Migraine Headache Disorder And Long-Term Disability Insurance Claims

Patients with migraine headaches may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their migraine headaches may qualify for long-term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.

What Are Migraine Headaches?

Causes of Migraine Headaches

Migraines are caused by an enlargement of blood vessels, which are then surrounded by chemicals released from nerve fibers, enlarging your temporal artery. The temporal artery is an artery beneath the skin on the outside of your skill, which becomes painfully inflamed when it comes into contact with the nerve fiber chemicals. The bigger the artery, the more painful the headaches are.

Number of People Affected by Migraines

Over 28 million people in the United States alone suffer from migraine headaches. Somewhere around 17% of all women and 6% of men have experienced them. Many of the people who get migraines often receive warning signs from their bodies before actually getting a headache. These usually include euphoria, depression, yawning, or a specific food craving.

Qualifying for Long Term Disability Based on Migraines

Occasional migraines are obviously an inconvenience, but those who experience severe migraine headaches on a more consistent basis can find it very difficult to function on a daily basis. Migraine headache sufferers have been known to stay in bed in a dark room for hours, or even several days, at a time. Medications to treat migraines are not always effective right away, and medications themselves can cause significant side effects such as dizziness or drowsiness.

You should be prepared to go through a tough fight to win the approval of your benefits due to a migraine headache disorder. Many long-term disability claims for chronic migraines are denied, especially if there is not an overwhelming amount of medical evidence to support the fact that one’s migraines have a severe impact on one’s ability to work or perform activities of daily living.

If you are suffering from chronic migraines and you have a long-term disability insurance policy, here is what the long-term disability insurance company will look at in determining whether your migraines reach the level of a disability.

Limitations on Activities

There are no specific guidelines that must be satisfied to qualify for disability due to migraines. In general, however, you must prove to the insurance company that your migraines affect your level of functioning to the point where you cannot perform basic work activities regularly.

For the insurance company to conclude that you cannot work, you must experience significant limitations in things like concentrating, understanding and remembering instructions, difficulty interacting with others, lifting and carrying weight, walking, and standing. The insurance adjuster handling your claim will consider the frequency of your headaches and how often you would need to miss work due to your migraines. Moreover, the insurance company will also consider any other conditions you have that further limit your ability to work in conjunction with your headache disorder (for example, if you have a back injury that prevents you from bending).

When you apply for disability, the long-term disability insurance company evaluates your ability to perform work activities.

Tips on Applying For Disability With Migraines

While you are preparing your claim, it is a good idea to keep a journal of your migraines, noting the duration, symptoms, and severity of each occurrence. You should also note all the daily activities that are affected by your migraines. Even if you think something is relatively minor – such as whether you can sit or stand in one place for extended periods – these limitations can impact whether you are deemed totally disabled by the insurance company.

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Medical Evidence Required for Disability Due to Migraines

To be approved for disability, it is important that you have obtained regular treatment for your migraine headache disorder. Although the insurance company will consider your subjective reports of your symptoms, they are most interested in objective medical evidence filed supporting the claim.

Medical Records

There is no definitive test to diagnose migraines; however, the insurance company will want to see in your medical records that your doctor has diagnosed you with recurrent migraine headaches. Migraines are often diagnosed based primarily on the patient’s reporting of their subjective symptoms and in the presence of a family history of migraines. However, doctors may also order additional tests, such as an MRI or CAT scan, to rule out other causes of headaches.

The insurance company will also be looking for the following types of evidence in your medical file:

• Doctors’ notes concerning the frequency and severity of your migraines;
• The results of any tests done to rule out other medical conditions;
• A list of medications and other treatments previously tried, as well as their outcomes and
• Records from any ER visits or hospitalizations related to your migraines.

The insurance company may also ask your doctor(s) to complete a report or questionnaire regarding your medical diagnosis and resulting limitations. In some cases, the insurance company will also seek input from family members or friends who are around you frequently.

Treatment

Treatment for migraines usually centers around pain medications, injections (such as Botox injections), and anti-nausea medications. Most medications are taken after the onset of a headache. However, some medications may be taken “prophylactically” (regularly) to reduce or prevent migraines. Doctors may also prescribe other drugs, such as beta-blockers or anti-depressants, to help alleviate the negative symptoms of headaches.

After the Denial of a Long Term Disability Claim for Migraines

Once you’ve applied for LTD benefits due to a migraine headache disorder, a claims examiner will request your medical records, analyze your file, further investigate your case, and eventually decide on whether to approve your disability claim. The claims examiner may also call you for a phone interview, send you additional forms to complete, or even ask you to go for a doctor’s exam (at the insurance company’s expense.) Although this claims examiner may request copies of your medical records directly from your medical providers, you should obtain your documents and provide them yourself.

FREE RESOURCE: Appeal a Lincoln Financial Disability Denial with our Disability Insurance Appeal Guide

Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your migraine headaches. Even if you have been denied benefits, that does not mean your fight is over. Many people are denied benefits the first time they apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.

While the process can be daunting, your experienced disability attorney will be able to guide you through the process. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills.

The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to an experienced disability lawyer about your migraine headache disorder and its impact on your ability to work, call us at (888) 321-8131. We would be happy to evaluate your case and discuss how to help you through the appeal process.