Navigating the insurance disability claim process while dealing with the physical, emotional, and financial challenges of a stroke can be overwhelming. At The Maddox Firm, our experienced team recognizes the unique complexities of stroke-related disability claims and is committed to advocating for your rights. In this article, we’ll share valuable insights to consider when filing, appealing, or litigating a short or long term disability claim for stroke.
How Does Stroke Cause Disability?
Stroke can cause disability by disrupting the normal blood supply to the brain, leading to the death of brain cells and the impairment of vital functions. When a stroke occurs, two main types can result: ischemic stroke and hemorrhagic stroke. In an ischemic stroke, a blood clot blocks a blood vessel, cutting off the blood flow to a specific area of the brain. A hemorrhagic stroke happens when a blood vessel bursts, causing bleeding into the brain.
Both types of strokes can have a profound impact on various aspects of your functioning.
Below we’ll discuss the physical and cognitive disabilities that may occur due to stroke.
Physical Disability Due to Stroke
Stroke can result in a range of symptoms that can significantly impact your mobility and physical functional abilities. Here are some common physical disabling symptoms that may arise:
Hemiparesis/Hemiplegia: One-sided weakness or paralysis is a prevalent physical disability after a stroke. It typically affects the face, arm, and leg on one side of the body. This can lead to difficulties with walking, balance, and performing everyday tasks.
Impaired Coordination and Balance: Stroke can disrupt your brain’s control over coordination and balance, making it challenging to maintain stability while standing, walking, or performing precise movements. This can increase the risk of falls and impact overall mobility.
Sensory Loss: Stroke may cause sensory impairments such as numbness, tingling, or reduced sensation on one side of the body. This can affect your ability to perceive touch, temperature, and pain, making it harder to perform tasks that require sensory feedback.
Visual Impairments: Depending on the location of the brain damage, stroke can lead to various visual problems, including blurred vision, double vision (diplopia), visual field cuts or loss, and difficulties with depth perception.
Speech and Swallowing Difficulties: Stroke can affect the muscles involved in speech and swallowing, leading to conditions such as aphasia (difficulty speaking or understanding language) and dysphagia (difficulty swallowing). These challenges can impact communication and nutrition.
Fatigue and Weakness: Many stroke survivors experience persistent fatigue and generalized weakness, which can significantly limit your physical endurance and ability to engage in daily activities.
Cognitive Impairment Due to Stroke
Stroke can result in significant cognitive impairments, affecting various aspects of your cognitive function. Cognitive impairment after a stroke may impact your thinking, memory, attention, and problem-solving abilities. Here are some common cognitive disabling symptoms that may arise:
Memory Loss: Stroke can cause difficulties with both short-term and long-term memory. This may manifest as forgetfulness, difficulty recalling recent events, or challenges in retaining new information.
Executive Dysfunction: Executive functions involve higher-level cognitive processes such as planning, organizing, decision-making, and problem-solving. Stroke can disrupt these abilities, leading to difficulties in initiating and completing tasks, setting goals, and making sound judgments.
Attention and Concentration Problems: Stroke survivors may experience difficulties sustaining attention, focusing on tasks, or filtering out distractions. This can impact your ability to concentrate, stay engaged, and follow conversations or instructions.
Language and Communication Impairments: Aphasia, a language disorder, can occur after stroke, affecting a person’s ability to speak, understand, read, and write. It can manifest as difficulty finding words, forming sentences, or comprehending spoken or written language.
Processing Speed Reduction: Stroke can slow down cognitive processing speed, making it more challenging to respond quickly to stimuli, process information efficiently, or keep pace with conversations or tasks.
Visual-Spatial Impairments: Some stroke survivors may experience difficulties with spatial awareness, visual perception, and judging distances. This can impact tasks such as navigating or recognizing faces and objects.
Impaired Problem-Solving and Reasoning: Stroke can affect logical reasoning, abstract thinking, and problem-solving abilities. You may find it challenging to analyze complex situations, identify solutions, or adapt to changing circumstances.
How Do Insurance Companies Evaluate Stroke Disability Claims?
When evaluating stroke disability claims, insurance companies consider specific factors related to stroke and its impact on your ability to work. Here are some key aspects insurance companies focus on when assessing stroke short or long term disability claims:
Medical Evidence: Insurance companies will review medical documentation related to your stroke, including the diagnosis, medical reports, imaging results, and physician notes. Your insurance company will look for evidence confirming the occurrence of a stroke and its severity.
Functional Limitations: Assessing the functional limitations caused by your stroke is crucial. Insurance companies may require functional assessments, such as physical or occupational therapy evaluations, to determine your impairments and limitations in performing activities of daily living (“ADL”s) or work-related tasks.
Neurological Deficits: Insurance companies pay close attention to the neurological deficits resulting from your stroke. They consider the impact on mobility, coordination, strength, balance, and fine motor skills. Documentation from your treating providers outlining these deficits is important in supporting the claim.
Cognitive Impairment: Since strokes can cause cognitive impairment, insurance companies evaluate evidence of any impact on your cognitive functions such as memory, attention, language skills, problem-solving, and decision-making.
Speech and Language Difficulties: Insurance companies review medical records and assessments related to aphasia or other speech and language deficits resulting from your stroke. They consider the impact on your ability to communicate effectively, both verbally and in writing.
Rehabilitation Efforts: Evidence of your participation in rehabilitation and adherence to treatment plans is important. Seeking “appropriate treatment” is a requirement of most disability insurance policies. Your insurance company will assess whether you have undergone recommended therapies, such as physical therapy, occupational therapy, speech therapy, or cognitive rehabilitation, and whether these interventions have led to improvements or if your functional limitations persist.
Occupation-Specific Assessment: Insurance companies may examine your occupation and its specific demands. They evaluate whether your stroke-related impairments prevent you from performing your essential job duties or any gainful employment based on your education, experience, and training.
Supportive Opinions: Expert opinions from treating physicians, specialists, and other healthcare professionals can play a significant role in the evaluation process. Their assessments and professional opinions regarding your functional limitations and ability to work must be considered by your insurance company.
Navigating stroke disability claims can be complex, and insurance companies may employ strategies to minimize or deny claims. Guidance from an experienced ERISA attorney familiar with stroke-related disability claims can greatly assist in presenting a strong case and advocating for your rights.
What Evidence Can I Submit for My Stroke Disability Claim?
It is crucial to provide a comprehensive range of evidence to demonstrate the impact of your stroke on your ability to work. Your evidence must support both that you are medically disabled due to your stroke, and that the impact of your stroke prevents you from working.
Medical Evidence for Stroke Disability
When submitting a stroke disability claim, medical evidence is essential. Without providing objective documentation of your stroke, its severity, and its impact on your functional abilities, your insurance company is unlikely to approve your claim.
Here are some key pieces of medical evidence that you may submit:
Diagnostic Testing: This includes any testing used to diagnose your stroke, such as carotid ultrasound or angiography results indicating blockages or narrowing of the carotid arteries; Transcranial Doppler (“TCD”) studies demonstrating abnormalities in blood flow velocity in the brain; and/or Electroencephalogram (“EEG”) results indicating abnormal electrical activity in the brain.
Hospital Records: If you were hospitalized for your stroke, you should provide your insurance company any of these records, including admission records documenting the date of admission, duration of stay, and initial diagnosis of stroke; emergency room reports providing details about your presenting symptoms, medical history, and initial assessment of your stroke; physician progress notes recording the treatment and management of your stroke during your hospitalization; and/or surgical records, if any procedures were performed to address your stroke, such as a carotid endarterectomy or thrombectomy.
Neurological Evaluations: You should submit evaluations conducted by neurologists or other specialists that specifically assess the neurological deficits resulting from your stroke. These evaluations can document impairments in mobility, coordination, strength, balance, and fine motor skills. They often include detailed neurological examinations and specific measurements of any functional limitations.
Imaging Results: Include copies of imaging tests, such as MRI or CT scans, that confirm the occurrence and nature of your stroke. These images can provide objective evidence of brain damage or abnormalities resulting from your stroke.
Cognitive Assessments: If you have undergone any neuropsychological evaluations or assessments conducted by specialists that assess cognitive impairments resulting from your stroke, you should submit these in support of your disability claim. These evaluations measure cognitive functions such as memory, attention, language skills, problem-solving, and decision-making, and can provide objective evidence of cognitive limitations.
Speech and Language Assessments: If you experience speech and language disabilities due to your stroke, include assessments by speech-language pathologists. These assessments should evaluate your ability to communicate effectively, both verbally and in writing. They can establish the impact of aphasia or other language impairments.
Rehabilitation Records: Submit documentation of your participation in rehabilitation programs, such as physical therapy, occupational therapy, speech therapy, or cognitive rehabilitation. Include progress reports, treatment plans, and any functional assessments conducted during the rehabilitation process.
Medication and Treatment History: Provide a detailed history of medications prescribed for the management of stroke-related symptoms, including any side effects experienced. You may also include information about other treatments, such as anticoagulant therapy or surgical interventions, relevant to your stroke.
Treating Physician Statements: Request statements from your treating physicians or specialists who have been involved in your stroke diagnosis, treatment, and ongoing care. These statements should outline the severity of your stroke, its impact on your functional abilities, and the prognosis for your recovery.
Functional Capacity Evaluation (“FCE”): An FCE is a comprehensive assessment conducted by a medical professional, such as an occupational therapist. The evaluation assesses your functional abilities, including physical strength, endurance, mobility, and cognitive skills. Submitting the results of an FCE can provide objective evidence of your restrictions and limitations.
Vocational Evidence for Stroke Disability
Your short or long term disability claim for stroke must also include evidence proving that you cannot perform the duties of your occupation. Vocational evidence plays a crucial role in demonstrating the impact of your stroke on your ability to work. Here are key types of vocational evidence that you can submit to support your claim:
Job Descriptions: Provide detailed descriptions of your past occupation or current job, including the physical and cognitive demands, required skills, and job responsibilities. This helps insurance companies understand the specific requirements of your work and how your stroke-related impairments may hinder your ability to perform those duties.
Educational and Work History: Submit a comprehensive resume that outlines your education, training, and employment record, including your job titles, dates of employment, and descriptions of the tasks and responsibilities associated with each position. This demonstrates your prior work experience and allows insurance companies to assess how your stroke-related limitations may impact your ability to perform similar job roles.
Vocational Expert Opinion: A vocational expert can evaluate your transferable skills, limitations, and employability in light of your stroke-related impairments. The vocational assessment can analyze the material duties of your occupation, both physical and cognitive, and determine if your stroke disables you from performing those tasks.
Letters from Employers or Colleagues: Obtain letters from your former employers or colleagues that describe the key tasks and responsibilities of your position. If you attempted to return to work following your stroke, these letters can explain the challenges you faced in performing your job duties following your stroke. These firsthand accounts of how your stroke-related impairments affected your work performance, productivity, and ability to meet job requirements can be submitted to your insurance company in support of your claim.
How Can The Maddox Firm Prove My Stroke Disability Claim?
If you are filing, appealing, or litigating a short or long term disability claim for stroke, The Maddox Firm can help. With a track record of helping numerous clients secure their disability benefits, our experienced team understands the intricacies of stroke-related disability claims and knows what insurance companies look for when approving claims.
Here’s how The Maddox Firm can prove your stroke short or long term disability claim:
We Examine Your Policy: Disability insurance policies contain crucial information about the requirements for approving short or long term disability benefits. The language of these policies can be complex, but our firm will meticulously analyze your disability insurance policy to clarify your insurer’s specific criteria, such as the definition of disability, elimination period, and benefit amount. We’ll also identify any potential challenges, such as pre-existing condition clauses, that may arise during your claim process.
We Collect and Organize Your Evidence: The Maddox Firm will take charge of requesting and obtaining your medical records, ensuring they provide a comprehensive and accurate picture of your condition. We can also coordinate with your employer to obtain any needed documentation. We will scrutinize the evidence to identify any weaknesses or red flags that may need to be addressed.
We Help You Obtain Additional Evidence: We will work closely with your treating healthcare providers to obtain supplemental statements that support your claim. Insurance companies often request an Attending Physician Statement (“APS”), and we will facilitate communication with your physician to ensure the APS accurately outlines the limitations and restrictions caused by your stroke, as well as supplemental statements of support. If necessary, we can recommend additional testing, such as a Functional Capacity Evaluation or Neuropsychological Evaluation, to further strengthen your claim. Moreover, if further vocational evidence is required, we can refer you to trusted vocational experts for a thorough vocational assessment.
We Can Represent You in Appeals and Litigation: In the event that your short or long term disability claim for stroke is denied or terminated, The Maddox Firm will represent you throughout the appeals process and, if needed, litigation. Our team will prepare a robust appeal that addresses the reasons for denial and presents new evidence supporting your claim. In litigation, we can file a lawsuit against your insurance company and provide representation in court.
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 with your stroke short or long term disability claim. The expert 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 stroke short or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.