Individuals suffering from osteoarthritis may face difficulties in carrying out their job duties with their disease and its associated complications. If such patients are unable to work due to their osteoarthritis, they could be eligible for long-term disability (LTD) benefits. In order to determine if they meet the criteria outlined in the specific plan, the insurance company will assess their claim.
What is Osteoarthritis?
Osteoarthritis is the most common form of arthritis, which causes pain and swelling of the joints that affects millions of Americans each year.
The condition is sometimes referred to as noninflammatory arthritis or “wear and tear arthritis,” which is different than inflammatory or rheumatoid arthritis. In the case of rheumatoid arthritis, the immune system mistakenly attacks a person’s joints and cartilage resulting in pain, stiffness, swelling, and often disfiguration. On the other hand, osteoarthritis is a degenerative condition that occurs when the protective cartilage on the ends of one’s bones wears down over time. Unlike rheumatoid arthritis, osteoarthritis is not considered to be an autoimmune disease.
How Does Osteoarthritis Occur?
As a result of age or physical “wear and tear,” a sufferer of osteoarthritis experiences a degenerative breakdown of their cartilage normally in the hands, knees, hips, or spine. Cartilage serves as a barrier that protects the ends of the bones from rubbing against one another and causing pain.
When Osteoarthritis Arthritis is a Disability
Osteoarthritis can be a debilitating condition that impacts one’s quality of life and ability to work. Because osteoarthritis is a degenerative joint disease, a person’s condition is expected to worsen over time, often resulting in tremendous pain and limited mobility that prevents a person from engaging in work or even the activities of daily life (ADL).
Being diagnosed with osteoarthritis is not enough to justify paying disability benefits. Your symptoms must limit your abilities so severely that you are unable to work. For example, you may have trouble:
- Lifting more than 10 pounds;
- Grasping small objects;
- Standing or sitting for extended periods; or
- Walking upstairs.
Qualifying for Long-Term Disability Insurance
Documenting Your Limitations Is Essential
The insurance company will decide your claim based on your application, information from your medical providers, and any other evidence obtained during the claim review process. The following will help you understand the kind of information your long-term disability insurance company needs to evaluate your LTD claim based on osteoarthritis.
If you find that your osteoarthritis limits your ability to work, you should work closely with your doctor to document your condition. In order to qualify for long-term disability benefits, you will need sufficient evidence detailing how your condition prevents you from working or performing daily tasks that you otherwise would be able to do.
The Definition of Disability
Under most LTD policies, an individual is considered disabled if he or she is: (a) unable to perform the material duties of his or her own occupation for the first two years of the policy; and (b) unable to perform the duties of just about any occupation after the first two years of the policy. The definition of disability is specific to each individual policy, so you must review your own LTD policy to determine how the term “disability” or “totally disabled” is defined for you.
Your provider will then determine whether your Osteoarthritis is severe enough to keep you from performing activities commonly required for working. These activities include:
- Sitting or standing;
- Kneeling or walking;
- Lifting; and
- Using fine motor skills.
Based on your limitations, you may be deemed capable of heavy, medium, light, or sedentary work.
Medical Evidence Proving Osteoarthritis
To prove the severity of your osteoarthritis symptoms, you will need medical evidence. This evidence can include doctor and hospital records, medical imaging studies, test results, and, sometimes, a residual functional capacity form filled out by your doctor. Generally speaking, your medical evidence needs to include:
- A verified diagnosis of osteoarthritis;
- Details regarding the frequency and severity of your symptoms and how they limit your ability to function at home or in the workplace;
- Imaging (X-rays, CT Scans, MRI’s) that shows degeneration in the joints or bone; and
- A detailed report of your treatment history.
Evaluating A Disability Claim For Osteoarthritis
For those who specifically suffer from osteoarthritis in the lower extremities, walking, climbing, lifting, or squatting may be difficult or almost impossible. In this case, you may be limited to sedentary or desk work only. If one’s osteoarthritis causes severe pain when sitting too long, or staying in one position, it may be found that sedentary work is also not an option.
On the other hand, people who suffer from osteoarthritis in the upper extremities may have trouble using their hands, shoulders, and arms, which would make it difficult to perform most tasks in the workplace including reaching, grabbing, writing, or typing. It may not be possible to perform any job when suffering from osteoarthritis in the upper extremities.
Living with chronic pain from arthritis can also cause mental health issues like depression and anxiety. One may also experience cognitive impairment due to the use of pain-relieving medication that may be prescribed to the patient. Ask each of your treating providers to complete an RFC form that details his or her opinions of your work-related limitations.
Work with an Experienced Long-Term Disability Insurance Attorney to Ensure You Get the Benefits You Deserve
You have a better chance of your claim being approved if you work with an experienced long-term disability lawyer. Your claim may have been denied, but that does not mean the fight is over. Many disability claims are initially denied, but you have the right to file an appeal. Getting expert help during the appeal process is often the difference between being denied and being approved for benefits.
Your long-term disability attorney will be familiar with how insurance providers handle osteoarthritis claims and will help you collect essential medical evidence. Your attorney will not get paid until you do, so you can proceed with your case without having to pay any upfront bills or costs. If your LTD claim has been wrongfully denied or terminated and you’d like to speak to an experienced long-term disability insurance attorney about your claim, call us at (888) 321-8131 to schedule a consultation.