Stroke | Long Term Disability Claim Tips

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A stroke may lead to short or long term physical and/or cognitive deficits requiring intense rehabilitative treatment.  Even with treatment, a stroke may cause enough damage and residual symptoms to cause a permanent disability.  If you are left disabled due to a stroke, there are several things you should know before you file your long term disability claim.

The insurance company will require evidence of treatment and appropriate care.

Most insurance policies require proof that you are receiving medical treatment and that such treatment is “appropriate.”

This means that the insurance company will want review any hospital records from your stroke, follow-up notes from your doctors, and do rehabilitative treatment or therapy that you subsequently received.  The insurance company will review the records for proof that you are under the care of an “appropriate” physician, which usually means a specialist, such as a neurologist.

The insurance company will also check whether you have been compliant with your doctor’s treatment plan.  If the insurance company finds that you have been non-compliant, there is a good chance that your claim will be denied.  For example, if your doctor recommended rehabilitative physical and cognitive therapy, but you never attended the program, the insurance company may deny your claim by saying that you are refusing to undergo “appropriate” treatment.

The insurance company will consider the combined impact of your physical and cognitive/mental symptoms.

Most people suffer a combination of physical and cognitive/mental symptoms following a stroke.  Some people may be disabled solely due to physical symptoms.  Others may be disabled solely due to cognitive/mental symptoms.  However, it’s most commonly a combination of both physical and cognitive/mental symptoms that leads to long term disability after a stroke.  Insurance companies generally recognize this and will consider the combined impact of your symptoms on your ability to work.

The insurance company will require documentation of your symptoms with abnormal objective findings.

The insurer will carefully review the medical evidence for documentation of residual symptoms following your stroke.  The insurance company will also look for abnormal clinical signs that are consistent with those symptoms.

Physical symptoms and abnormal findings may include:

  • Balance problems
  • Poor coordination
  • Difficulty walking and/or standing
  • Loss of manual dexterity
  • Muscle weakness with muscle strength deficits
  • Tremors or abnormal movements
  • Slowed movements
  • Paralysis (even slight)
  • Unstable walking
  • Abnormal or altered gait pattern
  • Episodes of falling
  • Numbness, tingling, or other sensory disturbances
  • Pain
  • Disorganization of motor function
  • Physical fatigue
  • Urinary or bladder problems
  • Nausea
  • Vertigo and/or dizziness
  • Headaches
  • Slurred speech
  • Facial abnormalities
  • Blurred or double vision
  • Any other neurological or autonomic abnormalities

Cognitive and/or mental symptoms and abnormal findings may include:

  • Difficulty remembering things
  • Episodes of confusion
  • Abnormal mental status examination
  • Problems concentrating and/or paying attention
  • Speech and/or communication difficulties
  • Disorganized thoughts
  • Personality changes
  • Emotional liability
  • Mental fatigue

The insurance company will want this evidence to be clear.  Therefore, you may run into problems if your doctor’s notes are incomplete, disorganized, or handwritten.  You may need your doctor to produce a clear and comprehensive list of your symptoms and clinical abnormalities for the insurance company to review.

The insurance company will require diagnostic testing results.

The insurance company will scrutinize your medical records to ensure that they contain sufficient diagnostic proof of your stroke and ongoing symptoms.  Typically, the insurance company will want to see abnormal findings on an MRI or CT scan.

However, if you are claiming disability due to complications from your stroke, the insurance company may want to see additional testing.  For example, if you are claiming an ongoing disability due to autonomic dysfunction, the insurance company may want to see the results of autonomic nervous system testing (“ANS”) or cardiopulmonary exercise testing (“CPET”).  If you are alleging severe cognitive deficits, the insurance company may also want to see the results of thorough neuropsychological testing.

The insurance company will require the opinion of your doctor.

The insurance company will want to know whether your doctor believes that you are disabled.  Unfortunately, a simple note from your doctor stating that you are “disabled” will rarely satisfy the insurance company.  Rather, the insurance company will want a detailed assessment from your doctor outlining the severity and limiting impact of your symptoms.

For example, the insurance company will want to know how long you can sit, stand, and walk without interruption and throughout a workday.  The insurance company will also want to know about any lifting, carrying, pushing, and/or pulling restrictions you may have.  The insurance company will also consider a number of non-exertional limitations, such as postural restrictions, difficulties using your hands for fine manipulations, cognitive difficulties, etc.

If your doctor does not provide a detailed assessment of your limitations, the insurance company may require examination by one of their “independent” medical examiners.  Of course, the insurance company’s doctors are anything but “independent.”  They are paid by the insurance company and, thus, have an inherent conflict of interest.  They tend to be far less favorable to claimants and often downplay significant findings, which can lead to a denial.

The insurance company will require proof of an ongoing disability.

Severe symptoms can improve with proper rehabilitative treatment following a stroke.  Insurance companies, of course, are aware of this potential for improvement.  As a result, insurance companies frequently demand proof of an ongoing disability after claim approval.

The insurance company may accept updated medical records or forms from your doctors as sufficient proof.  Therefore, it is usually advisable to remain in consistent treatment following your stroke.  If you cannot provide proof of an ongoing disability, the insurance company may require you to attend one of its “independent” medical examinations.

An experienced long term disability attorney can help you obtain and protect your benefits after a stroke.

An experienced New York disability attorney can greatly increase your chances of approval following a stroke.  The attorneys at Riemer & Associates have successfully assisted countless clients in obtaining and protecting their stroke-related disability benefits.  Our attorneys and trained legal team know what is needed to prove your claim and protect your ongoing entitlement to benefits for years to come.  Contact a long term disability attorney at Riemer & Associates today to discuss your stroke-related disability claim.

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