Osteomyelitis and Long Term Disability: What You Need to Know

If you are battling osteomyelitis, you understand the profound impact this chronic bone infection can have on your life. Not only does it cause severe pain and mobility restrictions, but it also presents a challenging path when seeking long term disability benefits. Osteomyelitis’s episodic nature means your ability to work can fluctuate unpredictably, complicating your financial stability and emotional well-being.

Below, we’ll discuss the essential steps to prove a long term disability claim for osteomyelitis and share information that can help you through the LTD claims process.

Is osteomyelitis a disability?

Yes, osteomyelitis is considered a disability, particularly when evaluating eligibility for long term disability benefits due to its significant impact on your ability to work.  Osteomyelitis is a serious infection of the bone that can be caused by bacteria, fungi, or other germs.  The infection may reach the bones through the bloodstream, from nearby infected tissue, or directly through an open fracture or surgical procedure.

There are two common types of osteomyelitis.  Acute osteomyelitis develops quickly, primarily affecting children and those with a recent injury or surgery, with symptoms manifesting over days to weeks.  However, many people develop chronic osteomyelitis.  Chronic osteomyelitis emerges when the infection persists or recurs, often due to incomplete treatment of an acute episode.  This form can last months or years and is more common in adults.

Osteomyelitis can lead to a range of symptoms that severely impact bodily functions and employment capabilities:

• • Pain and Swelling: Persistent or severe pain in the affected area, accompanied by swelling, can hinder mobility and the ability to perform physical job tasks.
  • Fever and Fatigue: Systemic infections can cause generalized weakness and high fevers, reducing overall productivity and endurance.
  • Limited Joint Mobility: Infections near joints can restrict movement, complicating tasks that require bending, walking, or lifting.
  • Chronic Drainage: Some cases involve open wounds that continually drain fluid, requiring frequent medical attention and affecting daily activities.
  • Bone Damage and Deformity: Chronic infection may lead to significant bone loss or deformity, which can necessitate surgical intervention and long recovery periods.
  • Neurological Symptoms: If an infection compresses nerves, it might lead to numbness or weakness, impairing manual dexterity and mobility.

These symptoms can drastically reduce your ability to perform your occupational duties.  This is not limited to jobs with high physical functional demands, either.  Your osteomyelitis may cause pain that makes it difficult to sit for extended periods, keep your neck in a static position to view a computer screen, finger a keyboard, or other tasks associated with sedentary occupations.  If your osteomyelitis symptoms present with enough severity and frequency to affect your ability to work, they may lead to disability.

Can I get long term disability for osteomyelitis?

Yes, you can get long term disability (“LTD”) benefits if you have osteomyelitis.  However, your eligibility for benefits will depend on the severity of your condition and the specifics of your LTD policy. Your policy is key to determining if you are eligible for benefits.

LTD policies vary in how they define disability, particularly when dealing with chronic and potentially debilitating conditions like osteomyelitis.  The definition of “disability” can differ between policies. An “Own Occupation” policy considers if you can perform the duties of your specific job.  On the other hand, an “Any Occupation” policy is stricter, requiring that you cannot perform any job for which you are suited by education, training, or experience.

The duration of your condition also plays a critical role.  Many policies require that you have been disabled for a certain period before benefits can begin.  Osteomyelitis, particularly in its chronic form, often satisfies these requirements due to its recurrent and long-term nature.

It’s important to also check for any exclusions or limitations in your policy that might affect coverage, such as those pertaining to pre-existing conditions or specific exclusions related to infectious diseases.

Understanding the specifics of your LTD policy and how your condition impacts your life will be crucial in securing benefits.  It may be beneficial to consult with an experienced long term disability attorney who can review your policy and explain the criteria you must meet for a successful LTD claim.

How can I prove my long term disability claim for osteomyelitis?

To prove your long term disability claim for osteomyelitis, it’s essential to compile comprehensive and detailed medical documentation and evidence that clearly demonstrates the severity and impact of your condition.

Types of medical evidence to support your osteomyelitis LTD claim may include:

• • Detailed Medical Records: Include all records from your doctors, hospitals, and clinics that document your osteomyelitis diagnosis, treatment, and response to treatment.  These records should provide a complete medical history that traces the progression of your osteomyelitis.
  • X-rays: Useful for detecting bone damage or changes caused by infection.
  • MRI and CT Scans: These imaging tests provide detailed pictures of the bone and the soft tissues surrounding it, helping to confirm the presence of an infection and assess its extent.
  • Bone Scans: Can detect bone diseases and infections by highlighting abnormal metabolic activity in the bones.
  • Blood Tests: Important for detecting markers of infection such as elevated white blood cell count and other inflammation markers.
  • Functional Capacity Evaluation (“FCE”): This assessment is performed by a physical therapist or occupational therapist and measures your physical abilities in various tasks.  An FCE can provide objective data on your physical limitations and the extent to which osteomyelitis affects your ability to perform work-related activities.
  • Vocational Assessments: These evaluations help determine how your osteomyelitis and its symptoms affect your ability to perform your current job or any job, taking into account your skills, education, and work experience.  The assessment can be crucial, especially if your insurance policy includes an “Any Occupation” definition of disability.
  • Physician’s Statements: A detailed statement from your treating physician that describes your symptoms, treatment responses, prognosis, and physical or functional limitations can be influential.  This should specifically relate to how osteomyelitis impacts your daily living and ability to work.
  • Personal Symptom Diary: Keeping a record of your daily symptoms, pain levels, and how they affect your activities can provide personal insights and support the clinical evidence presented.

Together, these documents and assessments form a robust case demonstrating how osteomyelitis limits your functionality and supports your claim for long term disability benefits.

What are common challenges in securing long term disability for osteomyelitis?

Securing long term disability benefits for osteomyelitis can be challenging due to the complex nature of the disease and the strict criteria set by insurance companies.  Here are some common hurdles claimants with osteomyelitis face when filing for long term disability:

• • Proving the Severity and Chronic Nature of the Condition: Osteomyelitis must be shown not only to exist but also to severely impact your ability to work.  Providing sufficient medical evidence to demonstrate the extent of the infection, the pain levels, and the resulting functional limitations can be difficult, especially if medical documentation is incomplete or does not adequately capture the daily impact of the condition.
  • Fluctuating Symptoms: Osteomyelitis can exhibit varying symptoms over time, especially if it is chronic. There may be periods of remission followed by flare-ups.  Your insurer may argue that during periods of remission, you are capable of working, thus complicating the approval process.  Continuously updated medical records and a symptom diary can help demonstrate the variability and real impact of your condition over time.
  • Linking Symptoms to Job Performance: It can be challenging to directly link the symptoms of osteomyelitis—such as pain, fatigue, and limited mobility—with specific job functions, especially for jobs that are less physically demanding.  Detailed job descriptions and vocational assessments can help illustrate how your symptoms prevent you from performing your job duties effectively.
  • Delayed Diagnosis and Treatment Gaps: Osteomyelitis can sometimes be difficult to diagnose promptly due to its subtle early symptoms, which can be mistaken for other conditions.  Additionally, gaps in treatment or inconsistent follow-up can weaken your claim, as insurers might interpret these as indications that your condition is not serious or disabling.
  • Insurance Policy Interpretations: Insurers may have stringent definitions of disability and what constitutes a disabling condition under their policies.  The specific language and terms of the policy can greatly affect the outcome of a claim.  Understanding and navigating these terms often requires insight from an ERISA attorney.
  • Pre-existing Condition Exclusions: Some insurance policies include clauses that limit coverage for conditions deemed pre-existing before the policy’s effective date.  If osteomyelitis developed or was treated before you were covered, this could potentially be a barrier to receiving benefits.

Successfully overcoming these challenges often requires thorough preparation of your claim, including gathering comprehensive medical evidence and ongoing documentation of your condition’s impact.  It’s always recommended that you consult with an experienced ERISA attorney.  An attorney can maximize your chances of a successful outcome for your long term disability claim.

How can I manage my long term disability claim if osteomyelitis leads to recurring episodes or flares?

Managing a long term disability (“LTD”) claim for osteomyelitis, particularly when your condition has a fluctuating course with recurring episodes or flares, requires careful documentation of your functional limitations.

Here are a few tips for handling your LTD claim under these circumstances:

• • Keep Detailed Medical Records: Continuous and comprehensive documentation of your medical visits, treatments, and outcomes is crucial.  Regular updates from your healthcare providers should detail the chronic nature of your osteomyelitis and its episodes of exacerbation.  This helps to establish a clear medical history that demonstrates the recurrent and unpredictable flare-ups of your symptoms.
  • Maintain a Symptom Diary: Recording your daily symptoms, the severity of pain, mobility issues, and how these symptoms affect your ability to perform daily tasks can provide valuable evidence of the variability of your condition.  This diary can help illustrate the impact of osteomyelitis on your life during both flare-ups and remission periods.
  • Get Regular Evaluations from Your Doctor: Frequent medical evaluations can document the ongoing and changing nature of your condition.  Encourage your doctor to record any changes in your condition, especially during flare-ups, and how they affect your functional capabilities.
  • Functional Capacity Evaluation (“FCE”): Consider undergoing periodic Functional Capacity Evaluations.  These can provide objective evidence about your physical capabilities and limitations during different phases of osteomyelitis.  Repeating the FCE during a flare-up and a remission period can demonstrate the fluctuating impact of the condition on your ability to work.
  • Use Vocational Expert Assessments: A vocational expert can assess how your symptoms during both flare-ups and more stable periods affect your job performance and employment opportunities.  This assessment can bolster your claim by providing a professional evaluation of your work-related limitations.
  • Prepare for Possible Surveillance: Insurance companies sometimes use surveillance to verify the severity of a claimant’s condition.  Being consistent in your medical reports and personal accounts will help maintain credibility in the face of such scrutiny.
  • Seek Legal Advice: Given the complexity of claims involving diseases with fluctuating symptoms, consulting with an ERISA long term disability attorney can be beneficial.  A knowledgeable attorney can help navigate the claims process, deal with denials or appeals, and ensure that your rights are protected.

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

Riemer Hess has over twenty-five years of experience successfully assisting clients in securing their long term disability benefits, including for complex medical conditions such as osteomyelitis.  We understand the intricacies of disability insurance claims and work tirelessly to ensure that each client’s case is supported by comprehensive medical evidence and expert assessments.  Our goal is to help you navigate the challenges of the LTD claims process and alleviate your stress so you can focus on their health and recovery.

Below is an example of a client we helped secure long term disability for osteomyelitis.

Client Success Story

Our client “Victoria” had been a dedicated senior accountant at a prominent firm for several years.  However, her career faced an unexpected hurdle when she began experiencing severe symptoms of osteomyelitis.  Initially, Victoria managed to continue her responsibilities thanks to her employer’s accommodation of full-time remote work.  But as the disease progressed, the severity of her symptoms increased.  She found herself grappling with debilitating pain that made it impossible to sit at her desk for prolonged periods.  Despite her best efforts, Victoria reached a point where continuing to work was no longer feasible.

Recognizing the seriousness of her situation, Victoria sought the expertise of Riemer Hess to assist with filing her long term disability claim.  Understanding the challenges posed by osteomyelitis, our team acted swiftly.  We referred Victoria to undergo a Functional Capacity Evaluation to objectively assess Victoria’s physical limitations and their impact on her ability to perform her job functions.  Following this, we coordinated with Victoria’s treating orthopedist to respond to the report.  Her orthopedist reviewed the evaluation report and provided a comprehensive letter supporting its results, affirming Victoria’s inability to work.

To further solidify her claim, Riemer Hess compiled detailed medical records, a symptom diary maintained by Victoria illustrating her daily struggles, and witness statements from her family and co-workers who could provide their insights into how her osteomyelitis had affected her job performance and daily activities.

Thanks to the robust and meticulously prepared evidence, Victoria’s insurer approved her claim for long term disability benefits.  Relieved and grateful for the support from Riemer Hess, she chose to retain our firm to monitor her ongoing claim.