Disability Due to COPD
Chronic obstructive pulmonary disease, also known as “COPD,” causes breathing difficulty and other serious symptoms that may result in short or long term disability. However, a COPD diagnosis will not automatically qualify you for short or long term disability benefits. For your COPD disability claim to succeed, you must first demonstrate to your insurance company how your COPD restricts your ability to perform the material duties of your occupation.
attorney experienced in short and long term disability claims can help you file for and win your short and/or long term disability benefits for COPD.
If you file for disability due to COPD, you must inform your insurance company of your symptoms, their severity and frequency, and how they inhibit you from working.
COPD is a progressive lung condition typically caused by smoke exposure. COPD causes inflammation of the lungs that then reduces airways. COPD can cause respiratory problems such as:
Shortness of breath (usually exercised-induced in beginning stages, and then progressing over time)
Recurring lung infections
Other non-respiratory symptoms from COPD include:
Swelling of lower extremities (legs, ankles, feet, etc.)
Unintentional weight loss
It is common for COPD patients to experience “exacerbations.” A COPD exacerbation is a flareup of symptoms, lasting anywhere from a couple of days to a few weeks. During a COPD exacerbation, your airways narrow due to swelling. Mucus can build up in the airways as well,
causing more acute symptoms than usual. An exacerbation may be triggered by a lung infection, but they can also occur with no known cause. In severe cases, a COPD exacerbation will require antibiotics and/or hospitalization. While COPD is treatable, it is an incurable and progressive disease. Your symptoms will most likely increase in severity and frequency over time. For example, upon your diagnosis, you may only experience coughing fits or breathlessness after exerting yourself in physical activity. Over time, your coughing and shortness of breath may occur even at times of rest.
Complications Due to COPD
COPD can lead to complications in other bodily systems. COPD may increase your risk of cardiovascular issues (such as heart disease and heart attack), high blood pressure, lung cancer, and depression and/or anxiety.
Any of the listed resulting conditions can lead to short or long term disability depending on the nature and severity of your symptoms.
Inability to Work Due to COPD
The physical and cognitive symptoms of COPD are often a barrier to working. At any stage of COPD, you may struggle to continue performing your job duties. For example, chronic fatigue caused by COPD may wreak havoc on your ability to concentrate for long intervals or complete a full workday without excessive and disruptive breaks. Shortness of breath and chronic cough may severely limit your capacity for phone calls, meetings, and any physical functioning associated with your job, whether it be walking, standing, or sitting in one position for extended periods.
Regardless of whether your COPD is in an early stage or late stage, your symptoms may impact your ability to work enough to qualify you for short or long term disability insurance benefits. Receiving disability benefits will be a matter of demonstrating to your disability insurance company how COPD stops you from performing your occupational duties.
How We Prove Disability for COPD
As mentioned earlier, your COPD diagnosis will not guarantee your short or long term disability claim gets approved. Your insurance company will have many questions about your condition: How long ago were your diagnosed with COPD? What symptoms are you experiencing? How does your COPD stop you from working?
COPD is a progressive disease, meaning that your symptoms may have been manageable on the onset of your diagnosis, only to worsen to a point where you can no longer work. Your disability insurance company will want to know the tipping point – what happened with your COPD to make you no longer able to work now?
The experienced team at The Maddox Firm understands what proof your insurance company expects in order to approve your short or long term disability insurance claim. Below we will expand on different types of evidence you can submit to your disability insurance company in support of your COPD disability claim.
Proving Your COPD Disability with Medical Evidence
Insurance companies have a financial incentive to deny your COPD disability claim. Objective medical evidence is typically the most ironclad proof of your COPD diagnosis and disabling symptoms you can present to support your claim.
There are a number of medical tests that can provide evidence of your COPD diagnosis and symptoms. These tests can include:
CT scans, chest x-rays, and other imaging evidencing your COPD
Pulse oximeter readings showing decreased oxygen levels
Pulmonary function testing results (discussed more below)
Arterial blood gases (a blood test used to determine your oxygen and carbon dioxide levels)
When filing a COPD disability claim, one of your first steps should be collecting these medical records from your healthcare providers.
Your disability insurance company will request your doctor(s) complete a form called an Attending Physician Statement. This form certifies that your doctor believes you are disabled from working because of your COPD symptoms. The Maddox Firm typically recommends that our clients have a specialist for their illness/injury complete the Attending Physician Statement, rather than an internist, since the specialist has more insight into the disabling condition.
In addition, your short or long term disability insurance policy will provide that you must be in treatment for your COPD in order to receive benefits. If you are not treating with a specialist, your insurance company may argue you are noncompliant with the terms of the policy. Your disability claim can then be denied on that basis.
COPD is typically treated by a pulmonologist. Your pulmonologist’s support of your COPD disability claim will be essential. Aside from the Attending Physician Statement, your pulmonologist may write a supplemental letter outlining your COPD diagnosis, symptoms, and explain to your insurance company why you can no longer work. Medical records such as office visit notes may contain helpful information regarding your disability. However, those visit notes are not meant for the insurance company, but rather for the doctor’s own reference and record. Therefore, the visit notes may not contain the full picture of all of your symptoms and side effects. A supportive letter from your pulmonologist can provide a detailed history of your COPD and how it stops you from working.
Proving Your COPD Disability with Additional Testing
Several testing options exist to substantiate the extent of your COPD symptoms on your physical functioning.
A Functional Capacity Evaluation. A Functional Capacity Evaluation is an assortment of tests that gauge your physical functioning. The evaluation can assess the extent of your physical restrictions (such as walking, squatting, standing, sitting, hand dexterity, grip strength, etc.). Oftentimes medical records and regular COPD testing/treatment do not give the full picture of your restrictions and limitations. The Functional Capacity Evaluation report gives your insurance company objective proof of how your COPD impedes your ability to perform your occupational duties.
CPET Testing. Cardiopulmonary exercise testing (“CPET”) is a non-invasive test measuring how physical exertion affects your oxygen levels. The CPET testing results can corroborate your self-reported fatigue and exertion-induced COPD exacerbations by offering an objective medical cause for your symptoms.
Pulmonary function testing. There are also specific pulmonary testing options available that can be used to measure your lung capacity. The two most common pulmonary function testing methods are a spirometry (a test using a mouthpiece connected to an electronic device measuring your breathing) and a plethysmography (a breathing test conducted inside a sealed booth). The results of these tests can show evidence of your COPD symptoms. Your pulmonologist may have already administered these tests before diagnosing your COPD.
Proving COPD Prevents You from Working
Your disability insurance company will require proof that your COPD symptoms have forced you to stop working. Most group short and long term disability policy terms define “disabled” as unable to work in your “own occupation.” After a certain period of time, typically two years, your insurance company may then require proof you cannot work in “any
occupation” that is reasonable for your level of education, training, and experience. Whether your disability claim falls under an “own occupation” or “any occupation” standard depends on the terms of your policy. Some disability insurance policies will differ. For example, individual policies purchased by the claimant may not contain any change in definition. Make sure to review your policy carefully before you file a COPD disability claim.
Under an “own occupation” standard, you must demonstrate you cannot perform the “substantial and material” duties of your occupation because of your COPD.
Vocational evidence can provide support for your COPD disability insurance claim. Vocational evidence can include:
Your job description
Statements of support from your employer and/or coworkers
An analytical report from a vocational expert
Your insurance company needs to understand all aspects of your occupation. Otherwise they may make inaccurate assumptions about your everyday duties, demands, and responsibilities. For example, your insurance company may categorize your job as “sedentary” when in actuality, your role entails walking, lifting/carrying, and/or travel, all hindered by your COPD symptoms. You must demonstrate to your insurance company what specific job duties your COPD interferes with and how.
Other Evidence to Support Your COPD Disability Claim
Additional evidence can be submitted to your insurance company for your COPD disability claim, including:
A personal statement. You can write a personal statement or affidavit with your COPD disability claim. The statement can discuss your educational and career background, what tasks your job involves, the history of your diagnosis, your symptoms and their impact on your daily activities, and how your COPD has forced you to leave work. A personal statement can fill in the gaps your medical records and vocational evidence do not cover. It’s also a good way to humanize your disability claim to your insurance company.
Witness statements. You may want to request your spouse, close family member(s), and/or co-workers write a statement in support of your COPD disability claim. A witness statement can expound on what they observed of your COPD illness and how it affected your ability to work.
A symptom diary. You may consider logging your day-to-day symptoms in a journal that you can then submit to your insurance company when filing your COPD disability claim. The symptom diary should include all COPD symptoms you experienced each day, how long your symptoms lasted, and how they affected your daily activities (such as household chores, errands, and hobbies). This record can help substantiate your self-reported symptoms such as headache and fatigue.
The Maddox Firm Can Help with Your COPD Disability Claim
The Maddox Firm routinely handles disability insurance claims, appeals, and litigation for complicated medical conditions like COPD. We can assist with your COPD disability claim from start to finish. Here are a few of the ways The Maddox Firm helps with COPD disability claims:
The Maddox Firm will examine your short or long term disability insurance policy. Disability insurance policies can be difficult to parse if you are unfamiliar with their language. We will determine the criteria your disability claim must meet based on the terms of your insurance policy. This sets the stage for your COPD disability claim strategy and lets you know what to expect.
The Maddox Firm takes over all communication with your insurance company. We will immediately send notice to your insurance company that we are now handling your claim on your behalf. We will take control of all written and phone correspondence with your insurance company representatives. This helps protect you from your insurance company’s misleading questions and underhanded tactics.
The Maddox Firm will gather and review your medical records. We can request medical records on your behalf, examine them for any red flags your insurance company will pick up on, and determine what additional evidence you will need for your COPD disability claim to be successful.
The Maddox Firm will help obtain additional evidence for your disability claim. Whether it is a supplemental letter from your doctor, an official job description from your employer, or referring you for additional testing, we will work on your behalf to obtain and review this evidence for submission in support of your COPD disability claim.
The Maddox Firm will prepare you for anything your insurance company throws your way. Should your insurance company demand an in-person or phone interview, we will work to postpone or cancel the interview. If the interview goes forward, we prepare you beforehand for what questions to expect. We attend the interview alongside you and make sure the interviewer does not overstep.
A COPD diagnosis can be devastating, and you may not know where to start when it comes to the disability insurance process. How do you know when it’s time to leave work? When should you file a claim? What will you need to get your benefits approved? An experienced disability insurance attorney can help answer these questions and create a strategy that ensures your claim is processed in an efficient, fair, and above-board manner.
We always recommend speaking with an attorney before filing a disability claim. If you have already received a denial, you should consult with an experienced attorney before filing an appeal. The team at The Maddox Firm will look over your insurance policy, correspondence f
rom 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.
No matter if you are filing a claim for the first time, appealing a claim denial or facing litigation against your insurance company, The Maddox Firm can help.