Ankylosing spondylitis is a serious condition that can affect your ability to perform your job and earn a living. If you have been diagnosed with AS and you are struggling to cope with your symptoms, you may wonder if you are eligible for disability insurance benefits. In this article, we will explain how ankylosing spondylitis affects your work capacity and what you need to know when filing for short or long term disability benefits.
Can I Get Short or Long Term Disability for Ankylosing Spondylitis?
Ankylosing spondylitis (“AS”) is a chronic inflammatory disease that affects the spine and other joints. It can cause severe pain, stiffness, and reduced mobility. If you have AS and you are unable to work because of your condition, you may qualify for short or long term disability benefits.
Short term disability benefits are usually provided by your employer or a privately purchased insurance policy and cover a portion of your income for a limited period of time, usually between three and six months. Long term disability benefits are also provided by private insurers, and they cover a larger percentage of your income for a longer period of time, typically until you reach retirement age or recover from your disability.
To qualify for short or long term disability benefits, you need to meet the eligibility criteria of your disability policy. The definition of disability you must meet may vary depending on the type of policy provided by your insurance company. Generally, you need to show that you have a medically determinable impairment that prevents you either from performing your own occupation or any other occupation for which you are reasonably qualified. You also need to show that you have been under the care of a physician and have followed the prescribed treatment for your condition. You may also need to satisfy a waiting period before you can start receiving benefits, which can range from a few days to several months.
Ankylosing spondylitis disability claims come with a number of unique challenges. These can include:
Fluctuating Nature of Symptoms: Ankylosing spondylitis is characterized by periods of flare-ups and remission, which can make it challenging to demonstrate a consistent level of disability. The fluctuating nature of symptoms means that your ability to function can vary significantly over time. This variability can lead to skepticism from insurance companies, as they might assess your condition during a period of remission, not fully appreciating the severity of your symptoms during flare-ups.
Invisibility of Symptoms: Many symptoms of AS, such as chronic pain and fatigue, are subjective and invisible to others. This invisibility can make it difficult to convey the severity of these symptoms and their impact on your daily functioning. The debilitating effects of AS are not always readily apparent, which can lead to misunderstandings or underestimation of your condition’s severity by your insurance company.
Younger Patient Bias: AS often affects individuals in their late adolescence or early adulthood, a demographic typically perceived as being in their prime working years. This can lead to a bias where the symptoms and limitations of younger patients are not taken as seriously as they would be in an older population. Additionally, insurance companies may be reluctant to approve a disability claim for someone they can foresee being paid benefits for many years. Younger individuals with AS may face additional scrutiny from the insurance company and need to provide more compelling evidence to prove that their condition genuinely limits their ability to work, despite their age.
Delayed Diagnosis and Documentation: The early symptoms of AS can be nonspecific and are often mistaken for more common back problems. This can lead to a delayed diagnosis, and consequently, a lack of early medical documentation of the condition. In disability claims, a long and well-documented medical history can significantly strengthen a case. The challenge for many with AS is to retrospectively demonstrate the impact of the condition from the onset of symptoms, despite the possible absence of early medical records specifically related to AS.
Each of these challenges necessitates a strategic approach in compiling and presenting a comprehensive and compelling disability claim. The key lies in detailed and consistent medical documentation, supplemented by supportive statements from healthcare professionals and others who can attest to your experiences and limitations.
How Does Ankylosing Spondylitis Cause Disability?
Ankylosing spondylitis (“AS”) can lead to disability through a range of symptoms that affect both physical and cognitive functions. These symptoms may include:
Chronic Pain and Stiffness: AS primarily affects the spine, causing significant pain and stiffness, especially in the lower back and hips. This can limit mobility and make everyday activities, including job-related functions, challenging.
Inflammation of Joints (Arthritis): Besides the spine, AS can also affect other joints like shoulders, ribs, and hips, leading to pain and reduced range of motion.
Fatigue: A common symptom of AS, fatigue can be debilitating, reducing your ability to carry out daily tasks and maintain employment.
Reduced Spinal Mobility: Over time, AS can lead to a fusion of the vertebrae, significantly limiting the flexibility and mobility of the spine.
Postural Changes: Advanced AS can cause a hunched-forward posture, which can affect balance and increase the risk of falls.
Eye Inflammation (Uveitis): This can lead to pain, sensitivity to light, and blurred vision.
Osteoporosis and Fracture Risk: People with AS may develop osteoporosis, increasing the risk of spinal fractures.
Cognitive Fatigue: Chronic pain and fatigue associated with AS can lead to cognitive fatigue, making it difficult to concentrate, remember things, or process information quickly.
Depression and Anxiety: The chronic nature of AS and its impact on lifestyle can lead to secondary mental health issues like depression and anxiety, which can further impair cognitive function.
Sleep Disturbances: AS can cause pain and discomfort that disrupts sleep, leading to sleep deprivation. Poor sleep can impair cognitive functions like memory, attention, and decision-making.
The severity and progression of AS can vary from person to person. Some people may experience mild or intermittent symptoms, while others may have more severe or chronic symptoms. Similarly, you may have periods of remission, where your symptoms improve or disappear, and periods of flare-ups, where your symptoms worsen or reappear. AS can also cause complications such as spinal fusion (which can cause permanent loss of mobility and posture), cardiovascular disease, or diabetes.
How Do I Prove My Ankylosing Spondylitis Disability Claim?
Proving an ankylosing spondylitis (“AS”) disability claim involves providing comprehensive medical evidence and documentation that clearly demonstrates how the condition limits your ability to work and perform daily activities. Here are examples of evidence that can support your AS disability claim:
Medical Imaging: X-rays, MRI, or CT scans can show evidence of inflammation or damage in the spine and sacroiliac joints, which are characteristic of AS.
Blood Tests: While there’s no specific blood test for AS, tests like the HLA-B27 marker can support the diagnosis, along with tests for inflammation markers like ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein).
Doctor’s Diagnosis and Medical Records: A formal diagnosis of AS from a rheumatologist, along with detailed medical records documenting the progression of the condition, treatments tried, and responses to those treatments, can be valuable evidence to support your claim.
Records of Treatments: Typically, disability policies require you to seek appropriate treatment in order to qualify for benefits. Make sure to provide your insurance company documentation of medications, physical therapy, and other treatments you have undergone, demonstrating compliance and effectiveness (or lack thereof).
Side Effects of Medications: If applicable, document how the side effects of medications further limit your capabilities. Keep a detailed account of each side effect's direct impact on your daily activities and overall well-being. It's also important to note any changes in your physical or mental health that may be attributed to these side effects over time.
Statements from Healthcare Providers: Obtain attending physician statements and letters from your doctors detailing how AS affects your physical and cognitive abilities. These documents should provide a comprehensive overview of your condition and symptoms illustrating the specific ways in which AS impacts your daily life and functionality. Additionally, they should include specific restrictions and limitations that prevent you from being able to perform your occupation or any occupation.
Statements from Employers or Coworkers: These can provide insight into how your AS has impacted your job performance and daily work activities. These statements can offer a third-party perspective on the practical challenges you face, highlighting any changes in productivity or work habits. They also serve to corroborate your own account of how AS affects your professional life, providing a more holistic view of your condition's impact in the workplace.
Functional Capacity Evaluation (“FCE”): A functional capacity evaluation can provide objective data on your physical abilities and limitations, such as lifting capacity, flexibility, endurance, and ability to stand or sit for prolonged periods.
Pain Journals or Diaries: Keep a record of daily pain levels, mobility issues, and how your symptoms affect your daily activities. This can be used as evidence to substantiate your symptoms to your insurance company. Additionally, documenting the emotional and psychological impact of your pain can provide a more comprehensive view of your condition. Over time, these records can also help track the progression of your symptoms and the effectiveness of treatments, aiding in the adjustment of your care plan.
Successfully securing short or long term disability for AS requires a well-documented claim that clearly illustrates how your condition impairs your ability to work. Working closely with a long term disability attorney experienced in ERISA claims can help strengthen your case.
How Can The Maddox Firm Prove My Ankylosing Spondylitis Disability Claim?
The experienced team at The Maddox Firm has helped hundreds of our clients successfully secure their disability insurance benefits, including many for arthritic conditions such as ankylosing spondylitis (“AS”). We understand the episodic nature of AS and are skilled in documenting how these fluctuations impact your ability to work consistently. Our team knows how to effectively communicate the severity of invisible symptoms like pain and fatigue to insurers, a crucial aspect of AS claims.
Here are just a few ways we can help prove your ankylosing spondylitis claim:
We Examine Your Policy and Assess Your Claim: Our first step is to thoroughly review your insurance policy to understand the coverage and the specific requirements for a disability claim. We assess your AS claim against these criteria, helping to identify any potential issues and strategize the best approach for your claim.
We Handle All Communications with Your Insurance Company: Dealing with insurance companies can be overwhelming, especially when managing a condition like AS. The Maddox Firm takes over all communications with your insurance provider, ensuring that all correspondence is handled professionally and in a manner that advances your claim. Our experience with AS claims means we’re adept at articulating the complexities of the condition, ensuring that your insurance company fully understands the extent of your disability.
We Help You Obtain Evidence to Support Your Claim: Strong medical evidence is crucial for AS claims due to the invisible and fluctuating nature of the condition. We work with you to compile comprehensive medical records, including diagnostic tests, treatment histories, and doctor’s statements. We also assist in arranging for additional evaluations, such as Functional Capacity Evaluations, which can provide objective evidence of your physical limitations. Our team understands the importance of documenting not only the physical impacts of AS but also the cognitive and psychological effects, ensuring a well-rounded presentation of your disability.
We Handle Appeals and Litigation: If your claim is initially denied, The Maddox Firm is prepared to handle appeals and, if necessary, litigation. We are experienced in navigating the complexities of ERISA and other long term disability claims and will represent your interests aggressively to secure the benefits you deserve.
Whether you are looking for assistance in navigating the short term disability or long term disability claims process, appealing a claim denial, or 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.