Myositis and Long-Term Disability Claims

Living with myositis can be incredibly challenging, especially when it affects your ability to work and perform daily tasks. Many people with myositis struggle with progressive muscle weakness, fatigue, and other complications that make it difficult to maintain employment. If your long-term disability (LTD) claim has been denied, you may feel frustrated and uncertain about your next steps. Understanding the nature of myositis, the medical evidence required for a successful disability claim, and how to fight a denial can help you navigate this complex process.

What is Myositis?

Myositis refers to a group of rare autoimmune diseases that cause chronic muscle inflammation and weakness. People with other autoimmune diseases, such as lupus, rheumatoid arthritis, and scleroderma, are more likely to develop myositis. The most common types include polymyositis, dermatomyositis, inclusion body myositis, and necrotizing autoimmune myopathy. These conditions can significantly affect a person’s ability to perform daily tasks, including work-related activities.

Symptoms and Complications That Can Prevent You from Working

Different types of myositis have different symptoms, but common problems that can affect your ability to work include:

• Muscle Weakness – Progressive weakness, especially in the shoulders, hips, and thighs, can make standing, lifting, and even walking difficult.
• Fatigue – Severe fatigue can interfere with work performance and daily functioning.
• Joint Pain and Swelling – Persistent pain can make movement and dexterity difficult.
• Difficulty Swallowing (Dysphagia) – Difficulty swallowing can lead to nutritional deficiencies and aspiration pneumonia.
• Breathing Problems – In some cases, myositis affects the breathing muscles, causing shortness of breath and requiring medical intervention.
• Skin Rashes (In Dermatomyositis) – Painful or itchy rashes may develop, causing discomfort and possible disfigurement.
• Frequent Falls – Muscle weakness often leads to balance problems and falls, increasing the risk of fractures and other injuries.

If these symptoms prevent you from performing your job duties or working full time, you may qualify for long-term disability (LTD) insurance benefits.

Medical Evidence Required for a Myositis Disability Claim

To successfully file a long-term disability claim, you must provide comprehensive medical evidence that demonstrates the severity of your condition. Important medical documentation includes:

• Clinical Evaluations – Documentation from a rheumatologist or primary care physician detailing the extent of muscle weakness and impairment.
• Electromyography (EMG) and Nerve Conduction Studies – These tests evaluate muscle and nerve function and support a diagnosis of myositis.
• Muscle Biopsy Results – A biopsy can confirm inflammation, muscle damage, and abnormalities consistent with myositis.
• Magnetic Resonance Imaging (MRI) Scans – MRI can detect muscle inflammation and signal disease progression.
• Blood Tests – Elevated creatine kinase (CK) levels and the presence of myositis autoantibodies can confirm the disease.
• Pulmonary Function Tests – If breathing problems are present, pulmonary function tests can show lung function impairment.
• Swallowing Studies – For individuals with dysphagia, imaging and functional tests can demonstrate the severity of the problem.
• Functional Assessments – Residual Functional Capacity (RFC) forms completed by your physician can outline specific limitations that affect your ability to work.

Challenges in Obtaining Long-Term Disability for Myositis

Obtaining LTD benefits for myositis can be challenging due to the complex nature of the disease. Insurance companies may deny claims based on:

• Lack of Objective Medical Evidence – While myositis symptoms can be severe, they are not always detectable with standard tests.
• Inadequate Documentation – A poorly documented claim may result in a denial or delay in benefits.
• Claiming the Condition Is Manageable – Insurers may argue that you can return to work with treatment, even if your symptoms persist.
• Failing to Meet the Policy’s Definition of Disability – LTD policies have different definitions of disability; some require a total inability to work, while others consider whether you can work in another capacity.

How a Long-Term Disability Lawyer Can Help with an Appeal or Lawsuit

If your long-term disability claim has been denied or terminated, a disability attorney can be an important advocate in appealing the denial or filing a lawsuit against the insurance company. An attorney can:

• Review Your Denial Letter – Analyze the insurer’s reasons for denial to identify weaknesses and develop a strategic response.
• Gather Additional Medical Evidence – Work with your doctors to obtain stronger documentation, updated medical records, and detailed physician statements.
• Manage the Appeal Process – Prepare and submit a comprehensive appeal that directly addresses the insurer’s reasons for denial.
• Communicate with the Insurance Company – Manage correspondence with the insurer to ensure compliance with deadlines and procedural requirements.
• Filing a Lawsuit If Necessary – If your appeal is unsuccessful, an attorney can file a lawsuit against the insurance company to fight for your benefits.
• Advocate For You In Court – Represent you in court and negotiate a settlement if the insurer refuses to reinstate your benefits.

Contact the Ortiz Law Firm for Help with Your Myositis Disability Claim

If myositis has made it impossible for you to continue working and your disability claim has been denied, you don’t have to navigate the complex appeals process alone. The Ortiz Law Firm has extensive experience handling long-term disability claim denials and appeals for individuals with myositis. Nick Ortiz has been handling disability insurance claims since 2005, and we represent claimants throughout the United States.

As a small firm, we offer a personalized and attentive client experience that large firms simply cannot match. When you work with us, you are not just another case number—we take the time to understand your unique situation and tailor our strategy to maximize your chances of success. We believe in close attorney-client communication and a hands-on approach to every case.

Contact us online or call us at (888) 321-8131 for a free case evaluation. We work on a contingency fee basis, which means you don’t pay unless we win your case.