If you suffer from Crohn’s disease, you know how difficult it can be to manage. Your co-workers don’t understand why you need to be near a bathroom all the time. You are in constant pain. It’s impossible to focus when you are always so concerned and distracted. You don’t know how long you can possibly keep this up.
You may be asking yourself: What are your long term options? Is Crohn’s disease considered a disability? The answer to that is yes – many people with Crohn’s do qualify for long term disability benefits. However, your odds of benefit approval will depend on the severity of your condition and how you present your case to your insurance company.
Below you will find what you need to know before filing your Crohn’s disease long term disability claim.
Crohn’s Disease and Long Term Disability
When filing your long term disability claim for Crohn’s disease, your insurance company will wonder why you could work one day but not the next. To answer this question, the insurance company will look at the progression of your symptoms.
Because Crohn's disease causes a wide range of symptoms, every symptom must be well-documented to demonstrate the progression of your condition. Symptoms vary, but they typically include a combination of physical, cognitive, and psychiatric issues.
Disabling Physical Symptoms of Crohn’s Disease
The physical symptoms of Crohn’s disease may vary, but include the following:
- Chronic diarrhea or loose stools
- Bloody diarrhea
- Mucus in stool
- Abdominal pain and cramping
- Feeling of abdominal “fullness”
- Abdominal distension
- Loss of appetite
- Unintentional weight loss
- Bowel obstruction
- Anal fissures
- Chronic fatigue
- Ineffective straining at stool (rectal tenesmus)
- Kidney issues
- Peripheral arthritis
- Eye or skin issues
Disabling Cognitive Symptoms of Crohn’s Disease
The issues Crohn’s disease causes extend beyond the gastrointestinal tract. Studies have shown that Crohn’s disease can directly result in cognitive deficits. If these cognitive deficits are severe enough, they can be disabling. Don’t think that only your physical symptoms should be reported to your insurance company - your cognitive symptoms, directly caused by your Crohn’s, should be included with your disability claim.
Examples of cognitive impairments caused by Crohn’s disease include:
- Problems with attention, concentration, and focus
- “Brain fog”
- Difficulty organizing thoughts
- Decreased processing speed
- Difficulty finding the right word (“word searching”)
- Difficulty processing or learning new information
- Poor memory
- Lack of mental flexibility
- Poor impulse control
- Inability to multitask
It is important to report these cognitive issues to your treating doctor(s) along with your physical symptoms.
Secondary Emotional Symptoms of Crohn’s Disease
For those with Crohn’s, there is a high risk of suffering from poor mental health due to your condition. Crohn’s disease creates a high level of uncertainty and stress, leading to potential emotional symptoms to arise as a result.
Secondary emotional symptoms that may develop due to Crohn’s disease include:
Keep in mind when filing for long term disability that your insurance company may try to characterize your Crohn’s disease as a mental illness. They may ignore your physical disabling symptoms in favor of your emotional symptoms because most policies limit how long benefits can be paid for a mental illness disability. To prevent this, your disability claim must make it clear that your emotional symptoms (i.e. depression, anxiety, etc.) are secondary to—and solely resulting from—your Crohn’s.
Inability to Work Due to Crohn’s Disease
Some people can manage their Crohn’s disease symptoms and continue working. But, as the disease progresses, moderate to severe Crohn’s disease may become extremely disabling.
When it comes to your long term disability insurance claim, your approval hinges on proving how your Crohn’s disease prevents you from working. Your insurance company will want to understand the ways your Crohn’s symptoms impair your ability to work in your occupation. It is imperative that you to explain in specific terms how your condition interferes with performing your own job duties.
For example, symptoms may be severe and/or frequent enough to require excessive days off from work or substantial leaves of absences. Frequent absences may also occur due to treatment, which may include multiple surgeries, hospital stays, and more time away from work for doctor’s appointments. Even while at work, many individuals find it difficult to stay on task due to pain, discomfort, and/or the need for frequent bathroom breaks.
Because spending too much time off task or away from work can result in poor productivity, many individuals with Crohn’s disease receive unfavorable performance reviews before going out on disability. Some individuals are even terminated due to excessive absenteeism and inability to keep up at work.
To determine whether your Crohn’s disease is disabling, your insurance company will want the opinion of your treating physician. Your insurance company will weigh its decision very heavily on your doctor’s opinion – so your doctor’s support is key. In fact, one of the most common reasons for denial of disability benefits for Crohn’s disease is that the treating physician’s opinion does not support the presence of a disabling condition. Many times, this happens because the treating physicians simply lack an understanding of the frequency, severity, and disabling impact of their patients’ symptoms and/or treatment.
One of the best ways to ensure that your doctor supports your disability claim is to consistently talk to your doctor about the frequency and severity of your symptoms and how they impact your ability to work. Many individuals find it helpful to record their symptoms and work absences in a diary or daily log, which can be brought to your doctor’s appointments and even submitted to your insurance company for consideration.
If you experience emotional difficulties due to Crohn’s disease, such as anxiety and depression, your insurance company will also consider the impact that such impairments have on your ability to work. Thus, it is equally important to talk to your doctor about the emotional impact that your Crohn’s disease has caused.
Getting Approved For Long Term Disability With Crohn’s Disease
In order to get your Crohn’s disease long term disability claim approved, your insurance company will want evidence of your diagnosis, symptoms, and how your condition disables you from working. The most important evidence to provide your insurance company is objective medical evidence.
The insurance company will typically require objective proof of diagnosis for any disability. This requirement can be particularly challenging for those with Crohn’s disease because there is no definitive diagnostic test for the disease. Instead, your insurance company will need to conduct a broad review of your medical records to assess your diagnosis.
Your insurance company will specifically look for physical examination findings from you doctor(s). These records should show documentation of your physical symptoms, including:
- Pain and tenderness in the abdomen
- Abdominal distension
- Body mass index (“BMI”)
Laboratory test results can support a Crohn’s disease diagnosis with your insurance company. This testing can rule out other conditions and check for signs that are commonly associated with Crohn’s. Laboratory testing may include:
- Blood protein levels
- Blood sedimentation levels
- Red and/or white blood cell count
- Stool samples
When diagnosing Crohn’s disease, imaging studies are a useful tool. Findings from imaging studies allow your treating doctor(s) to evaluate your colon, small intestine, esophagus, and other relevant organs, and in turn assess whether you exhibit the signs of Crohn’s disease.
Your insurance company will want records of any imaging studies you have undergone. These results and reports can provide necessary objective medical evidence of your Crohn’s diagnosis and symptoms.
Imaging studies that can support a Crohn’s disease disability claim include:
- Video capsule endoscopy
- Barium x-ray
- CT enterography
- Video capsule endoscopy
Your insurance company will not require that you undergo all of the above-noted tests, but it will want to see that you underwent all testing recommended by your physician(s).
Appropriate Treatment for Crohn’s Disease
Before your disability claim is approved, your insurance company will want to see that you are receiving “appropriate treatment” for your Crohn’s disease. This is a requirement in nearly every long term disability insurance policy. If you do not provide adequate proof that you are complying with all treatment recommendations from your doctor(s), your insurance company may deny your disability claim.
Unfortunately, there is no cure for Crohn’s disease. Treatment options are available to help manage your Crohn’s, with a focus on reducing inflammation that triggers symptoms and slow the progression of the disease. Appropriate treatment typically involves medication therapy and lifestyle changes, but surgical intervention may be required under certain circumstances.
Medications can be used to help manage the symptoms of Crohn’s. Depending on your personal symptoms, your doctor may prescribe:
- Anti-inflammatory medications
- Immunosuppressive medications
- Pain relievers
- Anti-diarrheal medications
- Iron supplements (in instances of chronic intestinal bleeding and anemia)
- Vitamin B-12 shots (in instances of vitamin B-12 deficiency)
- Calcium and vitamin D supplemental (to combat the increased risk of osteoporosis)
For some with Crohn’s, the symptoms are exacerbated by factors such as stress, diet, and other lifestyle choices. Your doctor(s) may recommend the following lifestyle changes to help curb your Crohn’s symptoms:
- Avoidance of stressful situations
- Avoidance of certain triggering foods
- Healthy diet
- Regular exercise
- Sufficient sleep
- Cessation of tobacco use
In some Crohn’s disease cases, surgical intervention may be recommended. Surgical procedures for Crohn’s disease may include:
- Bowel resection (removing an effected portion of the intestines and/or corrects a fistual)
- Stricturoplasty (opening up narrowed areas of the small intestines)
- Colectomy (removing the colon and/or connecting the small intestines directly to the rectum)
- Proctolectomy (removing both the colon and the rectum before creating a stoma)
Surgery for Crohn's disease is a serious treatment option with its own risks. Even if your surgery is successful, you may suffer from disabling side effects.
The Required Ongoing Proof For Your Crohn's Disability Claim
Disability benefit approval for Crohn’s disease is not the end of the road. After your claim is approved, your insurance company will still require proof of an ongoing disability. If they determine you have not been seeking sufficient treatment, they may have basis to terminate your benefits. Therefore, it is very important to frequent your doctor(s) and comply with all treatment recommendations after your insurance company approves your claim.
Insurance companies often set deadlines to submit updated evidence. These deadlines are usually very strict. If you fail to submit evidence by the deadline, or your insurance company does not consider your evidence sufficiently supportive of an ongoing disability, your insurance company will likely terminate benefits.
A competent disability insurance attorney can help gather your records and meet your insurance company’s demands to alleviate some of your stress and allow you to focus on what matters most: your health. It is recommended that you maintain legal representation even after your claim is approved.
A Long Term Disability Insurance Attorney Can Help
Due to the nature of Crohn’s disease, getting long term disability approval can be a challenging process. Your insurance company may be quick to label your condition as a mental illness, underestimate the severity of your symptoms, and demand a high level of medical evidence to support your claim.
Our long term disability insurance attorneys at Riemer Hess can help. We know the ins-and-outs of the disability claims process, what proof the insurance companies seek for claim approval, and how to maintain your benefits once you have been approved.
Riemer Hess can assess your situation, explain your legal rights and options, and answer any questions you have about long term disability insurance. To schedule your free consultation, call Riemer Hess LLC, Attorneys at Law, today at 212-297-0700.