Sjogren’s Syndrome and Long Term Disability: What You Need to Know

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Navigating the complexities of long term disability (“LTD”) claims can be daunting, especially when grappling with the challenges posed by Sjogren’s Syndrome.  As an autoimmune disorder known for its hallmark symptoms of dry eyes and mouth, Sjogren’s Syndrome can also cause other debilitating physical and cognitive impairments.  These symptoms collectively have the potential to impede your ability to work.

If you’re seeking LTD benefits due to Sjogren’s Syndrome, it’s important to understand the best strategies for establishing your claim with your insurer.  Below we’ll discuss how to determine your eligibility for LTD benefits and what evidence can help substantiate your Sjogren’s Syndrome LTD claim.


Can I get long term disability for Sjogren’s Syndrome?

Yes, Sjogren’s Syndrome can qualify you for long term disability (“LTD”) benefits, subject to your policy’s specific terms and conditions.  Sjogren’s Syndrome, an autoimmune disorder primarily known for causing dry eyes and mouth due to reduced tear and saliva production, can also present with many other serious symptoms that impact your physical and cognitive functioning.

Common symptoms of Sjogren’s Syndrome include:

    • Dry eyes and dry mouth;
    • Debilitating fatigue;
    • Joint pain;
    • Muscle weakness; and
    • Neurological issues (such as difficulty concentrating, memory problems, and brain fog).

If presenting with enough severity and frequency, these symptoms can impair your ability to carry out daily activities and sustain gainful employment, leading to long term disability.

To be eligible for LTD benefits, you typically need to meet the standard definition of disability outlined in your insurance policy.  This often entails demonstrating an inability to perform the material duties of your occupation due to a medically determinable impairment, such as Sjogren’s Syndrome, for a specified duration, typically lasting six months or longer.

Sjogren’s Syndrome symptoms can disable you from fulfilling the essential tasks of your occupation.  Physically, chronic pain, fatigue, and weakness can limit mobility and stamina, while dryness and discomfort in the eyes and mouth can impair vision and speech, hindering job performance.  Cognitively, neurological symptoms like difficulty concentrating, memory lapses, and brain fog can impede essential cognitive functions necessary for many occupations, such as problem-solving, decision-making, and multitasking.  These cognitive impairments often result in decreased productivity, errors in work tasks, and challenges in meeting job requirements and deadlines.

If you are experiencing significant limitations in your ability to work due to Sjogren’s Syndrome, you may be eligible for LTD benefits under the terms of your insurance policy.  However, your insurer will require evidence proving you cannot work.  This evidence usually involves comprehensive medical and vocational documentation demonstrating the extent of your impairment and its impact on your ability to work.  In the next section, we will explore in detail the types of evidence that can help strengthen your LTD claim for Sjogren’s Syndrome.


What is needed to prove a long term disability claim for Sjogren’s Syndrome?

To substantiate a long term disability (“LTD”) claim for Sjogren’s Syndrome, it’s essential to compile various types of evidence to demonstrate the severity of your impairment and how it prevents you from working.

Here are some valuable types of evidence that can support your Sjogren’s Syndrome LTD claim:

    • Diagnostic Testing: Diagnostic testing plays a crucial role in establishing the presence and severity of Sjogren’s Syndrome.  Blood tests for specific autoantibodies associated with the condition, such as anti-SSA (Ro) and anti-SSB (La), can help confirm your diagnosis.  Additionally, salivary gland biopsies may be performed to assess inflammation and damage to the salivary glands, a hallmark feature of Sjogren’s Syndrome.  Imaging studies such as ultrasound or MRI scans may also be utilized to visualize structural changes or abnormalities in affected organs, further supporting your diagnosis.
    • Objective Medical Evidence: Objective medical evidence is crucial for your insurer because it provides measurable and verifiable data to support the severity of your condition and the extent of its impact on your ability to work.  This includes documented symptoms such as dry eyes and mouth, as well as objective signs of inflammation or damage observed during physical examinations.  Laboratory test results indicating abnormalities in blood counts, markers of inflammation (e.g., erythrocyte sedimentation rate or C-reactive protein), and other relevant parameters provide objective evidence of the systemic effects of Sjogren’s Syndrome on the body.
    • Subjective Medical Evidence: Subjective medical evidence encompasses reported symptoms and experiences that cannot be directly observed or measured by healthcare providers.  In the case of Sjogren’s Syndrome, you may experience symptoms such as chronic fatigue and joint pain that significantly impact your daily functioning.  Detailed documentation of these subjective symptoms, including their frequency, severity, and impact on activities of daily living, is essential for establishing the subjective component of disability and demonstrating the pervasive effects of Sjogren’s Syndrome on quality of life and functional capacity.
    • Functional Capacity Evaluation: A Functional Capacity Evaluation (“FCE”) assesses your physical abilities and limitations, providing objective data on your ability to perform work-related tasks.  These evaluations measure strength, endurance, flexibility, and range of motion, helping to quantify how Sjogren’s Syndrome prevents you from working.
    • Neuropsychological Evaluations: If you experience any cognitive impairments often associated with Sjogren’s Syndrome, it can be helpful to undergo a neuropsychological evaluation to support your claim.  The evaluation involves comprehensive testing to evaluate memory, attention, processing speed, executive function, and other cognitive skills affected by your condition.  Neuropsychological findings provide critical objective evidence of cognitive deficits that may hinder your ability to perform work-related tasks effectively.
    • Vocational Evidence: Vocational evidence includes your resume, work history, and official job descriptions from your employer detailing the demands of your occupation.  Additionally, vocational assessments conducted by vocational experts can also help establish your work capacity in light of your Sjogren’s Syndrome-related limitations.  These assessments offer an in-depth analysis of your inability to work based on your education, skills, work experience, and residual functional capacity (“RFC”).  The assessment report can be used to support your LTD claim with your insurer.

By compiling comprehensive medical, functional, and vocational evidence tailored to the specific challenges posed by Sjogren’s Syndrome, you can significantly strengthen your long term disability claim and improve your chances of a successful outcome.


What are common challenges individuals with Sjogren’s Syndrome face when seeking long term disability benefits?

Doctor holding clipboard with file in hospital room-2Those filing for long term (“LTD”) disability benefits for Sjogren’s Syndrome often run into a few common challenges.  One common problem with Sjogren’s Syndrome disability claims is substantiating the subjective symptoms associated with the condition.  Subjective symptoms are difficult for others to see or measure, such as chronic fatigue, pain, and headache.  These symptoms can significantly impact your ability to work, but they’re not easy to demonstrate via objective medical evidence.  Because of this, your insurer may question the severity of your condition, potentially leading to claim denial.

Another challenge with Sjogren’s Syndrome LTD claims is showing your insurer how your symptoms affect you when they may fluctuate in severity and frequency.  Symptoms of Sjogren’s Syndrome can vary a lot from day to day – or even from hour to hour.  This can make it hard to paint a clear picture of how your condition affects your ability to work over the long-term.  Your insurer may be skeptical of why you can’t work some days but can on others, which can make it harder to get them to approve your claim.

Another factor to consider is that Sjogren’s Syndrome isn’t always well understood by disability insurers.  Your insurer may doubt the seriousness of your condition and how it prevents you from working.  Without compelling and comprehensive evidence to support your claim, this lack of understanding can lead to delays or denials in getting the disability benefits you need.

These challenges are frustrating, but they can be overcome with the correct strategies – and with the assistance of an experienced long term disability attorney.  A knowledgeable ERISA attorney will understand the best approach to substantiate your Sjogren’s Syndrome LTD claim and avoid common mistakes claimants make during the claims process.


What should I do if my long term disability claim for Sjogren’s Syndrome is denied?

While it can be upsetting and overwhelming if your long term disability (“LTD”) claim for Sjogren’s Syndrome is denied, there are steps you can take to challenge the decision.

First, carefully review the denial letter from your insurer to understand the reasoning behind their decision.  This letter should outline the specific reasons for the denial and any deadlines for appealing the decision.  If your claim is governed by ERISA, you generally have 180 days from the date of the denial to file an appeal.  Understanding these details is crucial for planning your next steps.

Next, consider requesting your claim file from your insurer.  The claim file contains all the information and documents related to your disability claim used by your insurer to make their decision, including medical records, correspondence, and assessments.  It also often includes internal notes and reports from your insurer.  Reviewing your claim file can help you identify any missing information or errors that may have contributed to the initial denial.  It can also provide valuable insights into how your insurer evaluated your claim and where there may be opportunities to strengthen your appeal.

Seeking assistance from an experienced ERISA attorney can be invaluable before filing an appeal on your own.  Remember, an appeal is often your last opportunity to avoid lengthy and costly litigation.  An attorney with experience handling LTD claims can help you navigate the complex appeals process, advocate on your behalf with the insurer, and ensure that your rights are protected throughout the process.  They can also help you gather additional evidence, prepare written arguments, and present your case effectively during the appeal.


How can an attorney help me with my Sjogren’s Syndrome long term disability claim?

Navigating a long term disability (“LTD”) claim for Sjogren’s Syndrome can be overwhelming.  Working with an ERISA attorney simplifies this process.  At Riemer Hess, our experience with disability insurance processes and our personalized approach to client representation ensure that your claim is as strong as possible.  We focus on gathering comprehensive evidence, managing communications with insurers, and representing your interests in appeals, aiming to secure the benefits you need to prioritize your health and well-being.

Here’s an example of a client we helped win a Sjogren’s Syndrome LTD claim:

Our client “Emily” was a successful chief accounting officer within a large organization.  For years, Emily thrived in her high-powered role even as she grappled with the bothersome but manageable symptoms of dry eyes and mouth associated with Sjogren’s Syndrome.  However, everything changed when Emily was blindsided by a rapid onset of more disabling symptoms, including excruciating joint pain, debilitating fatigue, and frustrating memory lapses.  Following an official diagnosis of Sjogren’s Syndrome, Emily found herself struggling to maintain her usual pace and productivity at work.

As her symptoms continued to worsen, Emily faced the harsh reality of no longer being able to keep up with the demands of her workload.  Faced with no other option, she made the difficult decision to halt her career and focus on prioritizing her health.  However, when Emily filed a long term disability claim with her insurer, she encountered an unexpected roadblock.  Despite providing thorough documentation of her condition, her insurer kept requesting additional information, leaving Emily feeling frustrated and helpless.

Recognizing the need for expert assistance, Emily turned to Riemer Hess for help in securing her LTD benefits.  Riemer Hess reviewed correspondence from her insurer, the documentation she had already submitted, and her insurance policy.  They quickly identified her insurer’s focus on evidence of cognitive limitations and promptly referred Emily for a neuropsychological evaluation to provide the necessary support.

In addition to addressing the cognitive aspect of Emily’s disability, Riemer Hess also recognized the importance of presenting a comprehensive picture of her job duties to her insurer.  Riemer Hess arranged for Emily to undergo a vocational assessment, shedding light on the specific challenges she faced in performing her role.  Furthermore, Riemer Hess obtained supportive statements from Emily’s supervisor and co-workers, highlighting the tangible impact of her condition on her ability to work effectively.

Armed with this wealth of compelling evidence, Riemer Hess submitted a comprehensive appeal on Emily’s behalf.  Their diligent efforts paid off when the insurer, satisfied with the additional evidence provided, finally approved Emily’s claim for long term disability benefits.  Grateful for the support she received, Emily chose to retain Riemer Hess to monitor her claim going forward.

At Riemer Hess, our experienced ERISA attorneys understand the disability insurance claim process and what your insurer will look for, whether you’re filing a claimappealing a wrongful denial, or looking to litigate with your insurer.  To arrange for a consultation with lawyers at Riemer Hess, call us at 212-297-0700 or click the button below to schedule an exploratory call.

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