Long Term Disability for GERD: What You Need to Know

Gastroesophageal reflux disease (“GERD”) is a chronic condition in which stomach acid frequently flows back into the esophagus, causing irritation and discomfort.  While GERD may be manageable for some, for others, it can lead to severe complications such as esophagitis, respiratory issues, and even an increased risk of esophageal cancer.  The serious symptoms of GERD may prevent you from performing your occupational functions.

When GERD becomes debilitating and interferes with your ability to work, long term disability benefits may be an option.  Working with an experienced ERISA attorney can help you navigate the complex claims process and improve your chances of securing the support you need.

Below we'll answer common questions those with GERD have about the long term disability claims process, including what evidence you can submit to your insurer and strategies to substantiate your claim for benefits.

Is GERD considered a disability?

Yes, GERD can be considered a disability, depending on the severity and frequency of your symptoms.  GERD can cause a variety of physical and cognitive symptoms, which may significantly impact your ability to work and perform daily activities.  When these symptoms are severe and chronic, they can make it difficult or impossible to maintain employment.

Disabling physical symptoms of GERD may include:

• • Chronic Heartburn: Persistent, severe heartburn can cause intense discomfort and pain, making it difficult to focus on tasks or perform physical activities.  This can lead to frequent absences from work and reduced productivity.
  • Regurgitation: The frequent regurgitation of food or sour liquid can cause ongoing discomfort, nausea, and potential embarrassment, especially in public or social work settings.  This can hinder your ability to work a consistent schedule as well as interact with colleagues and clients.
  • Dysphagia: Dysphagia (difficulty swallowing) can cause significant pain while eating, leading to malnutrition, weight loss, and general physical weakness.  These factors can reduce your stamina and energy levels, impacting your ability to perform physical tasks or work long hours.
  • Chest Pain: GERD-related chest pain can be so severe that it mimics the symptoms of a heart attack, leading to anxiety, stress, and frequent medical consultations.  This can disrupt your work routine and cause you to miss work frequently.
  • Chronic Cough or Laryngitis: Persistent coughing or voice changes can severely limit your ability to speak, which is essential in many jobs, such as teaching, sales, or customer service.
  • Respiratory Issues: Acid reflux can worsen respiratory conditions like asthma or bronchitis, leading to difficulty breathing, reduced physical capacity, and the need for frequent medical care.
  • Sleep Disruptions: GERD symptoms often intensify at night, leading to sleep disturbances.  Chronic sleep deprivation can cause extreme fatigue, reduce cognitive function, and make it challenging to maintain regular work hours.

GERD may also lead to cognitive symptoms that significantly impact your ability to work, including:

• • Fatigue: The physical discomfort and pain caused by GERD, combined with sleep disruptions, can lead to chronic fatigue.  This fatigue can impair your ability to focus, make decisions, and complete tasks efficiently at work.
  • Concentration Issues: The ongoing discomfort of GERD can make it difficult to concentrate on tasks, especially those that require sustained mental effort.  This can result in reduced productivity and an inability to meet job performance standards.
  • Memory Problems: Severe GERD, particularly when it leads to poor sleep and chronic stress, can cause memory issues.  This can affect your ability to remember important details, follow instructions, or complete tasks that require recall.
  • Anxiety and Depression: Chronic illness, like severe GERD, can contribute to secondary mental health issues such as anxiety and depression.  These conditions can further impair your cognitive functions, making it difficult to maintain focus and motivation.

GERD can also cause several disabling complications that interfere with daily functioning and may prevent you from working. Common disabling complications of GERD include:

• • Esophagitis: Chronic acid exposure can inflame the esophagus, leading to esophagitis.  This condition causes pain, difficulty swallowing, and increased risk of bleeding or ulcers in the esophagus, which can significantly impact your ability to eat and maintain energy levels for work.
  • Barrett’s Esophagus: Over time, damage from GERD can lead to changes in the cells of the esophagus, known as Barrett’s Esophagus.  This condition increases the risk of esophageal cancer and can cause chronic discomfort and the need for regular monitoring and medical intervention.
  • Esophageal Stricture: Scarring and narrowing of the esophagus (esophageal stricture) can result from long-term GERD.  This can cause severe swallowing difficulties, making it hard to consume food and liquids, leading to malnutrition or significant weight loss, both of which can hinder job performance.
  • Respiratory Issues: Acid reflux can irritate the throat and lungs, leading to chronic cough, asthma-like symptoms, or even aspiration pneumonia.  These respiratory issues can make it difficult to breathe comfortably and engage in physical or cognitively demanding tasks.

When these symptoms and complications are severe and persistent, they can significantly interfere with your ability to perform your job duties.  If GERD is preventing you from maintaining gainful employment, it may be considered a disability, qualifying you for long term disability benefits.

To explore your options, it’s advisable to consult with an experienced ERISA attorney who can guide you through the process of filing a disability claim, ensuring that you have the necessary documentation and support to strengthen your case.

Can I get long term disability for GERD?

Yes, you can get long term disability (“LTD”) for GERD, if your condition meets the requirements of your LTD policy.  While not every case of GERD will qualify for benefits, severe and chronic cases may meet the criteria for long term disability if they prevent you from maintaining gainful employment.

Key factors to consider include:

• • Severity of Symptoms: To qualify as a disability, your GERD symptoms must be severe enough that they interfere with your ability to perform essential job functions.  This might include chronic pain, difficulty swallowing, or complications like esophagitis.
  • Impact on Work: If your GERD causes frequent absences from work, inability to concentrate, or requires you to take frequent breaks, it could be considered a disability.
  • Complications: GERD can lead to serious health complications, such as Barrett’s esophagus or esophageal cancer, which could further affect your ability to work.
  • Medical Documentation: Strong medical evidence, including records of diagnosis, treatments, and the impact of GERD on your daily life, is crucial to getting a disability claim approved.

Your eligibility for long term disability insurance benefits highly depends on how your condition aligns with the definitions of disability in your policy.  Disability policies generally define disability in one of three ways:

• • Own Occupation: Under an “own occupation” definition, you are considered disabled if you are unable to perform the specific duties of your current job or occupation.  If your GERD symptoms prevent you from fulfilling the responsibilities of your own occupation, you may qualify for benefits under this standard.
  • Any Occupation: The “any occupation” definition is more stringent and requires that you be unable to perform the duties of any job for which your education, training, or experience reasonably qualifies you.  To meet this standard, your GERD must be severe enough to prevent you from working in any type of occupation.
  • Hybrid Definition: Many policies use a hybrid approach, which may initially define disability under the “own occupation” standard for a certain period (e.g., two years) and then switch to the “any occupation” standard.  If your GERD prevents you from working in your own occupation, you might initially qualify for benefits, but after the specified period, you will need to demonstrate that your condition also prevents you from working in any occupation.

Understanding the specific definition of disability in your policy is crucial to determining your eligibility for long term disability benefits for GERD. Consulting with an experienced ERISA attorney can help clarify how your condition fits within these definitions and guide you through the claims process.

How do I prove my GERD is disabling?

Proving that GERD is disabling requires comprehensive evidence of your condition’s impact on your daily life and work.  This can be done through a combination of medical and vocational evidence.  The goal is to demonstrate that your GERD symptoms are severe enough to prevent you from performing your job duties or any other substantial gainful activity.

Medical Evidence to Prove Your GERD Long Term Disability

When compiling evidence to substantiate your GERD symptoms to your insurer, you can start with detailed documentation from your healthcare providers.  Medical evidence to support your GERD long term disability claim may include:

• • Diagnostic Records: Detailed documentation of your GERD diagnosis, including test results such as endoscopy, esophageal pH monitoring, or manometry.  These should highlight symptoms like chronic heartburn, regurgitation, chest pain, difficulty swallowing, and complications such as esophagitis, Barrett’s esophagus, or respiratory issues.
  • Treatment Records: A thorough account of the treatments you’ve undergone, including prescribed medications (e.g., proton pump inhibitors), lifestyle changes (e.g., dietary adjustments), and any surgical interventions like fundoplication.  If your condition persists or worsens despite treatment, this can strengthen your claim.
  • Impact on Daily Functioning: Physician notes that detail how GERD impacts your ability to perform daily activities, such as eating, sleeping, and physical exertion.  Documentation of GERD-related sleep disturbances or how your symptoms worsen with certain physical activities, such as bending or lifting, is critical.
  • Relevant Medical Testing: Include results from specific GERD tests such as esophageal manometry, which measures the function of your esophagus and lower esophageal sphincter, and pH monitoring, which tracks acid levels in your esophagus over time.  These tests can provide objective evidence of the severity of your condition.

• • Functional Capacity Evaluation (“FCE”): An FCE is a comprehensive assessment conducted by a physical or occupational therapist that evaluates your physical capabilities.  For GERD, the FCE might focus on documenting how GERD symptoms, such as chest pain, regurgitation, or chronic cough, limit your ability to perform physical tasks like lifting, bending, or prolonged sitting or standing.        The report can also evaluate how GERD-induced fatigue, due to poor sleep or chronic pain, impacts your ability to sustain work activities over a full workday.
  • Neuropsychological Evaluation: If GERD has caused cognitive impairments, such as difficulty concentrating, memory problems, or mental fatigue, a neuropsychological evaluation can provide objective evidence of these issues.  This is particularly important if your job requires high cognitive function.

Vocational Evidence to Prove Your GERD Long Term Disability

Vocational evidence can play a critical role in proving a long term disability (“LTD”) claim for GERD by demonstrating how the condition limits your ability to perform your job or any other work.  Key types of vocational evidence to support your GERD claim may include:

• • Official Job Description: An official job description from your employer can provide a list of your job’s physical and cognitive demands, such as frequent bending, lifting, or concentration, can help establish how GERD symptoms impact your ability to perform these tasks.
  • Workplace Accommodations History: If you have sought accommodations at work, such as altered hours due to GERD-related fatigue, frequent breaks for medication or symptom management, or the ability to avoid physical tasks that exacerbate symptoms, documenting this can support your claim.  Evidence that these accommodations were insufficient can further bolster your case.
  • Performance Reviews: Performance reviews that note a decline in productivity or efficiency, especially if tied to GERD-related issues like poor concentration or physical discomfort, can provide proof of how your symptoms interfere with your job performance.

• • Vocational Assessment: A vocational expert can evaluate how your GERD symptoms impact your ability to perform your specific job duties and whether you can transition to other types of work.  The assessment might include reviewing the physical and cognitive demands of your current job to determine if you can continue performing it with your GERD symptoms.  A vocational expert can also determine whether your skills can be transferred to other less demanding jobs, or if your condition makes it impossible for you to work in any capacity.

To successfully prove that your GERD is disabling, you need to demonstrate that your condition is severe, chronic, and unresponsive to treatment.  Given the complexities involved, consulting with an experienced ERISA attorney can be invaluable.  They can help you gather the necessary evidence, work with medical and vocational experts, and guide you through the long term disability claims process to strengthen your claim.

What are the common reasons insurers deny GERD long term disability claims?

Insurers often deny GERD long term disability (“LTD”) claims for various reasons, many of which are related to the complexity of proving disability or meeting specific policy requirements.  Understanding why insurers deny LTD benefits for GERD can help you better prepare your claim and avoid potential pitfalls.

Common reasons insurers deny long term disability claims for GERD include:

• • Lack of Medical Evidence: GERD LTD claims are often denied if your medical records do not include sufficient documentation of your symptoms and their severity.  Insurers may require objective evidence such as endoscopy results, esophageal pH monitoring, or manometry to prove your condition’s impact on your ability to work.  Inadequate documentation of complications like esophagitis or Barrett’s esophagus can weaken your claim.
  • Insufficient Proof of Disability: Insurers may argue that your GERD does not prevent you from working if there is no clear evidence linking your symptoms—such as chronic heartburn, regurgitation, or chest pain—to your inability to perform job duties.  This often occurs when medical records do not clearly describe how GERD limits your physical or cognitive functioning.
  • Pre-existing Condition Exclusion: If your GERD diagnosis or treatment occurred before your disability insurance coverage began, insurers may deny your claim under a pre-existing condition exclusion.  They often scrutinize earlier medical records to determine whether your GERD symptoms existed before the coverage started.
  • Failure to Meet Policy Deadlines: Missing important deadlines for filing your claim, submitting medical documentation, or appealing a denial can lead to an automatic rejection.  GERD claims can be complex, so timely filing and organization are crucial.
  • Non-compliance with Treatment: If you are not following prescribed treatments—such as medications, lifestyle changes, or recommended surgeries—your insurer may argue that your condition is not severe enough to warrant benefits.  Non-compliance with medical advice is a common reason for claim denials in GERD cases, as most policies stipulate you must be seeking “appropriate treatment” for your symptoms.
  • Surveillance Evidence: Insurers may use surveillance to gather evidence that contradicts your reported limitations.  If you are seen engaging in activities that suggest your GERD symptoms are less severe than claimed, this can lead to a denial.
  • Subjective Symptoms: GERD often involves subjective symptoms like heartburn or regurgitation, which can be hard to quantify.  Insurers may deny your claim if they believe these symptoms are not adequately supported by objective medical evidence, such as diagnostic test results or detailed physician reports.
  • Inconsistent Statements: Any discrepancies in your statements about your GERD symptoms, whether in medical records or claims forms, can lead to a denial.  It’s important that your description of how GERD affects your ability to work is consistent throughout the claims process.

If your GERD long term disability claim is denied, it’s important to carefully review the denial letter to understand the specific reasons.  Gathering additional evidence, correcting any deficiencies in your documentation, and appealing within the given timeframe are crucial steps.

Consulting with an experienced ERISA attorney can provide valuable guidance and increase your chances of a successful appeal.  An attorney can help you navigate the appeals process, ensure that all necessary evidence is presented, and represent your interests in communications with the insurer.

How can an attorney help with my GERD long term disability claim?

A knowledgeable long term disability attorney can be an invaluable resource when navigating the complexities of a long term disability claim for GERD.  Given the challenges involved in proving that GERD is disabling, an experienced ERISA attorney can offer guidance, support, and advocacy throughout the claims process.

At Riemer Hess, we have over 30 years of experience securing long term disability benefits for our clients, including those who suffer from GERD.  We understand how insurers evaluate these claims and the best strategies to maximize your chances of a successful outcome.

Here is an example of how we helped a client win their LTD benefits due to GERD:

Mark, a dedicated systems analyst at a large company, had been living with scleroderma for several years.  Mark’s scleroderma caused several debilitating symptoms, including Raynaud’s disease, which affected his hands and made it impossible for him to use a computer for extended periods.  Additionally, he was hospitalized for a gastrointestinal operation, as scleroderma had led to severe gastroesophageal reflux disease (“GERD”). 

Mark’s GERD symptoms were intense—he experienced constant heartburn, regurgitation, and difficulty swallowing, which made eating and working even more challenging.  The condition also led to painful esophageal spasms that further complicated his ability to focus on his work as a systems analyst, a job that required him to sit for long periods, manage complex tasks, and work on a computer.

As Mark’s condition progressed, it began to significantly impact his daily life and ability to work.  During a routine physical, his general practitioner recommended that it was time for him to stop working and apply for disability benefits.  Mark followed his doctor’s advice and filed two long term disability claims—one with each of his insurance providers.  However, while one insurer placed his claim under review, the other denied his claim outright, citing insufficient medical evidence.

Faced with the denial of one of his claims and the overwhelming nature of his conditions, Mark sought the help of Riemer Hess.  Our attorneys immediately stepped in to take control of both claims.  Our first step was to advise Mark not to let his doctors complete any forms from the insurers until we had reviewed them.  This allowed us to ensure that his medical records and physician statements accurately reflected the severity of his scleroderma and GERD symptoms.  We also requested the complete claim file from the insurer who had denied his claim so we could analyze their reasoning and build a robust case for appeal.

We worked closely with Mark to gather strong medical evidence, starting with a Functional Capacity Evaluation (“FCE”).  This comprehensive evaluation documented his physical limitations, including his inability to sit or use a computer for extended periods due to Raynaud’s and GERD-related pain and fatigue.  We had his doctors review the FCE report and write statements supporting its results, ensuring their support in validating the extent of his limitations.  To further bolster his claim, we advised Mark to keep a detailed symptom diary, where he recorded the daily impact of his GERD symptoms, including how acid reflux and swallowing difficulties disrupted his sleep, concentration, and ability to function throughout the day.

Armed with thorough medical records, the FCE, and Mark’s symptom diary, we presented all the evidence in a detailed appeal to the insurer that had initially denied his claim.  The compelling documentation we provided proved that Mark’s GERD, along with his scleroderma-related symptoms, made it impossible for him to perform the duties of his occupation or any other work for which he was qualified.  As a result, the insurer reversed its decision, and Mark was finally approved for his long term disability benefits.

Grateful for the successful outcome, Mark retained Riemer Hess to monitor his ongoing disability claim, ensuring that his benefits continue without interruption.