Benefit Limitations In Long-Term Disability Claims For Chemical And Environmental Sensitivities

Chemical and environmental sensitivities (CES) can lead to a wide array of disabling symptoms. In severe cases, these sensitivities can profoundly impact a person’s ability to work and complete regular life activities. When symptoms impact a person’s ability to perform their occupation, pursuing disability benefits is essential, especially if a claimant’s symptoms are specifically related to their work environment. However, many long-term disability claims for chemical and environmental sensitivities are denied.

Understanding LTD Claims for Chemical and Environmental Sensitivities

The first step in a long-term disability claim for CES is understanding these conditions. Chemical and environmental sensitivities include, but are not limited to:

• Multiple Chemical Sensitivity (MCS).
• Sick Building Syndrome.
• Chronic Toxic Encephalopathy.

Symptoms are typically triggered by exposure to certain levels of chemicals or environmental conditions. Triggers may include:

1. Tobacco smoke.
2. Carpeting.
3. Perfumes.
4. Paint.
5. Plants.

Chemical and environmental sensitivities can cause a range of symptoms, including:

1. Fatigue.
2. Difficulty concentrating.
3. Headaches.
4. Memory loss.
5. Muscle pain.
6. Difficulty breathing.

Given the often impairing nature of these conditions, sufferers may be eligible for long-term disability benefits. However, the lack of universally recognized diagnostic criteria makes the claim and approval process complex and difficult to navigate.

Strategies for a Successful Claim

You can take several steps to improve your chances of a successful disability insurance claim.

1. Understand the Definition of Disability: Most insurance companies categorize disability into “own occupation” and “any occupation.” Under “own occupation,” you’re considered disabled if you can’t perform the tasks of your specific job. Under the “any occupation” definition, you must be unable to perform the duties of any job that meets certain criteria.
2. Maintain Thorough Medical Records: Documenting your medical journey is crucial. Ensure your doctors note your symptoms, frequency, severity, and impact on your daily life. Ask your doctor to complete a residual functional capacity form. This evidence can be invaluable in building your case.
3. Proactively Manage Your Condition: Diligently follow your doctor’s advice, attend all scheduled appointments, and participate in recommended therapies or treatments. These actions demonstrate to the insurance company that you’re actively managing your condition.
4. Engage an Experienced Disability Lawyer: A disability lawyer can help you navigate the challenges and complexities of your claim. They can guide you through the claim process and help you understand your policy limitations. A disability lawyer can also advocate for you if your claim is wrongfully denied or terminated.
5. Prepare for Possible Appeals: Understand that initial denials are not the end of the road. Most long-term disability claims are initially denied, and claims can often be won during the appeal process.

Limitations in Long-Term Disability Claims

LTD benefits can be a lifeline for those unable to work due to CES. However, it’s important to understand that insurance policies often have limitations that can greatly impact your claim.

Whether your conditions are physical or mental is very important to your claim. In many cases, insurers may misclassify CES claims under mental health, which often has a 24-month limit on benefits. CES can indeed cause mental health issues due to the constant strain of managing symptoms. However, the core issue is still a physical hypersensitivity to certain chemicals or environmental factors.

Some insurance policies also have a 24-month benefit limitation for disabilities that are “self-reported” or difficult to verify objectively. “Self-reported” condition limitations typically include chemical and environmental sensitivities. The medical community is still striving for objective diagnostic tests for this type of sensitivity. After this period, benefits may be discontinued even if your symptoms persist.

Chemical and environmental sensitivity limitations in long-term disability claims are uncommon but not unheard of. Here is an example of one such policy limitation:

“Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by an allergy or sensitivity to chemicals or the environment including, but not limited to:

1. Environmental allergies.
2. Sick Building Syndrome.
3. Multiple Chemical Sensitivity Syndrome.
4. Chronic Toxic Encephalopathy.

This limitation will not apply to:

1. Asthma.
2. Allergy-induced reactive lung disease.”

Wrongful Denials of LTD Claims for CES

Unfortunately, it is not uncommon for insurance companies to wrongfully deny LTD claims for chemical and environmental sensitivity. The subjective nature of CES and the absence of widely accepted diagnostic criteria give insurers an excuse to deny claims.

Seeking Justice and Upholding Your Rights

Navigating the world of long-term disability claims with a chemical or environmental sensitivity is no easy feat. The subjective nature of these conditions, strict limitations, and the likelihood of a claim denial create an uphill battle. The fight can be tough, but knowing your rights and advocating for your health is paramount. Despite the challenges, obtaining disability benefits is not an impossible task.

Don’t hesitate to seek legal assistance if you believe your claim has been wrongfully denied. Collaborate with a knowledgeable and experienced disability lawyer like Nick Ortiz to present your claim effectively and combat wrongful denials. With a deep understanding of the system and effective advocacy, he can help you secure the benefits you need. If you want to schedule a free case evaluation, call the Ortiz Law Firm today at (888) 321-8131.