Long Term Disability for Chiari Malformation: What You Need to Know

If you’ve been diagnosed with Chiari malformation and are struggling to continue working, you may be wondering whether long term disability benefits can offer the support you need.  Chiari malformation is a complex neurological condition that can cause a wide range of symptoms, from debilitating headaches and dizziness to fatigue and cognitive difficulties.  These symptoms can make it impossible to maintain a full-time job, especially in roles that demand mental focus, physical stamina, or both.

However, getting long term disability benefits for Chiari malformation isn’t always straightforward.  Insurance companies often dispute the seriousness of the condition or misclassify it, denying claims or cutting off benefits prematurely.

Below we’ll answer common questions about what you need to know about filing, proving, and protecting a long term disability claim for Chiari malformation.

Is Chiari malformation considered a disability?

Yes, Chiari malformation can be considered a disability if it interferes with your ability to perform your job or daily activities.  This condition occurs when brain tissue extends into the spinal canal, potentially disrupting normal brain and spinal cord function.  While some people with Chiari malformation remain asymptomatic or have only mild issues, others experience serious, chronic symptoms that make it difficult or impossible to work full-time.

Common disabling symptoms of Chiari malformation include:

• • Persistent, severe headaches, often worsened by coughing or straining;
  • Dizziness or balance problems that make standing or walking difficult;
  • Fatigue and cognitive issues such as brain fog or poor concentration;
  • Muscle weakness, especially in the arms or legs;
  • Numbness or tingling in the extremities; and/or
  • Difficulty swallowing, speaking, or breathing.

When symptoms of Chiari malformation become frequent or severe, they can significantly interfere with your ability to maintain consistent job performance.  For example, persistent headaches and neck pain can make it nearly impossible to concentrate during meetings, focus on computer work, or tolerate long hours at a desk.  Dizziness and balance issues may prevent you from safely walking through an office, navigating a hospital floor, or operating equipment—putting both you and others at risk.  Muscle weakness or numbness can affect your ability to type, write, or perform fine motor tasks, while fatigue and cognitive issues like brain fog can make it difficult to follow instructions, manage deadlines, or engage in critical thinking.

For professionals in high-responsibility roles—such as physicians, lawyers, engineers, or teachers—these symptoms can disrupt essential job functions and compromise their ability to perform safely, reliably, and effectively.

Can I get long term disability for Chiari malformation?

Yes, you can get long term disability (“LTD”) benefits for Chiari malformation if your symptoms are severe enough to prevent you from working.  However, insurance companies won’t approve your claim based solely on your diagnosis—they will look closely at how your condition impacts your ability to perform your job consistently and reliably.

Whether your claim is approved will largely depend on the specific terms of your disability insurance policy.  Every policy has its own definitions, limitations, and exclusions that can significantly affect your eligibility.  That’s why it’s so important to carefully review your policy and understand what it requires—and ideally, to do so with the help of an experienced long term disability attorney.

Many LTD policies define “disability” as the inability to perform the material duties of your own occupation during an initial period (usually 24 months).  After that, the definition often changes to whether you can perform any occupation for which you are reasonably qualified.  This shift can be especially important for Chiari malformation claims, since symptoms like chronic pain, fatigue, or balance issues may prevent you from doing your specific job but not necessarily rule out all types of work—at least in the eyes of your insurer.

Additionally, some policies contain limitations on conditions that are considered “subjective” or based primarily on self-reported symptoms, such as headaches or fatigue.  Chiari malformation often includes these symptoms, even though the condition itself is structural and visible on MRI.  Insurers may try to apply these limitations to cut off your benefits after a short period, usually 24 months.

This is where having a long term disability attorney makes a critical difference.  An experienced attorney can interpret the fine print in your policy to determine the exact standard you must meet, identify whether any exclusions or limitations might apply to your Chiari malformation claim, and help you collect and organize the right kind of evidence to meet your policy’s requirements.

Chiari malformation claims can be complex due to the nature of the condition and the way insurance companies evaluate it.  Having a legal professional on your side who the LTD claims process can help you avoid pitfalls and improve your chances of approval.

How do I prove that Chiari malformation prevents me from working?

To prove that Chiari malformation prevents you from working, you need to provide both medical and vocational evidence that clearly shows how your condition limits your ability to perform your job duties on a consistent basis.  Insurance companies require objective proof—not just a diagnosis, but documentation of functional limitations that interfere with your ability to sustain gainful employment.

Start by gathering thorough medical evidence, which may include:

• • MRI imaging that confirms the Chiari malformation diagnosis and shows the extent of cerebellar tonsil herniation.
  • Physician treatment notes detailing the frequency, severity, and persistence of symptoms such as chronic headaches, dizziness, balance issues, or numbness.
  • Neurological examinations showing deficits in motor function, coordination, or sensory processing.
  • Neuropsychological evaluations if you’re experiencing cognitive impairments like brain fog, difficulty concentrating, or memory loss. These tests can objectively measure how your brain function is impacted by your condition.
  • A Functional Capacity Evaluation (“FCE”), which is a series of standardized tests conducted by a physical therapist or occupational therapist to assess your physical limitations. An FCE can demonstrate limitations in standing, sitting, lifting, or walking, which are often relevant for disability claims.
  • Medication records and side effects that may also affect your work performance—some treatments for Chiari malformation, including pain medications, can cause drowsiness or cognitive impairment.

In addition to medical records, vocational evidence can help bridge the gap between your symptoms and your inability to work. This can include:

• • A vocational assessment by a certified expert, which analyzes your job requirements and evaluates whether your functional limitations prevent you from performing that work.
  • Job descriptions and employer records, showing the physical or cognitive demands of your job that you can no longer meet.
  • Personal statements explaining how your Chiari malformation symptoms prevent you from completing tasks, maintaining focus, or keeping up with your work schedule.
  • Statements from coworkers or supervisors about observed changes in your performance or attendance since the onset of your Chiari malformation symptoms.

By combining objective medical evidence with a detailed vocational analysis, you create a strong case that your Chiari malformation not only exists but also prevents you from performing your job.  This multi-layered evidence is especially important because insurance companies often scrutinize claims based on conditions that have fluctuating or “invisible” symptoms.

An experienced long term disability attorney can play a key role in gathering the right evidence and presenting it effectively to the insurance company.  They can help coordinate medical evaluations like Functional Capacity Evaluations or neuropsychological evaluations, work with your doctors to ensure their statements fully address your policy’s definition of disability, and gather supporting evidence from vocational experts when needed.  More importantly, an attorney knows how to frame this evidence in a way that clearly demonstrates how your Chiari malformation symptoms prevent you from working, addressing common insurer arguments head-on and minimizing the risk of a denial or early termination.

Can I qualify for long term disability benefits if my Chiari malformation symptoms fluctuate?

Yes, you can still qualify for long term disability (“LTD”) benefits even if your Chiari malformation symptoms fluctuate.  Many people with Chiari experience periods of relative stability followed by flare-ups of intense symptoms like severe headaches, dizziness, muscle weakness, or balance problems.  These ups and downs can make it difficult to maintain consistent attendance or performance at work, which is a key consideration for disability claims.

Insurance companies often look for evidence that you are unable to sustain reliable, full-time work on a reasonably continuous basis. That means even if you’re functional some days, you may still qualify for benefits if your bad days are frequent, unpredictable, or disruptive enough to make steady employment impossible.  To prove this, your medical records should include detailed notes from your doctors about the episodic nature of your symptoms, how often flare-ups occur, and how they affect your ability to function.

There are a few other ways to help document the inconsistency and severity of your condition:

• • A symptom diary is a personal, day-to-day record where you track your Chiari malformation symptoms as they occur.  This might include documenting the time and severity of headaches, episodes of dizziness, difficulty concentrating, or physical weakness.  By consistently recording your symptoms over time, you can show patterns of unpredictability and frequency that might not be fully captured during brief medical visits.  Symptom diaries can help paint a clear picture of how often you’re affected and how these symptoms interfere with your ability to work, helping to bridge the gap between medical records and lived experience.
  • Witness statements from family members, friends, coworkers, or supervisors can also be valuable in a disability claim.  These individuals can offer firsthand observations of how your symptoms manifest in daily life and how they impact your functionality, reliability, and performance.  A statement from a spouse might describe your struggles with basic tasks on bad days, while a supervisor might note your increasing absences or reduced capacity at work.  These perspectives provide additional credibility and context that support your claim.
  • A Functional Capacity Evaluation (“FCE”) is another critical tool.  This standardized test, typically performed by a physical or occupational therapist, measures your ability to perform specific work-related activities like lifting, walking, sitting, and concentrating.  An FCE offers objective data about your physical limitations, often highlighting discrepancies between what you may be able to do briefly versus what you can sustain throughout a full workday or week.  Because Chiari symptoms often fluctuate, an FCE can help demonstrate that your capacity is not just limited, but also inconsistent and unreliable—key factors in qualifying for disability benefits.

What matters most is demonstrating to your insurer that, despite the fluctuating nature of your symptoms, you cannot perform your job reliably and safely over time.  This type of claim can be more challenging, but with strong evidence and legal guidance, it’s absolutely possible to receive LTD benefits.  Consider consulting an experienced long term disability attorney.  They can help you build the strongest possible case by coordinating the right evaluations, compiling persuasive documentation, and ensuring your claim clearly reflects the real impact of your Chiari malformation symptoms.

Why do insurance companies often deny LTD claims for Chiari malformation?

Insurance companies frequently deny long term disability (“LTD”) claims for Chiari malformation, even when symptoms are serious and life-altering.  This condition presents unique challenges because its symptoms can vary widely from person to person and often don’t show up clearly on standard medical tests.  As a result, insurers may be quick to question whether your condition is truly disabling.

Here are some common reasons for denial and how insurers justify them:

• • Symptoms are considered “subjective”: Headaches, dizziness, fatigue, and cognitive issues are difficult to quantify and don’t always show up on imaging or lab tests, making it easier for your insurer to dispute them.
  • MRI findings are downplayed: If the cerebellar tonsil herniation is considered mild, your insurer may argue it shouldn’t be disabling—even if your symptoms are severe.
  • Lack of detailed medical documentation: Vague or inconsistent treatment notes that don’t explain how your symptoms interfere with work can lead to a claim being denied.
  • Failure to pursue certain treatments: If you haven’t had surgery or if your insurer believes your condition could be managed with medication or physical therapy, they may argue you’re not doing enough to improve.
  • Claims of inconsistency: Surveillance, social media posts, or discrepancies in your records may be used to question your credibility or suggest exaggeration.
  • Doctors’ opinions aren’t strong enough: If your physician doesn’t clearly state that you’re unable to work—or fails to link your Chiari malformation symptoms to specific work limitations—your insurer may not find their opinion persuasive.

Because of these challenges, working with a long term disability attorney can make a significant difference.  An attorney can help ensure your medical evidence is detailed and targeted, communicate with your doctors about what your insurer needs to see, and build a strong narrative to show how Chiari malformation truly prevents you from working.  They can also respond to inquiries from your insurer, handle appeals, and protect your rights every step of the way.

What are some common mistakes to avoid when filing a disability claim for Chiari malformation?

When filing a long term disability (“LTD”) claim for Chiari malformation, there are several common mistakes claimants may make that can seriously hurt your chances of approval.  Because this condition involves both visible brain abnormalities and subjective symptoms, it’s especially important to be thorough, consistent, and strategic in how you present your case.

Here are key mistakes to avoid:

• • Relying only on your diagnosis: Simply having a Chiari malformation diagnosis isn’t enough to qualify for benefits.  Your insurer will require that you demonstrate how your symptoms interfere with your ability to work on a regular, reliable basis.
  • Not documenting symptoms in detail: Vague or general statements like “frequent headaches” or “gets dizzy” won’t satisfy your insurer.  Your claim should be supported by detailed medical records that describe the frequency, intensity, and duration of your Chiari malformation symptoms—and how they affect your daily functioning.
  • Skipping or delaying treatment: If you aren’t actively treating your Chiari malformation or following medical advice, your insurer may assume your symptoms aren’t serious.  Additionally, most policies have an “appropriate treatment” provision that means if you are not following your doctor’s treatment plan, your claim may be denied.  Regular follow-ups and documented treatment efforts show that you’re doing your part to manage your health.
  • Ignoring “invisible” symptoms: Cognitive issues, fatigue, or brain fog may not show up on an MRI, but they can still be disabling.  Make sure your doctors acknowledge and document these symptoms, and consider undergoing a neuropsychological evaluation to provide objective proof.
  • Not submitting supporting documentation from specialists: Insurance companies give more weight to detailed evaluations from neurologists, neurosurgeons, and other relevant specialists.  Relying only on your primary care doctor may weaken your case.
  • Failing to include vocational evidence: Your job duties matter.  If you don’t explain how your Chiari malformation symptoms make it impossible to meet the specific demands of your occupation, your insurer may argue that you can still work.
  • Failing to engage an attorney: Trying to handle your claim alone can leave you vulnerable to missteps, missing critical deadlines, or submitting incomplete evidence.  A long term disability attorney understands the legal standards, knows how insurers evaluate Chiari malformation claims, and can guide you through the process to improve your chances of approval.  Engaging legal help early can prevent mistakes that might otherwise delay or jeopardize your benefits.

Avoiding these mistakes—and submitting clear, comprehensive evidence from the start—can make your claim much stronger. An ERISA attorney can help guide you through the process, ensure your documentation is solid, and communicate with your doctors and insurer to help avoid common pitfalls.

What if my LTD claim for Chiari malformation is denied?

If your long term disability (“LTD”) claim for Chiari malformation is denied, don’t panic—you have the right to appeal.  Most group LTD policies are governed by ERISA (the Employee Retirement Income Security Act), which requires you to go through an internal appeal process with your insurance company before you can file a lawsuit.  This appeal is time-sensitive and evidence-driven, and it’s often your last opportunity to submit new information to support your claim.

Under ERISA, you generally have 180 days from the date of your denial to file your appeal.  It’s crucial to use this time wisely by strengthening your claim with new and persuasive evidence.  Many people make the mistake of sending a short appeal letter without addressing the specific reasons for denial.  To give your claim the best chance of success, your appeal should be comprehensive and targeted.

Key steps in the ERISA appeal process include:

• • Reviewing the denial letter carefully to understand why your claim was denied—such as lack of objective evidence, inconsistent records, or failure to meet the policy’s definition of disability.
  • Gathering additional medical evidence, like updated treatment notes, MRI results, a Functional Capacity Evaluation (“FCE”), or a neuropsychological evaluation if cognitive symptoms are involved.
  • Obtaining supportive statements from your treating doctors that clearly explain how your Chiari malformation prevents you from performing your job duties.
  • Including vocational evidence to show why your limitations prevent you from working in your specific occupation—or any occupation, if your policy uses that standard.
  • Writing a detailed appeal letter that organizes all your evidence and addresses your insurer’s objections directly.

Because the appeal process under ERISA is so stringent—and because courts typically won’t consider any evidence that wasn’t included during the appeal—it’s extremely helpful to work with a long term disability attorney.  An attorney can ensure your appeal is thorough, legally sound, and well-supported by medical and vocational documentation.  They’ll also communicate with your doctors and your insurance company on your behalf, giving you the best possible shot at reversing the denial and restoring your benefits.

How can an attorney help with my Chiari malformation LTD claim?

An attorney can be a vital ally in your long term disability (“LTD”) claim for Chiari malformation, helping you navigate the process from start to finish and avoid the many pitfalls that commonly lead to denials.

Chiari malformation can be especially challenging to prove in a long term disability claim because many of its most disabling symptoms—such as headaches, dizziness, and cognitive issues—can be labeled as “subjective” by insurance companies.  An experienced attorney knows how to counter these tactics and ensure your condition is properly documented and understood.

Ultimately, an attorney acts as both your advocate and your safeguard—making sure your Chiari malformation is taken seriously, your policy terms are enforced, and your benefits are protected for the long haul.

For over 30 years, Riemer Hess has helped our professional and executive clients secure their long term disability benefits at all stages of the claims process, including those with Chiari malformation.  We understand the strategies needed to counter shady insurer tactics and support your claim for benefits as strongly as possible.

Below is a real life example of a client with Chiari malformation who Riemer Hess helped win their long term disability claim.

Riemer Hess Client Success Story: Chiari Malformation

“Owen,” a successful and highly respected physician, built his career on focus, precision, and mental sharpness.  But after developing troubling symptoms—cognitive difficulties, fatigue, and coordination issues—he was diagnosed with Chiari malformation.  As his symptoms progressed, Owen made the difficult but responsible decision to stop practicing medicine and filed a long term disability (“LTD”) claim through his private insurance policy.

The insurer approved his claim but misclassified his disability as a mental illness, limiting his benefits to just two years under the policy’s mental illness limitation.  This misclassification failed to reflect the true nature of Owen's Chiari malformation and placed his financial future at risk.  Seeking to correct the record and preserve his right to continued benefits, Owen turned to Riemer Hess for legal assistance.

Our team carefully developed a strategy to show that Owen’s cognitive decline was a direct result of his Chiari malformation, not a psychiatric condition.  We arranged for him to undergo a neuropsychological evaluation shortly before the expiration of the two-year mental illness limitation.  After the testing but before the report was finalized, Owen completed a new brain MRI, which revealed structural abnormalities consistent with Chiari malformation.

We then worked closely with both the neuropsychologist and Owen’s treating neurologist to ensure their reports clearly linked his cognitive deficits to the MRI findings.  Together, the evaluations provided compelling, objective evidence that Owen’s impairments were neurological in origin and stemmed from the physical effects of Chiari, not from any underlying mental health disorder.

With this coordinated evidence in hand, we submitted a robust appeal.  The insurer reversed its earlier decision, reinstated Owen’s benefits under the correct classification, and removed the arbitrary two-year limit.  Owen, greatly relieved and grateful for the outcome, chose to continue working with Riemer Hess to monitor and protect his benefits moving forward.

If you’re looking to file a long term disability insurance claim for lung cancer, appeal a wrongful claim denial, or litigate your insurer, Riemer Hess can help. Contact us today at (212) 297-0700 or click the button below for a consultation on your disability case.