Respiratory Conditions & Long-Term Disability
Many of us take the simple act of breathing for granted and don’t think about it until we have trouble doing it. When breathing becomes so difficult that it interferes with your everyday life, you may become unable to work.
Several different respiratory illnesses can limit your ability to breathe and directly impact your ability to maintain gainful employment. If that happens, your next step may be applying for disability.
Many employees are surprised when they are denied short-term or long-term disability when they are suffering from a respiratory illness. If you were denied disability under a group disability plan purchased by your employer or a plan that you purchased, our long-term disability attorney may be able to help.
Call us at 816-203-0143. If you send us your denial letter, we will review it for free and provide guidance on how to fight back.
Chronic Obstructive Pulmonary Disease (COPD)
COPD is a collective term for a number of lung conditions that can affect your ability to breathe properly. This chronic inflammatory disease is caused by exposure to irritants (including cigarette smoke) and makes the lungs progressively deteriorate. While cigarette smoke is a common cause of COPD, it’s not the only one. Adults who also suffer from asthma are twelve times more likely to develop COPD than those who don’t. Adults with a rare genetic variant may also develop COPD.
Caught early, patients can begin avoiding irritants and quitting smoking in addition to other treatments to help stop the progression. But in more advanced stages, severe, irreversible lung damage can progress, leaving the patient with breathing problems and issues with exertion, making work difficult or impossible. At this point, a patient may be ruled unable to work and become eligible for disability.
Other Breathing Disorders That May Qualify for Long-Term Disability
Other breathing disorders that may prevent you from working and allow you to qualify for long-term disability benefits include:
- Cystic Fibrosis
- Restrictive Lung Disease (RLD)
- Stroke Related Respiratory issues
- Pneumonia, bronchiectasis, pneumoconiosis, and other infections of the lungs
COPD and other breathing disorders are a common cause for disability claims because these conditions can make it impossible to carry out the duties of a variety of jobs.
If you or a loved one suffer from one of the conditions and are trying to apply for long-term disability benefits (or have had those benefits denied or terminated), our long-term disability attorney in Kansas City can help. Call us at 816-203-0143.
Proving a Long-Term Disability Claim Due to a Respiratory Condition
But it can be difficult to prove you not only have the condition but are also disabled from it.
Medical evidence, including test results, medical records, physicians’ notes, and prescription records are commonly submitted to show the severity of your condition. But without proper documentation, you won’t be able to demonstrate the extent of your disability. Consistent treatment and testing, including things like pulmonary function testing, is critical in their evaluation.
Additionally, a claims adjuster will review your residual functional capacity (RFC), a description of the physical and mental capacities you have alongside any impairment.
Why Was I Denied Long-Term Disability If I Have a Respiratory Condition?
Even after you’ve submitted everything to your insurer, you may still receive a denial letter. While many long-term disability claims are denied on the first try, getting help from a disability lawyer can improve your chances of a better outcome on appeals.
You may have been denied because of:
- Lack of medical testing or information from your doctors
- Not meeting the company’s definition of “disabled”
- Symptoms that are “self-reported,” lacking additional medical evidence (diagnosis, testing, etc.)
- Conflicting evidence the insurer collected during its investigation
- No link between your condition and your inability to work at your own occupation, or any occupation
- No objective basis for your diagnosis, or restrictions/limitations due to your condition
- The insurer’s physician doesn’t agree with yours
- You are seen (and recorded) in activities that your disability should prevent you from doing, and contradicts your doctor’s restrictions
- A missed deadline
- Other requirements your insurer failed to disclose
Whether you acquired your policy through your employer or purchased it yourself, you should review the policy completely before you apply. Because you may not know what type of evidence is critical to proving your claim, consulting with a long-term disability lawyer before submitting your application can help ensure that your application is complete when you submit it.
Insurance companies are known for “bad faith” practices, including denying or canceling benefits and terminating a policy without warning. These companies have been known to gather evidence on their own, outweighing the information you’ve submitted. A long-term disability lawyer who understands how the process works can advise you on ensuring that the odds—and your claims file—are stacked in your favor, not against you.
How to Appeal a Long-Term Disability Denial
Many people don’t realize that they have the opportunity to appeal a decision of denial. But you’ll have a short time period to respond—otherwise, you’ll lose your chance to appeal and potentially thousands in benefits. Some insurance policies only allow you a 30-day period to respond. If that’s the case, call our office immediately.
Insurance companies do not know your whole story and make decisions on the information they have. These companies also work hard to avoid paying your claim, hoping that you’ll give up.
If a lawsuit is your next option, you will not be able to include any additional evidence or testify, meaning that a judge will see only the documentation in your original claim file. This is why adding more than the required documentation to your claim file is so important—if you do make it to trial, the judge will have more than sufficient evidence to support your claim.
Some policies also have a “discretionary clause” included that allows insurers to change the rules as they go along. Discretionary clauses are legal in Missouri. This means that the company can deny a claim, and can even keep a court decision from being overturned.
Our Long-Term Disability Attorney Can Help
Insurance companies know you’re not familiar with the process of applying for long-term disability, and will use that to defeat your claim ay way they can.
If you haven’t filed your initial application for benefits yet, schedule a strategy session with our long-term disability attorney. One consultation may be the only help you need for your application. If your claim is denied, don’t give up—call us at 816-203-0143. We will review your denial letter free and offer suggestions for your appeal. We can also provide guidance on how we can help.
Need some answers before you call? Visit our library of resources, or instantly download our free disability appeal guide, Danger Proceed at Your Own Risk, which is packed with tips and mistakes to avoid. No matter what you choose to do, don't wait because short deadlines apply to these claims.