Autoimmune Encephalitis and Long-Term Disability

Autoimmune encephalitis is a group of diseases in which the body’s immune system mistakenly attacks the brain, causing inflammation. Its symptoms and diagnostic challenges often make it difficult for people to get the benefits they deserve. Here’s what you need to know if you’re pursuing a long-term disability (LTD) claim for autoimmune encephalitis.

Symptoms and Complications That Can Affect Your Ability to Work

Autoimmune encephalitis presents with a wide range of symptoms that can interfere with daily functioning, including:

• Cognitive Impairment: Memory loss and confusion
• Psychiatric Symptoms: Anxiety, panic attacks, hallucinations, or personality changes.
• Neurological Deficits: Seizures, muscle weakness, or tremors.
• Speech Problems: Problems with speaking or understanding speech.
• Autonomic Dysfunction: Irregular heart rate, changes in blood pressure, or problems with temperature regulation.

Severe complications can include persistent neurological damage and possible coma, requiring long-term rehabilitation or resulting in permanent disability. Even with treatment, some people experience residual effects that limit their ability to perform essential job functions.

Medical Evidence and Proof of Disability

Building a strong LTD claim requires comprehensive medical documentation to show how autoimmune encephalitis affects your ability to work. Key pieces of evidence include:

1. Neurological Evaluations: Reports from neurologists detailing cognitive, motor, and sensory impairments.
2. Neuropsychological Testing: Evaluations that show deficits in memory, attention, or problem-solving skills.
3. Imaging Studies: MRI scans that show brain inflammation or damage.
4. Lab Tests: Evidence of autoantibodies associated with autoimmune encephalitis, such as NMDA receptor antibodies.
5. Spinal Tap (Lumbar Puncture): Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be tested for signs of autoimmune encephalitis.

6. Treatment Records: Documentation of treatments such as immunotherapy, corticosteroids, or plasma exchange and their effects (or lack thereof) on symptoms.
7. Residual Functional Capacity (RFC) Form: This form, completed by your doctor, outlines specific physical, cognitive, and psychological limitations caused by your condition.

Challenges in Long-Term Disability Claims

Autoimmune encephalitis claims can face several hurdles:

• Subjective Symptoms: Symptoms such as fatigue or mental fog may be dismissed as “non-objective” by insurance companies.
• Intermittent Nature of Symptoms: Fluctuating severity may lead insurers to argue that you can still work during periods of remission.
• Denial Based on Treatment: Insurers may claim that ongoing treatment should eventually restore functionality, even when evidence shows permanent limitations.
• Definition of Disability: Most LTD policies require you to prove that your condition prevents you from performing your “own occupation” or “any occupation,” depending on the policy’s terms.

Appealing a denial often requires additional medical evidence, expert testimony, or the assistance of a legal professional.

How an LTD Attorney Can Help

Navigating the complexities of an LTD claim for autoimmune encephalitis can be overwhelming, especially when dealing with an insurer’s denial or delay. Here’s how an experienced long-term disability attorney, like Nick Ortiz of the Ortiz Law Firm, can provide comprehensive support to improve your chances of success:

Dedicated Legal Assistance and Direct Communication

When you partner with the Ortiz Law Firm, you get a team that’s deeply invested in your case:

• Personalized Attention: A dedicated paralegal and legal assistant will be assigned to your case, ensuring continuity and a thorough understanding of your situation.
• Accessible Communication Channels: You can contact our team by phone, email, text, or even fax. We also offer a secure client portal for 24/7 access to updates on the status of your case​.

Comprehensive Case Analysis and Strategy Development

A strong LTD appeal begins with understanding every aspect of your case:

• Claim File Review: We get the complete copy of you claim file from the insurer, often containing over 1,000 pages of records, correspondence, and documentation. We meticulously analyze these files to identify weaknesses in the insurer’s argument and ways to strengthen your appeal.
• Insurance Policy Evaluation: Each LTD policy has unique definitions of “disability” and specific requirements. We dissect the language of your policy to align your claim with its terms and demonstrate why your condition meets the criteria​.

Gathering and Strengthening Medical Evidence

The heart of any LTD claim is the medical evidence, and we ensure that yours is both thorough and compelling:

• Updated Medical Records: As we review your claim file, we also gather the most recent medical records from all of your treating physicians to ensure that the insurer has no reason for upholding the denial of your claim based on outdated evidence.
• Customized RFC Forms: We create customized Residual Functional Capacity (RFC) forms tailored to your specific limitations. These forms detail the impact of autoimmune encephalitis on your ability to perform work-related tasks​.
• Daily Limitations Affidavit: We will help you prepare an affidavit detailing how your condition affects your daily life. This personal account adds a human perspective and credibility to your case​.

Legal Strategy and Detailed Appeal Preparation

Each denial must be carefully dissected and countered with a strategic, evidence-based response:

• Comprehensive Legal Review: We identify errors in the insurer’s decision, from faulty medical assessments to misinterpretations of policy language.
• Compelling Appeal Document: Our legal team prepares a detailed appeal, typically 14–20 pages, summarizing medical evidence, vocational analysis, and legal arguments in a format designed to effectively challenge the insurer’s decision​.

Peace of Mind with No Upfront Costs

At the Ortiz Law Firm, we work on a “no win, no fee” basis. This means you only pay if we successfully secure your benefits, allowing you to focus on your health without worrying about financial risks​.

Get Help with Your Autoimmune Encephalitis Long-Term Disability Claim

Nick Ortiz and the team at the Ortiz Law Firm understand the complexities of autoimmune encephalitis and its impact on your ability to work. We have extensive experience helping clients nationwide secure the LTD benefits they deserve. If your claim has been denied and you want an experienced legal team to guide you through the appeal process, contact the Ortiz Law Firm for a free case evaluation. Call us today at (888) 321-8131 for help with your claim.