loss from the digestive tract, which can lead to anemia (low red blood cell count). Anemia can result in fatigue, weakness, and difficulty concentrating, which may impact your work performance.

  • Digestive Complications: Strictures (narrowing of the intestines), fistulas (abnormal connections between organs), and bowel obstructions can cause severe pain and discomfort. These complications caused by Crohn’s disease may require medical interventions and can lead to extended periods of recovery and limited functionality.

  • Impaired Concentration and Cognitive Function: The physical and emotional toll of Crohn’s disease may impair your concentration, memory, and cognitive function. This can affect your ability to perform work-related tasks that require focus and mental clarity.

  • Depression and Anxiety: Coping with the chronic nature of Crohn’s disease, frequent pain, and unpredictable flare-ups can cause secondary mental health challenges such as depression and anxiety. These conditions can impact your daily functioning and overall well-being.

Can I Receive Short or Long Term Disability Benefits for Crohn’s Disease?

Yes, it is possible to receive short term disability (“STD”) and long term disability (“LTD”) benefits for Crohn’s disease. However, the claims process can be complex and challenging due to the nature of the condition and the varying severity of symptoms from person to person.

Generally speaking, “disabled” in the context of disability insurance claims means that your Crohn’s disease symptoms prevent you from performing one or more of the material duties of your own occupation. For most group policies, this definition of disability will change after a period of time, typically around two years, at which point you will need to demonstrate that your Crohn’s disease disables you from working in any occupation reasonable to your level of education, training, and background. It’s very important to review your disability insurance policy to see what criteria you must meet in order to be awarded short or long term disability benefits.

Unfortunately, your insurance company will not just take your word for it when filing a disability claim. You will need to provide them with substantial evidence of your Crohn’s disease diagnosis and symptoms, how these symptoms impact your ability to work, and what level of physical and cognitive functioning the job duties of your occupation require.

How Do Insurance Companies Evaluate Crohn’s Disease Disability Claims?

Long Term Disability Insurance form for Crohn's Disease

When evaluating your Crohn’s disability insurance claim, your insurance company will look for evidence of your Crohn’s disease symptoms and how they preclude you from performing the material duties of your occupation. Crohn’s disease can be hard to get benefits approved for, due to the nature of the disease and the difficulties in obtaining objective evidence of your symptoms and their frequency.

Crohn’s disease is known for its unpredictable flare-ups and varying symptoms. You may cycle between active and remission phases. This can make it challenging to establish a consistent level of disability, as the severity and frequency of your symptoms may fluctuate over time. Your insurance company may wrongly conclude that your Crohn’s disease is not disruptive enough to prevent you from working.

Many of the symptoms of Crohn’s disease, such as pain and fatigue, are self-reported and “subjective,” meaning they are not easily provable through objective measures. This can lead to misconceptions or skepticism about the severity of your condition. Even with no basis, your insurance company may assume you are malingering or exaggerating how your Crohn’s disease impacts your ability to carry out daily activities.

Your insurance company may also claim that certain changes in medication and lifestyle should help alleviate the symptoms of Crohn’s Disease and that with treatment, your symptoms are manageable enough to continue working. Of course, this ignore that no treatment is a “one size fits all” solution, and whether your Crohn’s disease symptoms can be controlled with medication or lifestyle changes is highly dependent on your individual circumstances.

Given the challenges in securing benefits for Crohn’s disease, it’s important to consult an experienced ERISA attorney to help you navigate the complexities of the STD and/or LTD application process. A knowledgeable disability attorney will understand how to best present your Crohn’s disease claim to your insurance company.

How Do I Prove My Crohn’s Disease Disability Claim?

Providing ample clear and consistent evidence of your Crohn’s disease symptoms, their impact on your ability to work, and your efforts to manage your condition can strengthen your short or long term disability claim.

Evidence you may use to substantiate your Crohn’s disease disability claim may include:

  • Diagnosis and Medical History: Obtain records of your Crohn’s disease diagnosis from a gastroenterologist (or other relevant specialist) and document any family history of Crohn’s disease or other relevant genetic factors. Diagnostic testing for Crohn’s disease can include pathology reports from biopsies taken during endoscopy or colonoscopy procedures, imaging studies (such as CT scans, MRI scans, or small bowel series) that show inflammation, ulcers, or other signs of Crohn’s disease in the gastrointestinal tract, blood tests that may include markers of inflammation (such as C-reactive protein and erythrocyte sedimentation rate), complete blood count (CBC), and tests to assess nutrient deficiencies.

  • Imaging Results: You may provide your insurance company with copies of imaging reports and studies that highlight inflammation, strictures, fistulas, or other complications associated with Crohn’s disease.

  • Treatment History: Records of medications you have been prescribed to manage Crohn’s disease, including dosages and any changes made to your treatment plan, should be submitted to support your disability claim. You should also note any medication side-effects you experience. If you have undergone any surgeries or procedures related to your Crohn’s disease management, obtain these records and submit them to your insurance company.

  • Office Visit Notes: Detailed notes from your healthcare provider visits, including gastroenterologists, primary care physicians, and other specialists, can be used to show your insurance company documentation of your ongoing symptoms, the impressions of your providers from in-person physical examinations, and the impact of Crohn’s disease on your daily life.

  • Symptom Documentation: You may consider keeping a personal journal that describes your symptoms, including pain, fatigue, diarrhea, and their frequency and intensity. You should also record how your symptoms affect your ability to work, perform household tasks, and engage in social activities.

  • Functional Capacity Evaluation (“FCE”): If your Crohn’s disease symptoms have a significant impact on your physical functioning, you may consider undergoing an FCE. A licensed physical therapist or evaluator will perform a series of tests to measure your physical abilities and limitations, including sitting, standing, walking, squatting, and hand dexterity. The FCE report provides an in-depth objective analysis of your physical functioning restrictions.

  • Neuropsychological Evaluation: Crohn’s disease symptoms may cause cognitive issues, and a neuropsychological evaluation will assess any impairments you are experiencing. The evaluation report will provide an objective and detailed analysis of your cognitive deficits not ordinarily recorded by your regular healthcare providers during office visits.

  • Mental Health Treatment: If applicable, you should provide your insurance company documentation of any secondary mental health challenges, such as depression or anxiety, that stem from the impact of your Crohn’s disease. You may request your treating mental health professional to provide a letter of support that explains how your Crohn’s disease has caused these mental illness symptoms.

  • Vocational Evidence: Vocational evidence to support your Crohn’s disease disability claim may include an official job description, a personal affidavit that explains how your Crohn’s disease hinders you from meeting your job demands, and statements from your employer and/or colleagues detailing how your work performance has been affected by your symptoms. You may also opt to undergo a vocational assessment. A vocational assessment is conducted by an expert trained in evaluating the impact of medical conditions on an individual’s ability to work. The vocational report analyzes your skills, abilities, limitations, and the effects of your Crohn’s disease in order to determine your capacity to engage in different types of employment. This evidence substantiates the direct link between your Crohn’s disease symptoms and their impact on your professional performance.

Submitting evidence for a Crohn's Disease disability claim - picture of medical files

When submitting evidence to your insurance company, it’s important to provide clear, organized, and up-to-date records that clearly demonstrate the severity and impact of your Crohn’s disease. If you’re unsure about which specific documents to include, it’s essential to consult with an ERISA attorney who can guide you through the process.

How Can The Maddox Firm Help Prove My Crohn’s Disease Claim?

Establishing a viable disability claim for a condition like Crohn’s disease can be challenging and stressful, especially if you are unfamiliar with how the disability claims process works. The experienced team at The Maddox Firm understands how to help our clients successfully file for short or long term disability benefits due to Crohn’s disease.

Here are a few ways we can help you with your Crohn’s disease claim:

  • Examining your disability insurance policy: Your disability insurance policy provides key information on what criteria you must meet to qualify for benefits. Policy language can be confusing and complex. The Maddox Firm is highly familiar with these policies, including short term, long term, group, and individual. We will examine your policy and explain the terms to you, including any special clauses, eligibility requirements, or benefit limitations.

  • Gathering medical and vocational evidence: The Maddox Firm will work closely with your healthcare providers and employer to request and gather the necessary documentation needed for your short or long term disability claim. We make sure that your medical records accurately reflect your condition and its effects on your daily life and ability to work, and that your vocational evidence encompasses the scope of your occupational demands.

  • Obtaining additional evidence for your claim: To ensure that your disability claim demonstrates the full extent of your Crohn’s disease disability, The Maddox Firm can recommend additional testing, such as the FCE, neuropsychological evaluation, or vocational evidence, that will further document your disabling symptoms and their impact on your ability to work. We will also coordinate with your providers to obtain letters of support that outline your symptoms and your doctor’s opinion on whether your Crohn’s disease prevents you from working. These pieces of evidence can be crucial to proving your claim.

  • Taking over communications with your insurance company: Once retained, The Maddox Firm handles all communications with your insurance company on your behalf. We make sure your insurance company meets their obligations and deadlines, while providing them with all necessary paperwork in a timely manner. Our goal is to streamline the process to prevent any delay in deciding your claim.

  • Filing an appeal, litigation, or negotiating a settlement: If your Crohn’s disease short or long term disability claim has been denied, you typically have the opportunity to appeal your insurance company’s decision through an internal administrative process. The Maddox Firm has helped hundreds of clients successfully appeal an adverse determination and win their benefits. We can prepare and file an administrative appeal on your behalf. If your claim has been denied on appeal, The Maddox Firm can help you sue your insurance company and represent you in litigation. If your insurance company offers you a lump sum settlement to buy out your disability claim, The Maddox Firm can assist you with in negotiating a fair settlement.

Whether you are looking for assistance in navigating the claims process, appealing a denial, or litigating a final adverse decision, The Maddox Firm can help with your Crohn’s disease disability claim. 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 for Crohn’s disease.

Contact us to help you file your claim, appeal, or litigation the right way.


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