Multiple Sclerosis (“MS”) is a chronic, progressive autoimmune disease that affects the central nervous system and can cause a wide range of physical and cognitive symptoms. If you are living with MS, these symptoms can make it difficult or impossible to work, and may lead to long term disability. However, despite the very serious nature of MS, obtaining long term disability benefits can be an uphill battle.
Below we will discuss how to present the strongest long term disability claim possible for multiple sclerosis.
Can I get long term disability for multiple sclerosis?
Yes, you can receive long term disability for multiple sclerosis. The physical and cognitive symptoms of MS can make it very challenging to work on a consistent basis. In addition, MS is a chronic condition that can have periods of remission and relapse, which can make it difficult to predict how the disease will progress over time.
To qualify for long term disability for MS, your insurer will require you to prove that your symptoms are severe enough to prevent you from working on a consistent basis. This can sometimes be challenging, particularly during periods of remission.
What symptoms of multiple sclerosis cause disability?
MS causes a wide range of symptoms, many of which can be debilitating and significantly impact your ability to work. MS symptoms can be physical, cognitive, or a combination of both, and may vary widely from person to person. To prove disability, your physical and cognitive symptoms need to be comprehensively documented. You, therefore, should tell your health provider all of your symptoms each time you come in for an office visit.
Physical Symptoms of Multiple Sclerosis
MS causes physical symptoms by attacking the myelin sheath that protects nerve fibers in your brain and spinal cord. When the myelin is damaged, nerve signals can be disrupted or completely blocked, leading to a wide range of physical symptoms.
While the exact physical symptoms of MS vary from person to person. they may include:
- Weakness or paralysis in one or more limbs;
- Difficulty walking or maintaining balance;
- Numbness or tingling in the limbs or face;
- Spasms or stiffness in the muscles;
- Bladder or bowel problems; and/or
- Vision problems, including double vision, blurred vision, or loss of vision.
Cognitive Symptoms of Multiple Sclerosis
MS lesions can disrupt the transmission of nerve signals, leading to cognitive impairments. In addition, inflammation caused by MS can damage brain tissue and further contribute to cognitive dysfunction. The severity of cognitive symptoms in MS varies and depends on factors such as the location and extent of MS lesions in the brain, as well as individual factors such as age, education level, and cognitive reserve.
Cognitive symptoms of MS may include:
- Difficulty with memory or concentration;
- Slowed thinking or processing speed;
- Difficulty with problem-solving or decision-making;
- Changes in mood or behavior; and/or
- Depression or anxiety.
How do I prove my multiple sclerosis is disabling?
To prove that your MS is disabling, you will need to provide evidence demonstrating your diagnosis, the severity of your symptoms, and how your MS prevents you from working. Below we’ll discuss evidence you can use to support your long term disability claim for MS.
Medical Evidence for Multiple Sclerosis
Your insurer will require medical evidence of your MS diagnosis and symptoms. Objective medical evidence (such as imaging and test results) is one of the most important kinds of evidence you can submit to your insurer. However, your insurer must also consider your subjective medical evidence (such as your self-reported symptoms).
Here are some forms of medical evidence you may submit to your insurer:
- MRI Scans: Magnetic resonance imaging (MRI) is a non-invasive diagnostic tool that can detect lesions in the brain or spinal cord, which are characteristic of MS. MRI scans can also help show the progression of the disease over time, which can be important in establishing the severity of your symptoms.
- Neurological Examinations: A neurological examination by your treating physician can help document the extent of your physical limitations, such as weakness, spasticity, or difficulty with balance or coordination. The exam may also include assessments of your reflexes, sensation, and muscle tone.
- Medical Records: Your medical records can provide important evidence of the course of your disease and the treatments you have received. Medical records may include office visit notes from your treating providers, testing results, and any imaging. These records can help establish the severity of your symptoms and the extent to which they have impacted your ability to work.
- Neuropsychological Evaluation: MS can also cause cognitive impairments, such as memory loss, difficulty with problem-solving or decision-making, and slowed processing speed. A neuropsychological evaluation can document these impairments and establish their impact on your ability to work.
- Functional Capacity Evaluation: A Functional Capacity Evaluation (“FCE”) is an assessment of your physical and cognitive abilities, which can help determine your capacity for work. This evaluation may include tests of your strength, range of motion, endurance, and cognitive functioning.
- Statements from Treating Physicians: Statements from your treating physicians can provide your insurer with valuable information about the nature and severity of your symptoms, as well as the expected course of the disease. These statements can be particularly helpful if your physician has been treating you for an extended period of time.
- Symptom Diary: Make regular, frequent and detailed entries, noting how you are feeling and the nature of your symptoms each day. This “bad news” diary can be powerful evidence of the impact of your MS symptoms over an extended period of time.
Other Evidence for Multiple Sclerosis
In addition to medical evidence, there are several types of other evidence that can be submitted in support of an MS disability claim. This can include:
- Vocational evidence such as your official job description, resume, and a vocational assessment;
- Statements from family members, friends, and coworkers regarding your symptoms and limitations, as well as how the onset of MS has affected your work performance and ability to perform daily activities;
- A personal affidavit written by you, which provide valuable insight into the impact of MS on your daily life and ability to work.
How can an attorney help with my multiple sclerosis long term disability claim?
An experienced ERISA attorney can be a valuable resource in helping you navigate the long term disability process for MS. At Riemer Hess, we have over 25 years of experience securing disability benefits for clients suffering from MS.
Some of the ways Riemer Hess can assist with your MS long term disability claim include:
- Ensuring your medical record is complete. The initial application and appeals process is your one and only chance to present evidence in support of your claim. If your claim goes to court, the judge will review only what is already in the record. Therefore, we will make sure your medical record includes a full medical history, a detailed history of your MS, all treatment notes, medical test results, and doctor reports.
- Working with your doctors to prepare a compelling narrative report describing your condition and symptoms.
- Guarding against insurance company abuses. For example, your insurer will want to see your doctor’s treatment notes. These are the progress notes the doctor makes contemporaneously with an examination. Rather than consider the whole of the notes, however, your insurer will focus on the few words or phrases that serve its purpose (e.g., “patient is feeling better,” or “pain diminishing,” or “renewed energy”). Your insurer will try to use your doctor’s treatment notes against you, focusing on your “good” days and largely ignoring your flare-ups. We can combat your insurer’s misuse of treatment notes by (a) going through the notes with a fine-toothed comb to highlight all the references that speak to the extent of your disability; and (b) working with your doctor to prepare a separate report explaining how they use treatment notes and addressing any notation your insurer has misinterpreted.
- Bringing your paperwork to life. We are experienced disability insurance attorneys. We know how to package your application or appeal so that it presents your disability story in a way that is personal, vivid, and compelling.
- Keeping your claim on track by filing a timely application or appeal.
- Filing a comprehensive appeal. If your claim has been denied, we will make sure every point in your denial letter is addressed in your appeal.
Case Study: Multiple Sclerosis
Here’s an example of how Riemer Hess has helped a client with multiple sclerosis secure long term disability benefits.
“Alison” was the District Sales Manager for a major insurance company. Unfortunately, she had been struggling with multiple sclerosis for many years. After working for almost 30 years for this company and achieving significant professional success, she was denied long term disability benefits under both a group policy and an individual policy issued by her employer.
In addition to the heartbreaking effects of her own illness, Alison had to deal with the cruel fact that the very company to which she had devoted almost three decades of her life did not feel that she “deserved” long term disability benefits. Indeed, the insurance company denied Alison’s claim solely on the basis of a hired doctor’s opinion that Alison was capable of “sedentary” work.
How could Alison’s own employer forget that her job was in no sense of the word “sedentary?”
Alison hired Riemer Hess to appeal her denial. Riemer Hess gathered all of Alison’s available medical evidence, obtained detailed reports from Alison’s treating physicians supporting her disability, and prepared a comprehensive appeal letter attacking each reason raised by the insurance company in its denial, including its erroneous conclusion that Alison’s job was “sedentary.”
The insurance company reversed itself, paid Alison all past benefits owed, and placed Alison on long term disability with full benefits. Riemer Hess continues to work with Alison to ensure that her benefits are not interrupted.
If you're filing a multiple sclerosis long term disability claim, Riemer Hess can help. We have assisted many clients in successfully securing disability benefits for MS. Our partner attorney Scott Riemer has worked extensively with the National Multiple Sclerosis Society in litigation and volunteer work. The New York City Chapter of the National Multiple Sclerosis Society has awarded him the Public Education Award for this pro bono and volunteer work.
At Riemer Hess, our experienced ERISA attorneys understand the disability insurance claim process and what your insurance company will look for, whether you’re filing a claim, appealing a wrongful denial, or looking to litigate with your insurance company. To arrange for a consultation with the lawyers at Riemer Hess, call us at 212-297-0700 or click the button below to schedule an exploratory call.