Migraines are not just ordinary headaches – they are a neurological condition characterized by severe and often incapacitating symptoms. When migraines become chronic, which means they occur on 15 or more days per month for at least three months, the impact on your life can be devastating. If you suffer from chronic migraines, you may become unable to work and want to know your options for pursuing short or long term disability benefits.
In this article, we’ll discuss how chronic migraines cause disability, how insurance companies evaluate chronic migraine disability claims, and how The Maddox Firm can help prove your short or long term disability claim.
How Do Chronic Migraines Cause Disability?
Chronic migraines can cause disability due to their frequent and debilitating nature. Here are some ways chronic migraines can lead to disability:
Severe Pain: Migraine attacks are often accompanied by intense throbbing head pain, which can last for hours or even days. This pain can be so severe that it’s impossible for you to function at work or in their daily life.
Other Physical Symptoms: Migraines are not just about head pain; they often come with other symptoms like nausea, vomiting, sensitivity to light, and sound. These additional symptoms can further incapacitate you and make it impossible for you to carry out their normal activities.
Cognitive Impairment: Migraine-related symptoms can lead to cognitive dysfunction in many areas, including difficulty concentrating, memory problems, slowed processing speed, visual disturbances, and brain fog. When these cognitive impairments are severe and frequent, they can significantly hinder your ability to perform work-related tasks and maintain employment.
Frequent Attacks: Chronic migraines are defined by their frequency. Having migraines on more than half the days in a month can make it very difficult to maintain a regular job schedule.
Lost Productivity: When your migraines strike, you may need to take excessive time off from work, more than what any employer would find reasonable or have the ability to accommodate.
Medication Side Effects: To manage chronic migraines, you may be prescribed various medications. These medications can have side effects that, in some cases, are as debilitating as the migraines themselves. The side effects can interfere with daily life and work performance. Side effects can be disabling on their own.
Emotional Impact: Chronic migraines can lead to emotional distress, anxiety, and depression. This emotional toll can further contribute to disability by affecting your mental health and overall well-being.
Chronic Pain Syndrome: Over time, experiencing chronic pain can lead to the development of a condition known as chronic pain syndrome, in which the pain becomes a central focus of your life, leading to further disability.
Can I Receive Disability Benefits for Chronic Migraines?
It is possible to receive short or long term disability insurance benefits for chronic migraines, but whether your claim will be approved depends on the specific terms of your insurance policy and what evidence of your chronic migraine disability you submit to your insurance company.
Short term disability (“STD”) insurance typically provides partial replacement of your income for a limited period (usually up to six months) when you are unable to work due to a covered medical condition, including chronic migraines. Long term disability (“LTD”) insurance comes into play when you have a condition that is expected to last for an extended period, often beyond six months.
Both STD and LTD claims will require that you meet the policy’s “definition of disability” in order to be awarded benefits. Generally speaking, your eligibility for STD and/or LTD will depend on demonstrating with substantial evidence that your chronic migraines cause debilitating symptoms that prevent you from performing the material duties of your occupation.
In all cases, it’s crucial to understand the terms and conditions of your specific insurance policy, maintain thorough medical documentation, and work closely with your healthcare providers to support your claim. It’s always recommended that you consult with a long term disability attorney, especially if your claim is denied or if you encounter any challenges during the process.
How Do Insurance Companies Evaluate Chronic Migraine Disability Claims?
Insurance companies evaluate chronic migraine disability claims based on specific criteria and documentation. The process can be detailed and sometimes challenging, as insurance companies aim to ensure that the claimant genuinely qualifies for benefits. Here are some key factors insurance companies typically consider when evaluating chronic migraine disability claims:
Diagnosis and Medical Documentation: Your insurance company will look for a formal diagnosis of chronic migraines by a qualified medical professional, such as a neurologist or headache specialist. Medical records should include your diagnosis, treatment history, and any diagnostic tests that support the diagnosis.
Appropriate Treatment: Most disability insurance policies provide that you seek appropriate treatment for your chronic migraines. Your insurance company will note whether you have been complying with your doctors’ recommendations and assess the effectiveness of your treatment plan.
Severity and Frequency of Migraine Attacks: Your insurance company will consider the frequency and severity of your migraine attacks. Chronic migraines are usually defined as occurring 15 or more days per month for at least three months. Your insurance company may request details about the duration and intensity of your migraine attacks.
Functional Limitations: The impact of chronic migraines on your ability to work is a critical factor. Your insurance company will assess how your condition limits your ability to perform essential job tasks. They may consider factors like pain, fatigue, concentration difficulties, sensitivity to light and sound, and cognitive impairment during migraine episodes, and how these symptoms prevent you from meeting occupational demands.
Medical Opinion and Examination: Your insurance company may request an independent medical examination (“IME”) by a healthcare provider of their choosing. Additionally, they may also consult their own medical experts to review your paper file and provide an opinion. This can be problematic since these examiners and medical consultants are paid for by your insurance company, and therefore may be biased to deny your claim.
Filing a disability claim for chronic migraines can be particularly challenging. Migraine symptoms are primarily subjective, meaning they are experienced and described differently by each individual. This subjectivity can make it difficult to provide objective evidence to support your claim and easier for your insurance company to dismiss your very real condition. It’s not uncommon for chronic migraine claims to be denied due to lack of medical documentation and proof of symptoms.
Navigating the disability claim process for chronic migraines can be complex, but with the right support and thorough documentation, it is possible to secure the benefits you need. It is always beneficial to consult with an attorney experienced in disability claims to navigate the process and maximize your chances of getting your short or long term disability claim approved.
How Do I Prove Disability Due to Chronic Migraines?
When seeking disability benefits for chronic migraines, your insurance company will require you to demonstrate that your symptoms impair you from performing your occupational duties. There are several types of evidence you may submit to support your claim.
Medical evidence is crucial to substantiate your chronic migraines. While migraines are primarily characterized by subjective symptoms, there are objective medical findings and evidence that can help establish the severity and impact of your chronic migraines. Here are some examples of medical evidence that can support your chronic migraine claim:
Medical Diagnosis: A formal diagnosis from a qualified healthcare professional, such as a neurologist or headache specialist, is the foundational piece of evidence. Diagnosing migraines typically involves a comprehensive evaluation by your healthcare provider. The process includes clinical assessments, physical examinations, and symptom analysis. In some cases, your doctor may order diagnostic tests, such as MRI or CT scans, to rule out other conditions that could be causing similar symptoms. These tests are typically used to confirm the absence of other neurological issues. Based on the clinical assessment, symptom analysis, and test results, your doctor will confirm whether you have migraines and, if so, classify them as either episodic or chronic.
Medical Records: Comprehensive medical records should document the history and progression of your chronic migraines. These records should include details of the frequency and duration of your migraine attacks, the severity and intensity of each attack, any changes in your migraine patterns over time, and any diagnostic tests (e.g., MRI or CT scans) and their results to rule out other potential causes of your symptoms.
Treatment History: Evidence of various treatments you’ve undergone, including medications, therapies, and lifestyle changes, and their impact on your condition, can support your claim. This can demonstrate that you’ve been actively seeking treatment to manage your migraines.
Prescription Medications: Submit documentation of prescription medications prescribed for migraine management, along with any side effects you experience that may contribute to your disabling condition.
Hospitalization Records: If you have been hospitalized for migraines, these records can serve as objective evidence of the severity and impact of your condition.
Neurological Testing: Neurological tests, such as EEG (electroencephalogram) or imaging studies like MRI (magnetic resonance imaging) or CT (computed tomography) scans, may be conducted to rule out other medical conditions. Any abnormal findings on these tests can support your claim.
Neuropsychological Evaluation: A neuropsychological evaluation can provide objective evidence to support your chronic migraine disability claim by assessing the cognitive impact of migraines on your ability to perform work-related tasks. The evaluation report can help document your cognitive impairments, such as memory problems and reduced processing speed, offering valuable insight into how your chronic migraines impact your ability to work.
Expert Opinions: Statements from your treating healthcare providers, such as neurologists or pain specialists, regarding your limitations and how chronic migraines affect your ability to work and engage in daily life can be persuasive medical evidence. It’s always recommended that you have a specialist provide this statement, as they will have the most insight into your condition.
Beyond medical documentation of your chronic migraines, your insurance company will also want proof that your symptoms specifically prevent you from working. Other evidence you can use to support your claim include:
Migraine Diary: Keeping a detailed migraine diary can provide your insurance company more information about the frequency and intensity of your attacks. Your diary should include information on triggers, aura, symptoms, medication usage, and how your migraines affect your daily life. The more detail and consistency, the better. The diary can lend credibility to your subjective symptoms.
Employment Records: Detailed employment records, including your official job description, performance evaluations, and attendance records, can demonstrate your work history and how chronic migraines may have affected your job performance.
Employer and/or Colleague Statements: Statements from your employer, colleagues, or supervisors who have observed the impact of your migraines on your work performance can be persuasive evidence. These statements can provide insights into how your migraines impacted your ability to maintain regular attendance, meet job requirements, or perform essential job tasks.
Vocational Assessment: A vocational expert can evaluate your job-related limitations and potential for gainful employment while considering the restrictions imposed by your chronic migraines. The resulting vocational assessment provides your insurance company ample evidence of your specific job functions, both physical and cognitive, and how your chronic migraines interact with your ability to meet these demands. The expert’s opinions can carry significant weight with your insurance company.
How Can The Maddox Firm Prove My Chronic Migraine Disability Claim?
The Maddox Firm regularly helps our clients secure their short and/or long term disability claims, including for chronic migraines. Conditions like this with invisible and often subjective symptoms can be especially difficult to prove to insurance companies, who are looking for any reason to deny your claim and boost their profit margins. The Maddox Firm understands what documentation is needed to get your benefits approved.
Here are a few ways The Maddox Firm can help prove your chronic migraines disability claim:
The Maddox Firm examines your policy. We thoroughly review your disability policy to ensure it adequately covers your chronic migraines. This includes examining policy provisions related to definitions of disability, waiting periods, coverage limits, and any applicable exclusions. We can offer insights into whether the policy aligns with your specific needs and health condition, helping to prevent potential disputes or claim denials down the line.
The Maddox Firm handles all communications with your insurance company. We immediately take over all communications and correspondence with your insurance company, submitting all required documents accurately and promptly. At the same time, we protect your rights and ensure that your insurance company meets their own deadlines and obligations. If your insurance company tries to request an interview with you, we will push back on your behalf. Should an interview proceed, we attend the interview with you to make sure your rights are protected.
The Maddox Firm gathers and evaluates your evidence. The Maddox Firm will request and obtain medical records on your behalf, and our team will review your records to ensure they accurately reflect the impact of migraines on your health and work capabilities. We will also coordinate with your healthcare providers to obtain supplemental statements and expert opinions. Additionally, we may advise you to maintain migraine diaries and arrange for further testing, such as a neuropsychological evaluation, to provide objective evidence of your condition’s severity and limitations.
The Maddox Firm will handle an appeal or litigation on your behalf. If your chronic migraine disability claim has been denied or your benefits are terminated, The Maddox Firm can handle your appeal or litigation with your insurance company.
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. Our experienced team 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 chronic migraines.