Short and Long Term Disability for Scleroderma
- Matthew Maddox
- 5 hours ago
- 9 min read
If you suffer from scleroderma, a chronic and often progressive autoimmune disease, you may be considering filing for short or long term disability benefits. Characterized by the hardening and tightening of the skin and connective tissues, scleroderma can also severely impact internal organs, blood vessels, and the digestive system. The complexity of its symptoms and the variability in its progression make scleroderma a particularly difficult condition to manage, often necessitating a transition to short or long term disability benefits for those severely affected.
Successfully navigating the disability claims process with scleroderma involves a thorough understanding of the medical and vocational documentation required and the specific hurdles that may arise. In this article, we’ll discuss essential information necessary for those with scleroderma to increase their chances of a successful outcome for their short or long term disability claim.
How Does Scleroderma Impact My Ability to Work?
Scleroderma is a chronic systemic autoimmune disease primarily characterized by skin thickening and hardening, but it can also affect internal organs and vascular structures. The disease manifests in various ways, impacting daily activities and work capacity significantly.
Here’s a detailed look at the symptoms and complications of scleroderma and their effects that may lead to short or long term disability:
Skin Thickening and Hardening: This hallmark symptom can severely restrict joint mobility and manual dexterity, making tasks that require fine motor skills, like typing or handling tools, difficult.
Pain and Discomfort: Chronic pain is common and can be debilitating, often necessitating frequent breaks and potentially reducing work hours or productivity.
Fatigue: A pervasive sense of tiredness associated with scleroderma can hinder the ability to sustain regular work activities and can impair concentration.
Lung Complications: Pulmonary issues may lead to breathing difficulties, limiting physical exertion and stamina.
Digestive System Complications: Gastrointestinal problems can require dietary adjustments and frequent breaks, complicating work schedules.
Heart Complications: Cardiovascular complications can necessitate a reduced workload and increased medical monitoring.
Raynaud’s Phenomenon: Many people with scleroderma experience this condition where small blood vessels in the fingers and toes overreact to cold temperatures or stress, causing pain and discomfort, which can make working in certain environments challenging.
Any of the above symptoms and complications may cause disability, if they present with sufficient severity and frequency. You will need more than a scleroderma diagnosis to get approved for short or long term disability benefits. In the next section, we’ll cover common eligibility requirements for short or long term disability for those with scleroderma.
Can Scleroderma Qualify Me for Short or Long Term Disability Benefits?
Yes, scleroderma can qualify you for short or long term disability benefits, depending on the severity of your symptoms and their impact on your ability to work. In disability insurance policies, “disability” is commonly defined as the inability to perform the duties of your own occupation or any occupation for which you are reasonably suited by education, training, or experience, due to illness or injury.
Consider a graphic designer who develops scleroderma. The skin thickening and joint stiffness characteristic of the disease might severely impair their manual dexterity and ability to use design software, which are essential for their role. If their condition prevents them from effectively handling design tools or causes significant pain and fatigue that reduces their work efficiency, this could be a valid basis for a disability claim.
If your scleroderma symptoms impede your ability to perform your material job duties, you may qualify for short or long term disability benefits. However, to qualify for benefits, you must demonstrate that your scleroderma symptoms occur with enough severity and frequency to prevent you from performing your job functions. This involves providing your insurance company with detailed evidence of your diagnosis, symptoms, treatment, and how these directly impact your work capabilities.
What Documentation Is Essential When Filing a Short or Long Term Disability Claim for Scleroderma?
When filing a short or long term disability claim for scleroderma, thorough and detailed documentation is crucial to demonstrate the extent of your disability and its impact on your ability to work.
Here are the essential types of documentation you may submit to your insurance company in support of your short or long term disability claim:
Blood Tests: These can include Antinuclear Antibodies (“ANA”), which are common in scleroderma, indicating an autoimmune component. Scl-70 Antibody Test is particularly associated with diffuse scleroderma, RNA Polymerase III Antibodies are linked to an increased risk of renal crisis, and Anticentromere Antibodies are often found in patients with limited cutaneous scleroderma.
Skin Biopsy: This procedure can confirm your diagnosis by showing the characteristic changes in skin tissue associated with scleroderma.
Pulmonary Function Tests (“PFTs”): Essential for assessing lung function and detecting interstitial lung disease or pulmonary arterial hypertension, which are common complications of scleroderma.
High-Resolution CT (“HRCT”) Scan of the Chest: Used to provide detailed images of the lungs and assess the extent of any lung involvement.
Echocardiogram: Helps evaluate heart function and detect potential complications like pulmonary hypertension or heart involvement due to scleroderma.
Gastrointestinal Tests: These include Esophageal Manometry, which tests the function of the esophagus and lower esophageal sphincter, and Barium Swallow X-ray, which helps visualize the structure and function of the esophagus and stomach.
Capillaroscopy: A non-invasive test used to examine the small blood vessels (capillaries) in the skin at the base of the fingernails. It can reveal abnormalities typical of scleroderma.
Joint and Muscle Assessment: Techniques such as MRI and ultrasound can assess joint and muscle involvement, detecting soft tissue abnormalities and assessing vascular changes.
Kidney Function Tests: Regular blood pressure monitoring and blood tests to check kidney function are crucial, given the risk of renal crisis in scleroderma patients.
Office Visit Notes: Detailed notes from each of your doctor’s visits that describe your symptoms, their progression, and the impact on your daily activities are essential. These should highlight the specific challenges you face due to scleroderma.
Treatment Records: Provide a comprehensive record of the treatments you have undergone, including medications, physical therapy, and any other interventions. These should reflect your adherence to your doctor’s recommendations and your response to these treatments, indicating whether there has been any improvement or deterioration in your condition.
Functional Capacity Evaluation (“FCE”): This evaluation is performed by a healthcare professional and is designed to assess your physical capabilities with respect to performing work-related tasks. An FCE can provide critical evidence about your functional limitations and whether you can meet the physical demands of your job.
Vocational Assessment: Include a detailed assessment of your job requirements and how your symptoms affect your ability to meet these requirements. This may involve an analysis by a vocational expert who can articulate why your specific symptoms and limitations prevent you from performing your job or any job in the competitive labor market.
Symptom Diary: Keeping a detailed diary of your daily symptoms can provide a nuanced view of how scleroderma affects your life on a regular basis. This diary should include notes on your level of pain, fatigue, mobility issues, and any other symptoms, as well as how these symptoms impact your ability to perform work-related and daily activities.
Witness Statements: Statements from family, friends, colleagues, and employers who can testify to the impact scleroderma has on your daily life and work performance can add a personal and practical perspective to your claim, supporting the other more clinical evidence.
Gathering this comprehensive documentation can strengthen your claim by providing a clear and detailed picture of how scleroderma limits your work capabilities, thereby helping you to secure the necessary disability benefits.
How Do Insurance Companies Evaluate Disability Claims Based on Scleroderma?
Insurance companies evaluate disability claims based on scleroderma by closely examining the medical and vocational evidence provided to assess the severity of the condition and its impact on your ability to work. However, claimants with scleroderma often face specific challenges in the disability claim process.
Here are specific challenges those with scleroderma often face in the disability claims process:
Variability of Symptoms: Scleroderma can manifest differently in each patient, with symptoms ranging from mild to severe. This variability can make it difficult to establish a clear and consistent picture of disability.
Lack of Awareness: Because scleroderma is relatively rare, there may be a lack of understanding or awareness about the disease among insurance company representatives, which can lead to underestimation of its impact.
Complexity of Documentation: The extensive documentation required to demonstrate the impact of scleroderma, including detailed medical records, test results, and specialist evaluations, can be cumbersome to compile and may be challenging to interpret without specialized medical knowledge.
Common reasons insurance companies deny short or long term disability claims for scleroderma include:
Insufficient Medical Evidence: Claims often get denied if the medical evidence provided does not adequately document the severity of the condition or its specific impact on your ability to perform your job.
Discrepancies in Documentation: Inconsistencies between different sources of information, such as conflicting opinions between doctors or between medical records and your reported symptoms, can lead to denials.
Non-compliance with Treatment: If you do not follow prescribed treatments or fail to attend regular medical appointments, your insurance company may argue that you have not fully attempted to manage your condition. Most insurance policies include an “appropriate treatment” clause which requires that you seek regular treatment with your doctors and follow their recommendations. If your insurance company feels you have failed to do so, they may deny your claim.
To improve the likelihood of a successful claim, you should ensure that your medical and vocational documentation comprehensively represents your condition and its impact on your daily life and work capabilities. It may also be beneficial to consult with a long term disability attorney who understands the complexities of scleroderma and can help navigate the claims process effectively.
What Tips Can Help Me Get My Scleroderma Short or Long Term Disability Claim Approved?
Navigating the disability claims process successfully as some with scleroderma involves a combination of thorough preparation, understanding of your rights, and proactive management of your health and medical records.
Here are some key tips to help scleroderma patients through this complex process:
Understand Your Policy: Familiarize yourself with the specifics of your disability insurance policy. Understanding what your policy covers, the definition of disability it uses, and the benefits you are entitled to can help you make informed decisions throughout the claim process.
Gather Comprehensive Medical Documentation: Ensure that you have all relevant medical records, including diagnostic tests, doctor’s visit notes, and treatment records. Detailed documentation that shows the progression and impact of scleroderma on your daily functions is crucial.
Maintain Consistent Treatment: Following your doctor’s recommended treatment plan not only helps manage your condition but also demonstrates to the insurance company that you are actively seeking to mitigate your symptoms. Non-compliance can be a reason for denial.
Consult Specialists: Engaging with specialists who understand scleroderma, such as rheumatologists, dermatologists, or pulmonologists, can provide more detailed and specific insights into how your condition affects your ability to work. Their evaluations can add substantial weight to your claim.
Keep a Symptom Diary: Regularly updating a symptom diary that records your daily health status and how your symptoms affect your ability to perform work-related and daily activities can provide valuable subjective evidence for your claim.
Undergo a Functional Capacity Evaluation (“FCE”): This evaluation, conducted by a healthcare professional, will objectively assess your physical abilities in a detailed manner. The FCE provides essential objective evidence of your physical limitations, specifically for job-related functions, which hold significant weight with your insurance company.
Seek Legal Advice: Consulting with a short and long term disability attorney who has experience with complex conditions like scleroderma can be invaluable. They can help navigate the legal complexities of disability claims, ensure that your paperwork and evidence is complete and comprehensive, and advocate on your behalf with your insurance company.
How Can The Maddox Firm Prove My Short or Long Term Disability Claim for Scleroderma?
At The Maddox Firm, we understand the complexities and challenges that come with filing short or long term disability claims for conditions like scleroderma. Our experienced team is dedicated to navigating these processes efficiently, ensuring that your rights are protected and that you receive the benefits you deserve.
Here are a few ways we can help prove your scleroderma short or long term disability claim:
We Examine Your Policy and Assess Your Claim: We start by thoroughly reviewing your disability insurance policy to understand the specific coverage and the definitions of disability it employs. This enables us to assess your claim accurately against the policy criteria and devise the best strategy for moving forward.
We Handle All Communications with Your Insurance Company: Dealing with insurance companies can be overwhelming, especially when you're managing a chronic condition like scleroderma. We take over all communications on your behalf, from submitting the initial claim to handling any follow-up queries. This ensures that your claim is presented clearly and effectively, reducing stress and minimizing potential errors.
We Help You Obtain Evidence to Support Your Claim: Gathering the right medical evidence is critical. We work with your healthcare providers to obtain comprehensive documentation of your diagnosis, treatment, and the impact of scleroderma on your daily life. This includes arranging for additional tests or evaluations if necessary to strengthen your claim.
We Handle Appeals and Litigation: If your claim is denied, we are prepared to challenge the decision through appeals and, if necessary, litigation. Our legal team has extensive experience in disability law and will advocate vigorously to secure the benefits you are entitled to.
With The Maddox Firm by your side, you can focus on managing your health while we handle the complexities of your disability claim.
A short term disability or long term disability claim can be a complicated process. If you need help during the claims process, with appealing a claim denial, or with 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.
