Carpal tunnel syndrome is a common condition caused by compression of the median nerve in the wrist. If you suffer from carpal tunnel syndrome and your job requires significant typing or other dexterous movements, you may be considering filing for long term disability insurance benefits.
However, you may have questions before filing a claim: Is carpal tunnel considered a disability? How do you prove to your insurance company that it’s severe enough to prevent you from working?
Before filing a long term disability claim for carpal tunnel syndrome, here are some things you should know to help your chances for benefit approval.
Is Carpal Tunnel Syndrome A Disability?
Yes-- carpal tunnel syndrome, in some cases, can lead to long term disability. The condition causes numbness, pain, tingling, and weakness in the hands and fingers, which can vary in severity from bothersome to debilitating.
Whether your insurance company considers your carpal tunnel syndrome depends on a few factors: primarily, the severity of your symptoms and how those symptoms interfere with your job duties. If you suffer from severe carpal tunnel and your occupation demands a high level of computer use, writing, and other uses of your affected hands/fingers/wrists, you may be eligible for long term disability benefits.
In order to get approved for long term disability, your insurance company will want you to explain your symptoms and the specific ways their impair your ability to perform your job duties.
Inability to Work Due to Carpal Tunnel Syndrome
Your insurance company will require an explanation of not only your symptoms, but how they stop you from working in your occupation.
For example, if you work as a surgeon, your job likely requires high levels of hand dexterity, function, and grip strength. Carpal tunnel syndrome can hinder your ability to handle surgical tools, affect your precision in movements, and impair you from working on procedures without breaks that are not feasible to take.
Or if you are an attorney, your job may require long hours at a computer, heavy typing of legal documents, and handwriting notes during consultations or meetings. Your occupational duties could then aggravate your carpal tunnel syndrome symptoms. The pain in your wrists and hands could force you to take breaks, slowing down your work pace and causing you to miss crucial deadlines.
Before filing your carpal tunnel syndrome disability claim, it is a good idea to consider the specific ways your condition affects your ability to work. If your insurance company doesn’t understand the level of hand/wrist/finger function your job requires, they may deny your benefits on the basis that your carpal tunnel syndrome has no significant effect on your ability to perform your occupational duties. Drawing up examples to the contrary for your insurance company can substantiate your claim, painting a clearer picture for them of how your carpal tunnel prevents you from working.
What Medical Evidence Can Prove My Carpal Tunnel Syndrome As A Disability?
Before approving long term disability benefits, your insurance company will require objective proof of your carpal tunnel syndrome. This evidence comes in a few forms: proof of your diagnosis through documented symptoms, clinical examination findings, an electromyogram, and a nerve condition study.
When reviewing your claim, your insurance company will want to see clear documentation of symptoms consistent with carpal tunnel syndrome. These symptoms commonly include:
- Complaints of shooting pain in the wrists;
- Reports of numbness, tingling, pain, weakness in the wrists/hands/fingers;
- Difficulty gripping/holding items;
- Waking in the night due to discomfort.
You should report all of your symptoms to your treating doctor(s), as well as their severity, frequency, and – if applicable – how they progress over time.
Your symptoms may be intermittent, but your insurance company will want to see exacerbation by certain work-related activities involving the hands, such as typing, driving, writing, or using hand tools.
Symptoms may affect the hands bilaterally or unilaterally. If your symptoms only affect your non-dominant hand, the insurance company is more likely to question your long term disability claim.
Clinical Examination Findings
Your insurance company will look in your medical records for clear documentation of abnormal clinical findings upon examination. These clinical findings will typically need to include abnormalities upon sensory examination (i.e., altered sensation to pinprick or light touch) and motor examination (i.e., muscle weakness or muscle wasting).
There are also several special clinical tests that can be performed for carpal tunnel syndrome, including:
- The Phalen sign
- Carpal compression test
- Hoffmann-Tinel sign
- Palpatory test, and
- The square wrist sign.
Positive/abnormal findings from these tests will help substantiate your carpal tunnel syndrome disability claim.
An EMG is a sensitive diagnostic test that measures the electrical activity in the muscles in response to nerve stimulation. While abnormal test results may provide an accurate and reliable indicator of carpal tunnel syndrome, the test has also been known to produce some falsely negative results. The results, at times, may also be inconclusive.
Your insurance company will take your EMG findings into consideration when looking at your carpal tunnel disability claim.
Nerve Conduction Study (“NCV”)
Your insurance company may want to see the results of a nerve condition study, especially if your EMG was negative or inconclusive. An NCV is a diagnostic test the measures nerve conduction velocity – that is, the speed of conduction of electrical impulses in a nerve. The NCV results can provide a reliable indicator of carpal tunnel syndrome. However, like the EMG, the NCV is known to produce falsely negative results.
What Else Will My Insurance Company Look For?
Proof of your carpal tunnel syndrome diagnosis is important, but your insurance company will want more than that to approve your long term disability claim.
Appropriate Treatment Is Necessary
Depending on the terms of your policy, your insurance company will likely require that you receive proper “appropriate” treatment for your carpal tunnel syndrome. Appropriate treatment may include:
Wrist splinting or use of a wrist stabilizer;
- Nonsteroidal anti-inflammatory medications (“NSAIDs”);
- Oral corticosteroids;
- Corticosteroid injections;
- Physical therapy, occupational therapy, and/or home exercises; and/or
- Carpal tunnel release surgery.
Your insurance company will also want to see that you are compliant with your doctor’s recommended course of treatment. For example, the insurance company may give you a difficult time if your refuse to undergo recommended carpal tunnel release surgery. Noncompliance can be used to deny your disability claim or terminate benefits after you’ve been approved.
Proving Inability To Work
To qualify for long term disability benefits, your carpal tunnel syndrome must be severe enough to prevent you from performing the essential functions of your job. To determine your eligibility, the insurance company will compare your residual functional capacity (“RFC”) to the demands of your job.
First, your insurance company will determine your RFC. An RFC is an estimate of how often you can perform certain work activities. For example, you can only type for approximately one hour due to pain and numbness in your hands. Your insurance company will want your doctor’s opinion on this point, so it is very important to clearly communicate the severity of your symptoms to your doctor.
Second, your insurance company will analyze the specific requirements of your job. To do this, the insurance company will ask your employer to provide a job description. Unfortunately, a job description rarely encompasses all job duties, particularly for professionals. For example, a job description may indicate that a CEO is responsible for handling millions of dollars in business and supervising multiple projects. However, that job description may fail to indicate how much computer usage the CEO must perform.
Third, your insurance company will compare your RFC to the requirements of your job. If the demands of your job exceed your RFC, your insurance company should find you disabled.
Proof of Ongoing Disability
Symptoms of carpal tunnel syndrome can improve over time, especially if treatment or surgical intervention is successful. As a result, insurance companies tend to require proof of an ongoing disability long after claim approval. Updated medical records may satisfy your insurance company, so long as they indicate persistent abnormal clinical findings. Sometimes, however, your insurance company may want to review updated diagnostic testing, such as an EMG and/or NCV study. If you do not provide the requested proof, your insurance company may terminate your previously approved disability benefits.
How Can A Disability Attorney Help?
Getting approved for long term disability insurance benefits due to carpal tunnel syndrome can be tricky. Insurance companies may be skeptical of the severity of your condition, or misunderstand the demands of your occupation and how your carpal tunnel negatively affects your ability to work. There is always a high burden of proof of disability on the claimant. If you don’t know what evidence to submit to your insurance company, you may be denied your rightful benefits.
An experienced long term disability attorney can help you navigate the disability claim process. At Riemer Hess, our attorneys have experience in getting carpal tunnel disability claims approved and know what your insurance company is looking for.
Ways a long term disability attorney can help include:
- Recommending further testing, such as a functional capacity assessment, to objectively demonstrate your RFC.
- Recommending a vocational assessment if they feel further clarification of your job duties is necessary.
- Requesting a narrative letter from your treating doctor that outlines the restrictions and limitations your condition imposes.
- After claim approval, making sure future updates to your insurance company are submitted in a manner that doesn’t threaten termination of your benefits.
To maximize your chances of qualifying for benefits, work with New York disability attorneys who have a proven track record handling ERISA long term disability insurance claims.
If you have carpal tunnel syndrome and are planning to file for long term disability, or if your long term disability insurance claim has been denied, Riemer Hess can help. Call Riemer Hess LLC, Attorneys at Law, to arrange a consultation: 212-297-0700.