Navigating your medical treatment and insurance coverage after receiving a multiple sclerosis (MS) diagnosis is difficult, to say the least. At times, you’ve likely felt lost in the mounds of paperwork and complex networks as you try to receive care. But perhaps the most trying administrative difficulty is determining what medical conditions qualify for long-term disability benefits.
In short, it depends. The terms of your individual plan and the extent and nature of your symptoms, along with the law, will ultimately determine if you qualify.
Your MS diagnosis very well might make you eligible for long-term disability benefits. But to know for sure, you’ll first need to learn more about the legal processes and private insurance criteria involved in obtaining disability benefits for multiple sclerosis patients.
This guide will help you understand your eligibility, navigate administrative and legal systems, and assert your rights under the law. But first, let’s look at how MS can affect your employment.
Multiple Sclerosis and Its Impact on Employment
Many people keep working for years after their initial MS diagnosis. However, the slow progression of multiple sclerosis symptoms can make it difficult to determine when exactly you should stop working.
There’s no specific timeline. Instead, the impact that your symptoms have on your health, energy levels, and ability to perform specific tasks are generally the determining factors. Essentially, you’ll only need to stop working when your symptoms make you unable to perform your job.
Of course, factors like the level of physical activity necessary to perform your job duties will also determine how long you can sustain your full-time job. For instance, if you work in a physically demanding role, physically debilitating symptoms can make it impossible to carry on. Or if you’re in more of a sedentary position, symptoms like cognitive impairment can make it exceedingly difficult to get through a workday.
If you believe you could perform your job with accommodations from your employer, ask for them. Many employers are happy to work with employees to allow them to keep working for as long as possible.
Everyone’s MS journey is unique. But if you’re at a stage where you’re no longer able to work, even with accommodations from your employer, the next step is to determine if your specific medical conditions qualify you for long-term disability benefits.
Qualifying for Long-Term Disability Benefits With MS
Obtaining long-term disability benefits is contingent on fitting your insurance company’s definition of disabled. The way disability is defined differs across insurance plans. But in general, medical conditions like multiple sclerosis will likely qualify you for long-term disability benefits if your symptoms are advanced enough to prevent you from performing your job duties.
If you are ready to submit a claim for long-term disability, at a minimum, your long-term disability claim should include:
- A diagnosis of multiple sclerosis
- Medical records of the severity and duration of your condition
- A clear description of how your condition prevents you from performing job duties
The natural intermittency of MS symptoms often makes it difficult to prove to your insurer that you cannot work. There may be days or months at a time when your symptoms are relatively mild. If you have been working with your employer as you try to continue to work, your employer may support your claim by explaining that you are unable to consistently perform your job duties.
It is also important that you don’t downplay your experience and symptoms to your medical providers. Instead, offer a clear and precise recounting of how MS impacts you. This way, you’ll be able to furnish a medical record that reflects the reality of your condition.
Determining if You Still Qualify for Long-Term Disability Benefits After Being Terminated
Getting fired is a devastating experience—especially if you’re now relying on your former employer’s coverage for long-term disability benefits.
However, if you’ve found yourself dealing with MS after being terminated from your role, you may still qualify for benefits. The key here is proving that you were disabled before you were terminated, which may mean that your MS directly caused your termination.
If you were fired because, for instance, your MS symptoms prevented you from performing your role effectively, then you can still qualify for long-term disability benefits—even if you hadn’t yet been diagnosed with MS at the time of your termination. You’ll need to provide evidence that suggests you were disabled due to your emerging MS symptoms prior to being let go.
Losing your job doesn’t necessarily mean you’ve lost your right to long-term disability benefits. However, you do face an extra hurdle in the process—so in this scenario, it’s probably best to speak to an attorney ASAP.
Processes in Obtaining Long-Term Disability Benefits for MS
If you intend to submit a claim to see if you qualify for long-term disability, the first step is to gather documentation about your medical conditions.
First, you’ll submit your complete medical record and an official job description. You may also want to include impact statements regarding your condition. Write one yourself, but also ask your doctor, employer, friends and family to write statements for you to further strengthen your claim.
If your claim is denied, you will need to exhaust the insurer’s appeal procedures. You must comply with the deadlines for submitting any appeal.
Bear in mind that if your appeal is denied and you initiate litigation to fight the decision, the judge will likely only review the records submitted with your claim and your appeal.
Your insurer is incentivized to pay out as few claims as possible. This means that you’ll likely need to take your claim to court. In this case, you’ll initiate legal action only after exhausting the insurer’s appeals procedure.
With this in mind, it’s ideal to obtain an MS disability attorney to help you craft and submit the strongest appeal possible. This way, you have a better chance of receiving your rightful benefits without delay. Plus, your attorney will be able to fight for you in court if need be.
The Role of an Attorney in Determining Whether You Qualify for Long-Term Disability Benefits
Submitting a long-term disability claim and navigating and subsequent pushback from your insurance company is an exceedingly delicate and complex process. The best way to ensure that your claim is correct and convincing is to enlist an attorney.
Long-term disability attorneys have deep expertise in filing claims, appeals, and lawsuits to get their clients their rightful benefits. Basically, they can hold your insurance company to account and make sure they’re meeting the terms of your coverage.
Look for long-term disability lawyers with specific expertise in MS claims. The National MS Society’s list of vetted attorneys is one of the most reliable resources available. It lists attorneys with the proven knowledge base required to guide you through obtaining long-term disability benefits.
Find a Specialized Attorney Who Knows How to Demonstrate that You Qualify for Long-Term Disability
Your eligibility for benefits is contingent on a wide variety of diverse factors. Your plan, medical records, job description, and conditions are all used to determine if you qualify for long-term disability benefits. The process of submitting a claim and appeal are overwhelmingly complex.
Plus, your insurance company isn’t necessarily going to be on your side throughout the process. You are going up against a powerful company which has a financial incentive to deny claims, and you’re going to need a professional who can stand up for you.
Your attorney should specialize in helping clients obtain their rightful benefits. Look for a law firm that has a track record of success in this area, like Kantor & Kantor. Reach out for a consultation with one of our long-term disability attorneys today.
