Amyotrophic Lateral Sclerosis, commonly referred to as 鈥淎LS鈥� or 鈥淟ou Gehrig鈥檚 disease,鈥� is a rare and devastating neurodegenerative disorder that attacks nerve cells in the spinal cord and lower brain. Those with ALS experience a progressive inability to move their muscles, speak, eat, and breathe. The condition also causes an array of cognitive and emotional difficulties.
ALS is a disabling condition. However, although ALS is a progressive and fatal disease, getting approved for long term disability is not always a simple or straightforward process. To receive long term disability insurance benefits, your claim must still be supported by sufficient medical evidence and proof of appropriate treatment.
If you鈥檝e been diagnosed with ALS, there is a strong likelihood you will consider filing for long term disability. Below we鈥檒l discuss tips for filing your ALS long term disability claim.
Despite the seriousness of ALS, it is still important to adequately document your disability claim with your insurance company. Learning how to best substantiate your long term disability insurance claim (e.g., through medical evidence, proof of treatment, etc.) will help increase your chances of approval.
A significant aspect of your ALS disability claim is outlining your symptoms. A simple letter from your doctor stating your ALS diagnosis won't cut it with your insurance company - they will want to know the state of your condition and how your symptoms impair your ability to work.
There are different types of symptoms you can experience due to ALS: physical, cognitive, and secondary emotional symptoms. All of these are important to document with your disability claim for your insurance company.
The initial physical symptoms of ALS and the progression of the disease can vary from person to person. Symptoms often begin in one of the extremities and spread to other parts of your body. ALS symptoms may start with something seemingly benign, like muscle twitching or mild weakness in a limb. However, as the disease progresses, more and more muscles and activities become affected.
Common early symptoms of ALS include:
These symptoms have varying effects on your body and functional abilities. For example, if the initial symptoms affect the hands or arms, you may have difficulty buttoning a shirt, writing, typing on a computer, or turning a key in a lock. Alternatively, if the initial symptoms affect the legs, you may experience awkwardness while walking, tripping, or stumbling.
Common advanced symptoms of ALS include:
As ALS progresses, it begins to affect almost all of the muscles you control. For example, ALS results in severe weakness in your legs, leaving you wheelchair bound. ALS can paralyze the muscles you use to breathe forcing you to use a CPAP-like machine to help you breathe at night. ALS also can result in problems speaking and eating, leading to the use of communication technologies and a feeding tube, respectively.
Along with the motor dysfunction ALS causes, cognitive and executive dysfunction commonly occurs as well.
Cognitive and executive dysfunction symptoms of ALS may include:
These symptoms should be documented along with your physical ALS symptoms when filing for long term disability. Just as with any motor dysfunction, these cognitive symptoms may interfere with your ability to work, and therefore are important to represent to your insurance company.
Coping with the diagnosis and progression of ALS can cause profound emotional difficulties. It is not uncommon for those with ALS to experience clinical depression as a result of their condition.
It is important to communicate your mental health issues to your treating doctor(s), and to document the onset of your symptoms for your long term disability claim. However, be careful when filing your disability claim. Your insurance company may be quick to label your disability as a mental illness rather than a physical disability. This is because most long term disability insurance policies limit how long benefits can be paid for mental illnesses.
To prevent your insurance company from characterizing your disability as a mental illness, your treating doctor(s) should make it clear in their records that your emotional symptoms (i.e. depression, anxiety) are secondary to and directly resulting from your ALS.
Every disability insurance claim hinges on proving you are unable to work due to your condition. While it may seem obvious why cannot work as a result of ALS, never assume your insurance company will understand without a clear explanation. This is especially true as your symptoms first begin to emerge.
For example, the weakness and muscle cramping in your hands may cause issues with your fine manipulation and dexterity, interfering with your ability to type on a computer or take notes at a meeting. The weakness in your legs and feet may cause difficulty walking, stumbling, and increased clumsiness 鈥� thus making it difficult or impossible to travel to an important business meeting or arrive on time. Alternatively, your pain and fatigue may result in problems with attention, concentration, and focus that prevent you from following along during a presentation. Your pain and fatigue may also prevent you from physically completing a full workday.
The slurring of your speech and difficulty projecting your voice can make it difficult for you to give an important lecture, or debate a topic with a colleague. Worse yet, your uncontrollable outbursts of either laughing or crying can disrupt a business meeting or seminar. Also, your difficulty eating and drinking may prevent you from entertaining clients and attending luncheons.
Remember that disability benefits are only approved when your insurance company believes you can no longer perform your job duties. Having an understanding of the specific ways your ALS symptoms prevent you from working will increase your chances of disability claim approval.
While objective medical evidence and your doctor鈥檚 opinion will be the most influential evidence with your insurance company, it is often beneficial to explain exactly how your individual symptoms prevent you from performing your job duties.
This can be done by preparing a detailed, written narrative for the insurance company. Make sure your narrative addresses each of your symptoms by listing them separately. Explain your individual symptoms and how they impact your ability to perform specific job duties. The more detailed you are, the more convincing your narrative will be with your insurance company.
When filing a long term disability claim for ALS, your insurance company will be looking for objective medical evidence to support your diagnosis, disabling symptoms, and appropriate treatment.
Your long term disability insurance company will require proof of your ALS diagnosis for your long term disability claim. Unfortunately, ALS is difficult to diagnose early because it may appear similar to other more common neurological diseases. It is also difficult to diagnose because no one test can provide a definitive diagnosis.
The first step in obtaining an ALS diagnosis is to visit your doctor. An ALS diagnosis can be based primarily on the signs and symptoms observed by your doctor. If ALS is suspected, your physician will conduct a thorough evaluation. Your physician will obtain your full medical history and conduct detailed neurological examinations over time to determine if your symptoms of muscle weakness, atrophy, and hyperreflexia (and other symptoms) are getting progressively worse.
In addition to the physical examinations and the symptoms observed by your physician, the following diagnostic tests may be performed to help rule out other causes of your complaints:
When evaluating an ALS long term disability claim, the insurance company will want to confirm you鈥檙e receiving appropriate treatment. Noncompliance and lack of appropriate care can easily be used as a reason to deny your ALS long term disability claim.
Because there is no cure for ALS, treatment aims to alleviate symptoms, prevent unnecessary complications, and slow the rate of progression of the disease. ALS can cause a range of physical, cognitive, and emotional changes. Therefore, you will likely need a team of specialists to help manage your symptoms and care, improve your quality of life, and prolong your survival.
Your insurance company will look to see that you are pursuing all avenues of treatment as recommended by your treating doctor(s).
Medications such as Riluzole (Rilutek) and Edaravone (Radicava) are known to slow the progression of ALS. Your doctor may also prescribe medication to help you deal with your symptoms of muscle cramps/spasms, constipation, fatigue, excessive salivation and phlegm, pain, depression, sleep problems, and uncontrollable outbursts of laughing or crying.
This typically consists of mechanical ventilation devices to help you breathe at night. If your breathing problems are severe, your doctor may suggest a tube be inserted into your windpipe and connected to a respirator.
Physical therapy may help you manage pain and address mobility issues. A physical therapist may help you with low-impact exercises to enhance cardiovascular fitness and overall well-being. They can also help you adjust to mobility aids such as walkers and wheelchairs, and they may suggest devices to make life easier, such as a ramp for your house.
This treatment is aimed at helping you maintain independence. For example, occupational therapy can assist in choosing adaptive equipment and assistive technologies to help keep up your daily routines (e.g., with grooming, bathing, eating, dressing, etc.). An occupational therapist can also help you compensate for hand and arm weakness, for example.
Speech therapy 褨褧 useful when ALS begins to make it harder to talk. Speech therapists can help by teaching adaptive techniques. They can also teach you other methods 芯f communication, such as writing and the use of computer-based communications equipment.
As ALS progresses, you may have difficulty swallowing food and drinks. This can make it difficult to get the proper amount of nutrients. Nutritionists can advise on preparing nutritious meals that are easier to swallow. Unfortunately, suction devices and feeding tubes may be required as your symptoms progress to the later stages of ALS.
ALS can also take a toll on you mentally and emotionally. Therefore, it is often helpful to seek psychological treatment for emotional support and to help you adjust. Your mental health treatment records should reflect that your emotional symptoms (i.e. depression, anxiety) are secondary to and resulting from your ALS diagnosis.
Despite how serious an ALS diagnosis is, your insurance company will require objective evidence before approving disability benefits. A long term disability insurance attorney will know how to substantiate your ALS claim and significantly increase your chances of approval.
If you鈥檝e been diagnosed with ALS and are planning to file for long term disability, or if you鈥檝e recently had your ALS long term disability insurance claim denied, the New York disability attorneys at Riemer Hess can help. Call 糖心直播 at (212) 297-0700 for a consultation on your disability case.