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Although many professionals purchase disability insurance with the idea that they may need protection in case of a sudden disaster, such as being injured in a car accident, the fact is that many, if not most, disability claims stem from conditions that develop over time. When the onset of a disability is not sudden and obvious, the claims process can be very different and often more challenging.

Understanding the difference between disability insurance claims involving chronic illnesses and conditions claims involving sudden onset disabilities can make it much easier to succeed in obtaining benefits. While every claimant and medical condition is different, here are some general factors to keep in mind when preparing to file a claim or appeal a denial of benefits. Many people find it helpful to work with an experienced disability insurance attorney who knows how to present the right evidence to demonstrate the full extent of liability and obtain complete benefits due under the terms of the policy.

When a Condition is Chronic

The Centers for Disease Control defines a chronic disease as a condition that lasts for at least a year and that either limits the activities that are part of daily living or requires ongoing medical attention. A chronic illness does not necessarily cause a significant disability, but it has the potential to.

Some chronic conditions are caused by or exacerbated by an individual’s personal habits, such as smoking or other unhealthy lifestyle choices, but other conditions are the result of hereditary factors or other elements outside the individual’s control.

Chronic conditions often develop gradually over time. Symptoms may not be noticeable initially, or they may be attributed to other causes. For that reason, it is often difficult to pinpoint the time when a chronic condition began. For purposes of disability claims, the start of the condition is often linked to a physician’s diagnosis.

Examples of Common Chronic Illnesses and Conditions that Lead to Disability Claims

Chronic conditions can involve a wide variety of aspects of mental and physical health. It is important to understand that a chronic condition can prove disabling in different ways depending on the severity of the condition and how it interacts with the individual’s overall mental and physical health.

Some common examples of chronic conditions that can lead to long-term disability include:

• Musculoskeletal disorders such as arthritis, back pain, and joint issues
• Cancer
• Major depressive disorder
• Chronic obstructive pulmonary disease (COPD) and respiratory disorders
• Chronic fatigue syndrome
• Digestive system disorders such as Crohn’s disease
• Schizophrenia and bipolar disorder
• Neurological disorders such as Parkinson’s disease
• Impairment of hearing or vision
• Heart disease
• Autoimmune disorders such as rheumatoid arthritis and lupus

The human body is an intricate mechanism, and numerous conditions can impair the functioning of the body to a degree that makes it difficult or impossible to perform tasks needed to continue working in a particular profession. Insurance companies often do not acknowledge the effect these conditions can have so it is important to take the right steps to demonstrate the severity of the condition and the impact it has had on your professional career before you can obtain benefits under a long-term disability policy.

Unlike sudden onset conditions, a chronic condition often never improves and is more likely to worsen over time, leading to increased disability that continues throughout an individual’s life. It becomes vitally important to secure income and resources needed for the future.

How Disability Insurance Helps with a Chronic Condition

Doctors, accountants, executives, lawyers, and other professionals purchase disability insurance to provide income benefits to protect them in case a disabling condition prevents them from earning their usual income. It is a contractual bargain with the insurance company.

Both short-term and long-term disability insurance can be crucial. Short-term benefits can be obtained soon after a condition becomes so disabling that it interferes with the ability to work. However, these benefits usually will only continue for a few months at most. Long-term disability benefits can make up for lost income due to the inability to work for years and potentially even until retirement age.  

Qualifying for Disability Benefits Based on a Chronic Condition

There is no specific formula to apply to determine whether you qualify for disability benefits under your insurance policy because there are so many variables involved. It is important to read through the details of your policy closely to determine how disability is defined and what is covered. Since insurance policies are generally written in industry terminology that often seems like another language, it is helpful to consult a disability insurance attorney who can interpret the requirements and apply them to your situation to assess your coverage. 

For instance, you need to determine whether your policy provides benefits only if your condition prevents you from performing any occupation or whether the policy provides benefits if you are only unable to perform your “own” occupation due to the disability. (Your “own” occupation is considered the specific job you were performing at the time you became too disabled to continue working.)

It is also important to review the policy terms closely regarding pre-existing conditions. Many disability insurance policies will not cover conditions that were considered to have existed before the start of the policy. Others will only provide coverage after a waiting period. The question of whether a pre-existing condition is the cause of a current disability can be very complex, and insurance companies will often make tenuous connections to deny disability claims. An experienced attorney can often demonstrate why coverage should be provided when a claim is denied based on allegations that a condition pre-dated coverage.

Finally, it is important to be aware of how crucial it is to present the right medical evidence when filing a claim or appealing a claim denial seeking benefits based on a chronic condition.

Filing a Claim for Disability Benefits Based on a Chronic Illness

Although insurance companies seem to make themselves appear helpful and approachable when they are trying to encourage you to sign up for coverage, when the time comes to file a claim, the friendly demeanor tends to disappear. Instead, you are expected to follow the requirements to the letter. And it can be difficult to understand precisely what those requirements are.

Generally, you will be required to provide what’s known as “proof of loss” when you file an initial claim for long-term disability benefits, and you may need to provide additional proof to continue receiving benefits. As part of the claims process, you will also probably need to file an individual statement with information about your background, medical details about your disability, and your work duties and work history. It will be important to provide thorough and complete information because the insurance company will be reviewing every detail, looking for a reason to deny your claim.

The insurance company may require a functional capacity evaluation to measure the ability to perform certain tasks, such as bending and lifting. They may also require what they refer to as an “independent” medical examination with a physician hired by them. Not surprisingly, the results of these exams can be biased in favor of the insurer, but an experienced disability insurance attorney will understand how to challenge and counter the results.

Seltzer & Associates Helps Professionals Obtain Disability Benefits Based on Chronic Conditions

Proving the severity of an impairment and overcoming exclusions based on claims that an illness is a pre-existing condition can be a challenge for any professional filing disability insurance claims based on a chronic mental or physical condition. But the dedicated team at Seltzer & Associates is ready to assist. We focus on helping professionals around the country obtain the disability benefits they are entitled to through insurance policies. 

Our team understands the tactics used by insurance companies to avoid paying fair benefits, and we know how to succeed with disability claims. If you need to file a claim or have been denied benefits under your policy, we invite you to contact us online or call 888-699-4222 to schedule a complimentary consultation so we can discuss the ways we may be able to assist.