Over 200,000 people in the U.S. are hospitalized each year due to diverticulitis, with hundreds of thousands more affected. The symptoms of diverticulitis—including abdominal pain, digestive problems, and nausea—can highly disrupt your life and daily activities. If your diverticulitis prevents you from working, you may consider pursuing short or long term disability insurance benefits.
Understanding the nuances of the short and/or long term disability claims process can be challenging and overwhelming. The experienced team at The Maddox Firm can help. In this article, we’ll discuss strategies for filing for short and/or long term disability benefits due to diverticulitis and how The Maddox Firm can prove your claim.
How Can Diverticulitis Cause Short or Long Term Disability?
Diverticulitis is a medical condition that occurs when small pouches that form in the walls of the colon, called diverticula, become inflamed or infected. These pouches typically develop in areas where the colon’s muscular wall is weaker, allowing the inner lining of the colon to protrude through and form these small, bulging sacs.
The exact cause of diverticulitis is not fully understood, but it is thought to be related to a combination of factors, including a low-fiber diet, genetics, and increased pressure in the colon. A diet low in fiber can lead to harder stools, which require more pressure to move through the colon. This increased pressure can contribute to the development of diverticula.
The symptoms of diverticulitis may include:
Abdominal Pain: Severe, cramp-like abdominal pain, often localized in the lower left side of the abdomen, is a hallmark symptom of diverticulitis. This pain can be intense and disabling, making it difficult for you to perform daily activities.
Fever and Chills: In the case of diverticulitis with infection, you may experience fever and chills, which can be accompanied by weakness and fatigue, further limiting your ability to function normally.
Changes in Bowel Habits: Diverticulitis can lead to alterations in bowel habits, such as diarrhea or constipation. These changes can be disruptive and may cause discomfort.
Nausea and Vomiting: Some individuals with diverticulitis may experience nausea and vomiting, which can be particularly incapacitating.
Bloating and Gas: Abdominal bloating and excessive gas can contribute to discomfort and may affect your ability to engage in regular daily activities.
Loss of Appetite: The combination of pain, nausea, and other symptoms can lead to a loss of appetite, potentially resulting in weight loss and reduced energy levels.
Abscess Formation: In severe cases, diverticulitis can lead to abscess formation, perforation, or the development of fistulas. These often require hospitalization and surgical intervention and can result in an extended period of disability.
While most people with uncomplicated diverticulitis can recover with appropriate treatment, if you experience an acute episode of diverticulitis, you may become temporarily unable to work and be hospitalized in severe cases. There are also some situations in which diverticulitis can lead to more serious complications that may have longer-term consequences:
Recurrence: You may experience recurrent episodes of diverticulitis, which can be disruptive to your daily life and ability to work.
Complications: As mentioned above, severe cases of diverticulitis may result in complications such as abscess formation, perforation, or the development of fistulas. These serious complications may require surgical intervention. Recovery from surgery can take time, and in some cases, it may result in long-term changes in bowel habits.
Chronic Symptoms: While many people recover from acute diverticulitis episodes, you may develop chronic symptoms such as abdominal pain, bloating, or changes in bowel habits even after the acute episode has resolved. This can affect your quality of life and ability to perform your occupational duties in the long term.
Can I Receive Short or Long Term Disability Benefits for Diverticulitis?
It is possible to receive short or long term disability for diverticulitis, but it will depend on the severity of your condition, the terms of your insurance policy, and the duration of your disabling symptoms.
Short term disability insurance typically provides benefits for a relatively short duration, such as a few weeks to a few months, if you are unable to work due to a medical condition such as diverticulitis. For those experiencing an acute diverticulitis episode that subsides after treatment, short term disability may be an option for income replacement during your recovery period.
Long term disability insurance is designed to provide benefits for a more extended amount of time beyond the short term disability coverage. It typically starts providing benefits after a waiting period, which may be 90 days or more. To qualify for long term disability benefits, you usually need to demonstrate that diverticulitis prevents you from performing the duties of your own occupation or any occupation, depending on the policy terms, for an extended period of time.
When it comes to diverticulitis, whether you can receive disability benefits will depend on the following factors:
Severity of Your Condition: You must be able to prove that your diverticulitis symptoms are severe and frequent enough to prevent you from performing your occupational duties.
Policy Terms: To be awarded benefits, you must meet the eligibility criteria as laid out in your insurance policy. Different policies may have varying definitions of disability, waiting periods, benefit amounts, and pre-existing condition clauses.
Medical and Vocational Documentation: You will likely need to provide medical evidence, including doctor’s reports and treatment records, to support your claim for disability benefits. Additionally, your insurance company will require vocational documentation that details the demands of your occupation and why you cannot perform these functions due to diverticulitis. We’ll discuss more of what evidence you can provide your insurance company in the next section.
To determine your eligibility for disability benefits related to diverticulitis, it’s always recommended you speak with a long term disability attorney experienced in disability claims. A knowledgeable disability attorney can review your policy and help guide you through the disability claims process.
How Do Insurance Companies Evaluate Diverticulitis Disability Claims?
Insurance companies evaluate diverticulitis disability claims based on specific criteria outlined in your policy. While the exact process can vary depending on your insurance provider and policy terms, here’s a general overview of how insurance companies may evaluate disability claims for diverticulitis:
Medical Documentation: Your insurance company will typically require extensive medical documentation to assess the severity of your diverticulitis and its impact on your ability to work. This documentation may include detailed medical records, physician statements, diagnostic test results, reports of any relevant tests, such as imaging studies or colonoscopies, and records of surgeries, hospitalizations, medications, and other treatments related to diverticulitis.
Policy Definitions: Your insurance policy will have a specific definition of disability. Some policies may require that you are unable to perform the duties of your own occupation, while others may use broader definitions, such as being unable to engage in any gainful employment. Understanding your policy’s definition of disability is crucial when filing a claim.
Waiting Period: Disability insurance policies often have waiting periods before benefits become payable. For short term disability, this waiting period is usually shorter (e.g., 7 to 14 days), while long term disability may have a longer waiting period (e.g., 90 days). You must be unable to work for the entire waiting period before any benefits are paid.
Duration and Recurrence: Insurance companies may assess whether your diverticulitis is expected to be a temporary or long-term condition. If they believe it is temporary, you may qualify for short term disability benefits, whereas long term disability benefits may be considered if your condition is expected to persist.
Pre-Existing Conditions: Some policies have pre-existing condition clauses, which may exclude coverage for conditions that were diagnosed or treated before your policy’s effective date. If your diverticulitis falls under such a clause, you may face challenges in obtaining benefits.
How Do I Prove My Diverticulitis Disability Claim?
Proving your diverticulitis disability claim to an insurance company requires demonstrating through medical and vocational evidence the extent of your symptoms and how they impact your ability to work. Diverticulitis can be a particularly challenging condition to obtain short and/or long term disability benefits due to the nature of its symptoms. Many symptoms of diverticulitis are considered subjective, meaning they are not easily substantiated with objective testing and evidence. Your insurance company may view symptoms like abdominal pain, changes in bowel habits, or fatigue as self-reported, making it more challenging to demonstrate the severity of your condition.
Medical Evidence of Diverticulitis
Gathering and presenting comprehensive evidence of your symptoms is crucial to the success of your diverticulitis claim. Incomplete or inconsistent documentation may lead to your claim being denied.
Here are examples of medical evidence you can use to help you effectively prove your diverticulitis disability claim:
Medical Records: Gather all relevant medical records, including those from gastroenterologists, surgeons, or other specialists who have treated your diverticulitis. These records should include your diagnosis of diverticulitis and detailed descriptions of your symptoms, such as abdominal pain, changes in bowel habits, fever, and other related symptoms.
Blood Tests: Blood tests can help assess the extent of inflammation and infection associated with diverticulitis. Common blood tests to measure the scope of your diverticulitis include Complete Blood Count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
Imaging Studies: CT scans of the abdomen and pelvis are one of the most common imaging studies used to diagnose diverticulitis. They can provide detailed images of the colon and show signs of inflammation, abscesses, or complications. In some cases, ultrasound may be used to evaluate the presence of diverticula and signs of inflammation, especially if a CT scan is not immediately available or if radiation exposure is a concern. These studies and reports should be submitted to your insurance company to support your claim.
Colonoscopy: While colonoscopy is not typically used to diagnose acute diverticulitis due to the risk of perforation, it may be recommended after the acute episode has resolved to evaluate the extent of diverticulosis (the presence of diverticula in the colon) and rule out other gastrointestinal conditions.
Barium Enema: In some cases, a barium enema may be used to visualize the colon and identify diverticula or complications.
Sigmoidoscopy: Sigmoidoscopy involves inserting a flexible tube with a camera (sigmoidoscope) into the rectum and lower colon to evaluate the area for signs of diverticulitis. It is used less frequently than colonoscopy but may be considered if diverticulitis is suspected in the lower part of the colon.
Magnetic Resonance Imaging (MRI): An MRI may be used in some cases to visualize the colon and surrounding structures without using radiation.
Physician Statements: Obtain statements from your treating healthcare provider(s) who can provide expert opinions on your condition. It’s always recommended to have a specialist, such as a gastroenterologist, provide the statement, as they will be the most informed on your condition. The physician statements should describe the severity of your diverticulitis and any complications, explain how your symptoms and limitations affect your ability to perform your job duties, and include the provider’s assessment of your prognosis and whether they believe your condition is expected to be long-term or recurring.
Prescription Medications: Include documentation of any prescription medications you are taking to manage diverticulitis. This can help demonstrate the medical necessity of your treatment.
Surgical and Hospitalization Records: If you’ve undergone surgery or been hospitalized due to diverticulitis, include these records as they can illustrate the severity of your condition and the medical interventions required.
Functional Capacity Evaluation (“FCE”): For more comprehensive and objective evidence of how your diverticulitis affects your physical functioning, you may undergo a functional capacity evaluation (“FCE”). This evaluation assesses your physical and functional abilities and limitations in the context of your job requirements.
Treatment Plans and Compliance: Show that you have been actively seeking medical treatment and adhering to your doctor’s recommended treatment plan, including any dietary restrictions or lifestyle modifications.
Non-Medical Evidence for Diverticulitis
Aside from medical records from your treating providers, you may submit other kinds of evidence to support your diverticulitis short or long term disability claim. This can include:
Symptom Diary: Maintain a detailed diary that documents your diverticulitis symptoms, their frequency, and severity. This personal account can complement your medical records and provide additional evidence of the impact on your daily life.
Vocational Evidence: Your resume, official job description, and a vocational assessment can all provide your insurance company with detailed information on your job role. This gives your insurance company a better understanding of what level of functioning your occupation requires and how your diverticulitis prevents you from meeting these demands.
Employer Statements: Request statements from your employer and/or supervisor describing how your diverticulitis symptoms have affected your job performance and attendance.
Witness Statements: Gather statements from family members, friends, and/or coworkers who can attest to the impact of your diverticulitis on your daily life and work.
Having comprehensive and well-documented evidence is key to demonstrating the severity of your diverticulitis and its impact on your ability to work. An experienced long term disability attorney can be invaluable in gathering this evidence, especially if your claim is initially denied or if you encounter challenges during the claims process. An experienced attorney can help you navigate the process, obtain your evidence, and present your claim to your insurance company in the most effective way possible.
How Can The Maddox Firm Help Prove My Diverticulitis Claim?
The Maddox Firm has helped hundreds of clients successfully file for short or long term disability benefits. Due to the subjective nature of diverticulitis, it can be particularly challenging to prove your claim. Our experienced team understands what documentation your insurance company will expect to award you benefits.
Here are a few ways we can help you with your diverticulitis claim:
We examine your insurance policy. Your disability insurance policy is key to planning a winning strategy for your diverticulitis claim. Policy language can be difficult to understand if you are not familiar. The Maddox Firm will examine your policy and explain to you the terms and eligibility requirements you must meet to secure your benefits.
We review your medical and vocational evidence. Because of the subjective symptoms associated with diverticulitis, it can be challenging to gather sufficient objective evidence of your symptoms and limitations. The Maddox Firm will request and obtain your medical records, review the treatment notes to determine if there is any missing information or red flags your insurance company will question, and formulate a strategy to obtain any necessary additional evidence.
We help you obtain additional evidence to support your claim. The Maddox Firm understands what documentation your insurance company expects to approve your diverticulitis claim. If needed, we will refer you to undergo additional testing, whether a Functional Capacity Evaluation that assesses your physical functioning or a vocational assessment to substantiate your occupational demands. The Maddox Firm coordinates with the evaluators to review the reports for accuracy and completeness. We will make sure they reflect the full scope of your diverticulitis disability and its impact on your ability to work. In addition, we also communicate with your treating doctors to proffer supplemental opinion letters to support your diverticulitis disability claim. This can all be submitted to your insurance company as valuable evidence of your diverticulitis’s impact on your ability to work.
We handle all communications with your insurance company. Once retained, The Maddox Firm steps in to take over all communications with your insurance company on your behalf. We will complete and submit all necessary paperwork on your behalf in a timely manner and make sure that your insurance company meets all of their required deadlines. Should your insurance company request an interview, your attorney will prepare you beforehand and attend the meeting to safeguard you from any overstepping or inappropriate questions.
We will file your appeal, litigation, or negotiate your settlement. If your diverticulitis short or long term disability claim is denied, The Maddox Firm can prepare and file an administrative appeal on your behalf. If your claim has been denied on appeal, The Maddox Firm can represent you in litigation with your insurance company. Your insurance company may also at some point offer a lump sum settlement to buy out your disability claim. The Maddox Firm routinely handles disability insurance appeals, litigation, and negotiations.
We always recommend speaking with a trusted attorney before filing or appealing a diverticulitis short or long term disability insurance claim. Whether you are looking for assistance in navigating the claims process, appealing a diverticulitis 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.