If you are diagnosed with multiple sclerosis, you may be entitled to file a claim for long term disability benefits. To qualify for long term disability, you must be able to prove that your condition prevents you from working. Usually, you must be able to prove that your condition prevents you from working in your occupation.
A diagnosis of multiple sclerosis does not, on its own, qualify you for long term disability benefits. You must demonstrate that the symptoms of multiple sclerosis prevent you from working. One of the first questions your long term disability insurer will have is, “how long ago were you diagnosed?” The insurance company will want to know that you continued to work after a diagnosis. Of course, if your condition deteriorated to the point of disability prior to a diagnosis, your doctor will be able to explain that.
Short Term Disability and Long Term Disability
Short term disability benefits are nearly always a benefit that is provided by your employer. Short term disability benefits replace a portion (or sometimes all) of your income if you become disabled. That disability may be temporary, or short term disability can bridge the gap between the time you become unable to work and the time long term disability benefits begin. Usually, short term disability benefits begin after a short waiting period or “elimination period” of 1 to 2 weeks. Short term disability benefits can last as little as 6 weeks or up to a full year.
Qualifying for short term disability does not stop an employer from terminating employment. Generally, if your employer is covered by the Family and Medical Leave Act, your job is protected for 12 weeks. After that, whether your employer continues to employ those on disability benefits is up to each company’s internal policy.
Long term disability benefits may be provided by your employer, or you may have bought your own long term disability benefit policy. If the long term disability benefits are provided by your employer, the long term disability benefits usually go hand in hand with a short term disability program. Once your short term disability benefits end, the long term disability benefits should begin. Of course, every long term disability plan is different, and you will want to consult with a long term disability attorney to help you determine how your plan works.
Other provisions of your long term disability policy that are worth considering are:
Elimination period or waiting period: An elimination period is the period of time that you must be disabled before the disability insurance company will begin paying benefits. Generally, this period of time is set at 90 or 180 days for employer provided long term disability plans. For long term disability policies bought separately, the elimination period can be as long as a full year.
Pre-disability income or prior income: Prior income will be defined to include your salary as of the date of disability, as an average of the prior year, or using a more complicated formula. Typically, bonuses are included, but they are sometimes expressly excluded.
Benefit percentage: The benefit percentage is the proportion of your prior income that you will receive in benefits. The most common percentage is 60%. Most long term disability plans provided by employers have a benefit percentage of 60%. In other long term disability policies, the percentage could be as low as 50% or as high as 80%.
Eligible participant or active employee: This provision will define who is covered by an employer-provided long term disability plan. Typically, you must be working full time (usually defined as over 30 hours per week) for a number of months (usually 3-4).
Maximum benefit period: This provision will describe when benefits will end. Usually benefits will end once you turn 65, 67, or Social Security Normal Retirement Age.
Appropriate care: These provisions provide that you must be under the appropriate care of a physician qualified to treat your condition.
Other income benefits or offsets: These provisions will describe the types of income that will reduce your long term disability benefit. For example, receiving Social Security Disability income will reduce your benefit by the amount you receive from the Social Security Administration.
Residual disability or partial disability: These provisions will allow you to continue working if you are no longer able to perform the same number of hours or all of your duties of your job. Typically, you will need to show a loss of income of at least 20%. If you can, you can receive a partial disability benefit.
Lifetime disability: Some policies continue to pay benefits after retirement age all the way through your natural life. Usually, you will have to demonstrate total disability prior to a certain age (usually 65). Then you will have to demonstrate total and continuous disability for number of years (usually 1 to 5).
The Disabling Symptoms of Multiple Sclerosis
Many of the symptoms of multiple sclerosis can be disabling, including loss of vision, muscle spasms, muscle weakness, numbness and tingling, problems with balance and coordination, and fatigue. To qualify for long term disability, you will need to provide medical evidence documenting your symptoms and how they affect your ability to work. This can be in the form of medical records of your physicians (including from a neurologist), treatment records, and a report from your treating physician.
Some of the symptoms of multiple sclerosis can only be demonstrated by keeping a diary. These symptoms include things like fatigue, pain, and problems with thinking or memory. If you keep a diary documenting your symptoms, this will be helpful in proving your long term disability claim.
Testing Evidence Can Demonstrate Disability Due to Multiple Sclerosis
Testing evidence will help you prove your long term disability claim. Multiple sclerosis is a degenerative disease, which means that it gets worse over time. Demonstrating that your condition has gotten worse over time will help you show that you can no longer do your job. Imaging tests, electrical activity tests, and functional tests are all ways to show the long term disability insurance company that you qualify for benefits.
Imaging tests that can show the progression of multiple sclerosis, including MRI and CT scans. Magnetic resonance imaging (MRI) uses a magnetic field and computer-generated radio waves to create images of your brain. A computerized tomography (CT) scan combines X-ray images using computer processing to create cross-sectional images. If you have imaging results such as an MRI or CT that show the progression of your condition, this will be helpful in proving your long term disability claim.
Electrical activity or evoked potential tests can also show the progression of multiple sclerosis. There are several types of evoked potential tests, such as:
Visual evoked potentials (VEP): With this test, you watch an alternating checkerboard pattern, and a technician measures the results.
Brainstem auditory evoked potentials (BAEP): With this test, you listen to a series of clicks, and a technician measures the results.
Somatosensory evoked potentials (SSEP): With this test, you receive several short electrical pulses on arms and/or legs, and a technician measures the results.
Functional tests that focus on how multiple sclerosis can cause you to be unable to work include functional capacity evaluations and neuropsychological evaluations. You should consider getting at least one of these two types of tests to prove you are no longer able to do your job.
A functional capacity evaluation is a test that measures your ability to do basic physical tasks. These evaluations will test several areas, including standing, sitting, lifting, gripping, and gross and fine motor skills. Functional capacity evaluations typically involve physical exertion, so they can be used to document symptoms like pain, weakness, range of motion, and fatigue.
A neuropsychological evaluation is a test that measures your cognitive abilities, including things like decision-making, reading, memory, and problem solving. If you have results from these tests that show how your multiple sclerosis has caused you to be unable to work, this will be helpful in proving your long term disability claim.
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The Maddox Firm can help you file a short term disability claim, a long term disability claim, or appeal a denial if you have multiple sclerosis. You can file a claim or an appeal without the assistance of a law firm but doing so runs an increased risk of denial. Filing an appeal on your own is even more risky. An appeal is your last chance to submit any evidence in support of your claim. If you need to file a lawsuit later, you will likely be barred from submitting any evidence not submitted with the appeal.
Reach us at (212) 970-1190 or book a consultation online.