If your multiple sclerosis long term disability (LTD) insurance claim was denied by your insurer, you may be able to submit an appeal.
What Is Multiple Sclerosis?
Multiple sclerosis is an auto-immune disease in which the immune system attacks the protective sheath (the myelin sheath) that covers nerve fibers. This demyelination leads to inflammation and results in scar tissue or “lesions.” This can cause nerves to not communicate as well as they should, which can lead to a range of debilitating conditions. The disease can cause movement problems, vision problems, and other issues.
What are the types of MS?
There are several types of MS, including:
- Clinically isolated syndrome (CIS): A pre-MS condition which involves an episode of MS symptoms which lasts at least 24 hours.
- Relapsing remitting MS (RRMS): Involves clear relapses of MS symptoms followed by remission periods where symptoms are mild or absent. This is the most common type of MS, accounting for 85% of cases.
- Secondary progressive MS (SPMS): Occurs when RRMS transitions to progressive MS. Notable relapses may occur but disability or worsening of function also happens.
- Primary progressive MS (PPMS): Neurological function gets progressively worse and is “active,” though short periods of “non active” PPMS can occur where patients are stable.
The boundaries between these types of MS are fairly fluid, but may be benchmarked by the number of lesions on the brain and spinal cord and whether these lesions are active or inactive.
What Causes Multiple Sclerosis?
The Mayo Clinic explains that the cause of multiple sclerosis is unknown. It is considered to be an autoimmune disease, in which the immune system attacks the patient’s own body instead of a virus or threat.
Mayo explains that experts are not aware of why multiple sclerosis occurs in some people but not in others, but does note that some demographics are more at risk for multiple sclerosis than others.
Women are two to three time more likely than men to have relapsing-remitting MS. It is most common among white people of Northern European descent, and least common in people of African, Asian, or Native American descent.
Most typically, the disease manifests when a patient is between 20 and 40 years old. Patients with immediate family who have MS are most likely to develop the disease themselves. The disease is also slightly more likely to appear in patients who have other autoimmune diseases, type 1 diabetes, or inflammatory bowel disease.
Infections with certain viruses, including Epstein-Barr, have been linked to multiple sclerosis. Mayo Clinic also explains that people with low levels of Vitamin D, and low exposure to sunlight, may be at higher risk for MS.
What Are the Multiple Sclerosis Symptoms?
Multiple Sclerosis is associated with a range of debilitating symptoms affecting movement and vision, bodily functions, and others,
Some movement symptoms and generalized symptoms include:
- Weakness in one or more limbs or the trunk of the body
- Numbness in limbs or trunk
- L’hermitte sign (an electric-shock sensation that presents when the neck is moved in a certain way, like when the neck is bent quickly towards the chin)
- Lack of coordination
- Unsteady gait
- Muscle stiffness
- Muscle spasms
- Slurred speech
Multiple sclerosis can affect not only movement, but other parts of the body. The disease can impact vision with the following symptoms:
- Blurry vision
- Prolonged double vision
- Vision loss
- Partial vision loss
- Pain during eye movement
Bodily function problems with MS can include:
- Sexual function issues
- Bladder and bowel problems
- Mental symptoms that may include depression, forgetfulness, or mood swings
Is There A Cure for Multiple Sclerosis?
There is no cure for multiple sclerosis. Treatment is available to help manage the presentation of multiple sclerosis symptoms, or to help a patient recover after an attack of symptoms.
For RRMS, there are several disease modifying therapies that patients can take to slow the progression of MS or lower relapse rates. Other drugs such as corticosteroids may be prescribed to ease symptoms and treat relapses.
Unfortunately, because there is no cure for MS, individuals with this condition may struggle with symptoms and relapses for the rest of their lives. This can be disabling for some patients, leading them to seek disability benefits from a long-term disability insurance policy. However, multiple sclerosis benefits may be difficult to acquire based on a policy’s terms.
Aren’t All LTD Insurance Policies Exactly Alike?
All LTD insurance policies provided by private employers fall under a federal law known as the Employee Retirement Income Security Act (ERISA), which means they all have to follow certain policies and procedures. These rules include establishing specific procedures for any employee who wishes to file an appeal regarding a denial of their long-term disability benefits.
Oftentimes, any LTD insurance policy that is purchased independently and those that are overseen by government entities, churches or schools are not ERISA-governed plans.
Keep in mind that LTD policies may define the word “disabled” differently, too. Some policies state that a person is disabled when not able to complete the duties of any job. Another LTD policy may determine a person is disabled if the person is not able to “substantially” complete the work of the employee’s current occupation.
Some LTD insurance policies change the definition of disability from a person being unable to perform the duties of their own occupation to “any occupation” after the employee has received disability benefits for a period of time. The change in the definition may allow the company to halt benefits at that point, which is generally noted as 24 months after the start of receiving LTD benefits. How long you can collect LTD benefits vary by company as well.
Some LTD policies list exceptions of conditions that they won’t cover. These exceptions may include cancer, obesity, alcohol or drug abuse-related ailments or uncontrolled diabetes.
All of the definitions and guidelines should be spelled out in the LTD policy summary of benefits information.
How Can an LTD Attorney Help With Your Multiple Sclerosis LTD Appeal?
Multiple sclerosis is a lifelong condition that can radically affect a patient’s abilities and way of life. Though some multiple sclerosis patients may experience mild symptoms that may not drastically change their life, many multiple sclerosis patients do experience severe symptoms.
The condition may require lifelong medical care, medication, physical and mental therapy, and other accommodations. These can be quite costly. Additionally, multiple sclerosis may impair a patient’s ability to work, so they may face financial hardship.
Long term disability insurance is one way that people can protect themselves from the financial hardships that a disability can bring. Long term disability insurance is one way that patients can secure an income if they later become diagnosed with a disability. These policies can be particularly valuable if a person does not have sufficient savings to serve as a safety net if they become disabled.
However, some insurers may not pay benefits even if a person is disabled. It is very common for a long-term disability claim to be denied initially. Many patients say that insurers initially deny claims as a way to maximize their own profits at the expense of consumers.
However, the law requires insurers to allow policy holders to appeal a claim denial. If your claim for long-term disability benefits is denied, your insurer must inform you of why your claim was denied, so you can then appeal the decision. This information will help you and your attorney, if you choose to work with one, make the best case possible.
Claims can be denied for multiple reasons — sometimes, your insurer believes that you are not truly disabled and may deny your benefits on the deceleration that your benefits are not necessary. Sometimes, claims are denied for technical reasons, such as a lack of adequate information or a claim not having been filed on time.
Appealing an LTD insurance claim denial can be a long process, but an experienced LTD attorney can help file the strongest appeal possible. This can involve gathering evidence that supports your claim that you are disabled and need benefits. An attorney can help find the appropriate medical records, documentation from your employer, and other evidence.
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