Proving Autoimmune Diseases on SSDI and LTD Disability Insurance Claims

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By: Bill Henry
PublishedAug 18, 2017
3 minute read

Picture of woman suffering from an autoimmune disease worried about getting denied SSDI benefits

In this article, our SSDI and lTD lawyers discuss getting awarded benefits and fighting denials for SSDI and autoimmune disease cases.

Disabilities are not always visibly apparent, like autoimmune diseases, but they can be just as debilitating as visible ones. Those who suffer from these hidden disabilities not only have to live with the stigma of being labeled “hyper-sensitive” or “hysterical” because they may look healthy, but they also have a much harder time getting a disability insurance claim approved.

While difficult to prove, these invisible disabilities can prevent someone from being able to work and provide for themselves and their families. This blog will discuss what these conditions are and what an individual can do to bolster their disability claim for approval.

What are these invisible conditions?

An autoimmune disease is when the immune system can no longer differentiate between a foreign invader – like bacteria and viruses – from the cells in its own body, which leads it to attack its own cells in confusion.

An autoimmune disease can affect almost any part of the body, including the heart, brain, nerves, muscles, skin, joints, lungs, kidneys, glands, the digestive tract and blood vessels. This can cause chronic pain and/or flare ups, leading to partial to complete disruption in one’s ability to carry out normal daily tasks, let alone the ability to work.

Some common autoimmune diseases are:

picture of a list of auto immune diseases

Invisible Disabilities and Insurance Companies

It’s understandable that an insurance company may approach these disabilities with caution, as unseen disabilities can be harder to prove and thus easier to fake. However, it also puts those who suffer from these conditions in a difficult position when it comes time to filing for a disability insurance claim.

Insurance examiners aren’t usually trained on what autoimmune diseases are. Instead they focus on the residual function – or what the limiting effects are of a disease or injury in regards to a person’s ability to work. Due to this limited focus and limited knowledge, an examiner doesn’t always competently interpret the medical evidence submitted.

While the task may be a bit more difficult, it’s not impossible by any means. There are some things you can do to help prove your disability claim.

Proving the Invisible

Many people think that if they get a written diagnosis from their doctor, then the insurance company will award them disability. This is not the case. This is the first step in proving your disability to an insurance company. Additionally, an insurance company will want objective evidence to back up your doctor’s diagnosis – like x-rays, blood tests, colonoscopy etc. You’ll also need to show how your illness impedes your ability to work – this is done by documenting your functional limitations and your work environment/duties. In short, here is what you need to include on your disability claim:

  1. Get an official diagnosis letter from your doctor.
  2. Compile medical records as evidence of your disability.
  3. Demonstrate the functional limitations of your disability and how they relate to your job role.

Gathering Evidence

When compiling evidence, it’s important to realize that there are two forms of medical evidence, subjective and objective. Objective evidence are things like x-rays, MRIs, blood tests and clinical observations of a medical professional. Subjective evidence are things like pain and fatigue which are hard to verify. Thus, it is extremely important to support subjective statements with objective testing and clinical observations.

For example, a worker who claims that the fatigue association with their autoimmune disorder adds to their inability to perform their job role, should have their doctor support their claim with a functional capacity evaluation (FCE) – where the doctor documents the person’s fatigue through clinical observation and testing.

Types of functional limitations:

If you have your diagnosis letter and have compiled an objective medical record, then you will need to start including evidence as to why your autoimmune disorder hinders your ability to work. To start, let’s looks at how your functional limitations. These are broken down into three categories:

1. Exertional (Strength related activities)

Think about physical aspects of your job – are you required to sit/stand for long periods of time, or occasionally lift boxes? If your disability affects your ability to carry out these aspects of your job, then it’s important to include.

2. Non-Exertional (Non-strength related activities)

These are non-strength related activities and can be the most important aspects of your job, like seeing. Think of activities related to manual manipulation, posture, vision and communication, such as:

  • typing, handling objects
  • stooping, climbing, crouching
  • seeing, speaking, hearing
  • maintaining stamina

Also think about your work environment, is it loud, dusty, or have temperature extremes? A work environment is an important factor in a person’s ability to do their job. If the environment exacerbates your disability and affects your ability to work, then you should include this in your claim.

3. Mental (Cognitive activities)

Autoimmune diseases and the medicines that go along with them can have an impact on a person’s cognitive abilities. Think about aspects of your job that require you to concentrate or use memory. If you are required to socialize, are things like anxiety and/or depression affecting your interpersonal skills? If yes to any of these, then make sure to include them in your claim.

Important! Take into account how your medication affects your functional limitations. If your autoimmune disorder requires certain medications and those medications have side effects that affect your ability to work and increase your functional limitations, then you should include that evidence in your claim.

To submit evidence of functional limitations start by documenting your work environment – take pictures, include a job description or letter from your superior. Then make sure your medical record shows how your autoimmune disorder and/or medications prevent you from performing those job functions.

Next Steps:

Learn more about disability insurance by downloading our free educational guide – it discusses what types of evidence to use and what to do if your claim is denied.

If you would like further information, or would like help with your claim, then schedule an assessment with our disability attorney now.

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