Systemic Lupus Erythematosus and Long Term Disability: What You Need to Know

Navigating the complexities of Systemic Lupus Erythematosus (“SLE”) is a daunting task.  When you’re faced with the added challenge of filing for long term disability insurance benefits, the process can feel overwhelming.  SLE’s unpredictable flares and a wide range of debilitating symptoms can disrupt your ability to work and perform daily activities, yet these effects are often misunderstood or underestimated by insurers.

Below we’ll explain what evidence is necessary to support your SLE long term disability claim, the common hurdles you might face, and how an ERISA long term disability attorney can significantly increase your chances of a successful outcome.

Can I get long term disability for Systemic Lupus Eryhematosus?

Yes, you can get long term disability (“LTD”) for Systemic Lupus Eryhematosus (“SLE”).  However, obtaining LTD benefits depends on several factors, including:

• • Severity and Documentation: The severity of your symptoms and how well they are documented in your medical records are crucial.  SLE can cause a range of symptoms such as severe fatigue, joint pain, and organ inflammation, which can significantly impact your ability to work.
  • Impact on Work Capacity: Your insurer will require that you demonstrate how your symptoms prevent you from performing your material occupational duties.  The more specific the information on how SLE affects your daily functions at work, the stronger your claim.
  • Medical Support: Consistent treatment from healthcare providers specializing in SLE, such as rheumatologists, is essential.  Their detailed reports can substantiate the severity and impact of your condition.  We’ll discuss specific medical evidence to support your claim in the next section.
  • Policy Requirements: Review your disability insurance policy details to understand the specific criteria for qualifying for benefits, including any exclusions or limitations related to pre-existing conditions.

If you are considering applying for long term disability due to SLE, it is always recommended that you consult with an ERISA long term disability attorney.  An experienced attorney can review your policy, ensure that all necessary documentation is thorough, and help you successfully navigate the complexities of the claims process.

How does Systemic Lupus Erythematosus cause disability?

Systemic Lupus Erythematosus (“SLE”) can cause disability through its diverse and variable symptoms, all of which can severely impair your ability to work and perform daily activities.  SLE is a chronic autoimmune disease where the immune system attacks its own tissues, causing widespread inflammation and damage in the affected organs.  It can affect the joints, skin, brain, lungs, kidneys, and blood vessels, leading to a wide range of symptoms and complications.

The nature and severity of SLE symptoms can vary from person to person, and the disease often follows a pattern of flare-ups followed by periods of remission.  Because SLE affects everyone differently, disability is determined not just by the presence of the disease itself but by how it impacts your functional capacity and quality of life.

Disabling symptoms of SLE may include:

• • Fatigue: This is one of the most common symptoms reported by individuals with SLE and can be severe enough to interfere with all types of activities, including work.
  • Joint Pain and Swelling: Arthritis is another common symptom of SLE, affecting the joints with pain and swelling, which can limit mobility and dexterity.
  • Skin Issues: Skin rashes, particularly the characteristic “butterfly rash” across the cheeks and nose, can be exacerbated by exposure to sunlight.  Other skin issues include lesions that might appear on other parts of the body, often worsened by ultraviolet light.
  • Neurological and Cognitive Changes: Known as “lupus fog,” this involves cognitive impairments such as confusion, fatigue, memory impairment, and difficulties in expressing thoughts.  These can impair your ability to perform tasks that require mental focus and communication.
  • Kidney Involvement: Lupus nephritis, which is inflammation of the kidneys, can lead to kidney failure if not adequately treated.  The requirements for regular treatment and the effects of kidney disease can make full-time employment difficult.
  • Cardiovascular and Pulmonary Problems: SLE increases the risk of cardiovascular disease, including heart attacks and stroke.  Pulmonary issues might include pleuritis and pulmonary hypertension, which cause shortness of breath and limited physical capacity.
  • Psychological Impact: Chronic pain, the unpredictable nature of the disease, and visible symptoms can lead to secondary psychological issues, including depression and anxiety, which further contribute to disability.

How do I prove Systemic Lupus Erythematosus to my disability insurer?

Proving Systemic Lupus Erythematosus (“SLE”) as a disability to your insurance company involves a comprehensive approach that includes both medical and vocational evidence to support your claim.  This evidence should together provide a complete picture on the severity of your SLE symptoms, the scope of your occupational duties, and how your SLE impacts your ability to carry out these functions.

Medical Evidence for SLE Long Term Disability Claims

When filing for long term disability benefits due to Systemic Lupus Erythematosus (“SLE”), presenting robust medical evidence is crucial.  This evidence not only substantiates your claim but also outlines the extent of your disability, helping insurers understand the severity of your condition.

Objective medical evidence is the cornerstone of a successful SLE disability claim, as it provides concrete, measurable proof of the disease and its impact on your body.  This type of evidence is critical because it offers quantifiable data that can be independently verified, giving credibility to your claim. 

Below is a list of diagnostic and objective evidence that is particularly persuasive in documenting the presence and severity of SLE:

• • Blood Tests: Include results showing positive antinuclear antibodies ("ANA") test, which is commonly found in SLE patients.  Other relevant tests might include anti-double strand DNA, anti-Smith antibodies, and other autoimmune markers.
  • Imaging Tests: X-rays, MRIs, or ultrasounds showing any organ or joint damage caused by SLE.
  • Biopsy Results: If applicable, especially in cases of kidney involvement (lupus nephritis), a biopsy can provide definitive evidence of organ involvement.

• • Clinical Records: Detailed medical records from your rheumatologist or other specialists treating your SLE that document the progression of your disease, your response to treatment, and any complications or side effects.
  • Laboratory Test Results: Regular updates of laboratory tests that monitor the activity of the disease, like complement levels, erythrocyte sedimentation rate ("ESR"), C-reactive protein ("CRP"), and complete blood counts.
  • Physician’s Statements: Statements from your healthcare providers that explain how your symptoms meet the disability criteria outlined in your insurance policy.

  • Functional Capacity Evaluation ("FCE"): A Functional Capacity Evaluation ("FCE") provides objective data about your physical abilities and limitations, specifically quantifying your strength, endurance, and flexibility.  This evaluation is crucial for documenting how SLE's physical symptoms, like joint pain and fatigue, limit your ability to perform specific work-related tasks, offering clear evidence for LTD claims.

    Neuropsychological Evaluation: A neuropsychological evaluation measures cognitive functions affected by SLE, such as memory, attention, and problem-solving skills. It provides critical evidence of "lupus fog" by detailing cognitive impairments and their impact on your ability to perform job duties, which supports claims by illustrating that cognitive deficits hinder work performance and daily living.

Subjective medical evidence allows you to illustrate the personal impact of SLE on your life, complementing and enhancing the objective data.  This evidence can be particularly powerful in showing the day-to-day challenges you face, which may not be fully captured by objective measurements alone.

Here are some key examples of subjective medical evidence:

• • Symptom Diary: Keep a detailed account of your daily symptoms, their severity, and their impact on your daily activities.  This should include notes on fatigue, pain, cognitive difficulties, and any other symptoms relevant to your case.
  • Personal Affidavit: A personal affidavit can outline your background, your occupational duties, the onset of your SLE, and provide a detailed account of how your SLE symptoms have impacted your work performance.
  • Pain and Fatigue Assessments: These can be documented through questionnaires or scales used by your doctors to evaluate the intensity and impact of your pain and fatigue.

Vocational Evidence for SLE LTD Claims

In addition to medical evidence, vocational evidence is essential in illustrating how Systemic Lupus Erythematosus (“SLE”) impacts your ability to work.  This type of evidence specifically ties your symptoms to your work environment and job performance, offering a practical view of your disability in a professional context.

Below is a breakdown of the vocational evidence that can be pivotal in supporting your long term disability claim:

• • Job Description: Documentation from your employer detailing your job responsibilities and the physical and mental requirements of your job.
  • Vocational Assessment: A vocational assessment conducted by a vocational expert demonstrates how your symptoms and their fluctuations affect your ability to perform your job or any job, considering your education, experience, and skill set.
  • Statements from Colleagues or Employers: These can provide firsthand observations of your struggles in the workplace due to SLE.

Combining all these types of evidence provides your insurer a holistic view of how SLE affects your life and substantiates your claim for disability benefits.

What common challenges do those with Systemic Lupus Erythematosus face when filing for LTD?

Individuals with Systemic Lupus Erythematosus (“SLE”) often encounter several challenges when filing for long term disability (“LTD”) benefits.  These challenges stem from the nature of the disease, the requirements of insurance policies, and the complexities of the claims process.

Here are some common hurdles those with SLE face in the LTD claims process:

• • Fluctuating Symptoms: SLE is characterized by periods of flare-ups and remission, which can make it difficult to demonstrate a consistent level of disability.  Your insurer may argue that during periods of remission, you are capable of working, despite the chronic nature of the condition.
  • Subjective Symptoms: Many symptoms of SLE, such as fatigue and pain, are subjective and not easily measured by standard medical tests.  Insurers are more skeptical of symptoms that cannot be corroborated through objective medical evidence.  This can make it challenging to provide the concrete evidence of disability that insurers require.
  • Complexity of the Disease: SLE can affect multiple organ systems in different ways, which requires documentation from various medical specialists.  Coordinating care and ensuring that all relevant information is properly reported and linked to the disability can be cumbersome and time-consuming.
  • Lack of Understanding: There can be a lack of understanding or awareness about SLE among insurer representatives, which may lead to underestimating the impact of the condition on your ability to work.  Educating the insurer about the specific ways in which SLE affects your job performance is often necessary.
  • Strict Policy Definitions: LTD policies often have strict definitions of disability, and proving that SLE meets these definitions can be difficult, especially if the policy requires demonstrating that you cannot perform any job for which you are reasonably qualified based on your education and experience.
  • Denials Based on Pre-existing Conditions: Some insurance policies have clauses that exclude pre-existing conditions or have waiting periods before coverage starts.  If your SLE symptoms were present or treated before the coverage began, this could be a basis for denial.
  • Surveillance and Privacy Concerns: Insurers sometimes employ surveillance tactics to verify the severity of your symptoms.  The resulting surveillance is often taken out of context or edited in order for your insurer to justify a claim denial or termination of your benefits.

To overcome these challenges, consulting with an attorney with experience in long term disability claims can help.  An ERISA disability attorney can help you navigate the complex LTD claims process and advocate effectively on your behalf.

How can a long term disability attorney help with my Systemic Lupus Erythematosus LTD claim?

A long term disability (“LTD”) attorney plays a critical role in navigating the often complex and challenging process of filing for LTD benefits, especially for conditions like Systemic Lupus Erythematosus (“SLE”) which can have variable and subjective symptoms.

Here’s how an LTD attorney can assist:

• • Interpretation of Your Policy: Long term disability attorneys are skilled in reading and interpreting the fine print of disability insurance policies, which can be complex and filled with legal jargon.  They can clarify what constitutes a disability under your specific policy, the extent of your coverage, and any exclusions or limitations that might affect your claim.
  • Advice on Pre-existing Conditions: An experienced ERISA attorney can help determine how pre-existing condition clauses in your policy might impact your claim and advise on the best ways to address these issues.

• • Gathering Medical Evidence: An attorney will help ensure that your medical documentation adequately supports your claim.  This includes advising on the types of medical evidence needed, such as detailed statements from your physicians, test results, and records of ongoing treatments.
  • Documentation of Symptoms and Limitations: An attorney can assist you in documenting non-medical evidence, including a detailed description of your daily limitations and how your condition affects your ability to work.  They can also guide you on maintaining a symptom diary.

• • Communication with Insurance Companies: LTD attorneys handle communications with your insurer, ensuring that all correspondence is timely, documented, and adheres to the legal standards required for your claim.
  • Handling Denials: If your initial claim is denied, an LTD attorney can manage the appeals process, a critical stage where many claims are contested.  They know the procedural rules and best strategies for a successful appeal.
  • Litigation Support: If necessary, an LTD attorney can escalate the matter to court, preparing your case for litigation and representing you throughout the process.

Dealing with a serious condition such as SLE is stressful enough without the added burden of legal and administrative tasks.  Having an attorney handle the complexities of your LTD claim can provide peace of mind and allow you to focus on your health.

Client Case Study

"Amelia," a seasoned graphic designer for a large advertising agency, faced an increasingly challenging work environment due to her diagnosis of Systemic Lupus Erythematosus (“SLE”).  Known for her meticulous attention to detail and creative vision, the physical and cognitive demands of her profession became insurmountable as her condition worsened.  Despite her determination, Amelia found herself unable to meet deadlines and maintain the rigorous pace required by her role due to severe joint pain, overwhelming fatigue, and cognitive impairments.

While Amelia’s long term disability claim was initially approved, it was done so under a secondary mental health condition.  This meant her benefits would be restricted to a mere two years—a common limitation for claims primarily based on mental health diagnoses.  Realizing the need to address the misclassification of her disability, Amelia turned to Riemer Hess for support.  Our firm promptly took action.

Riemer Hess worked diligently to refocus the claim on Amelia’s SLE.  We coordinated with Amelia’s rheumatologist, who began to directly handle updates from the insurer, providing expert testimony on the severe impact of SLE on Amelia’s physical capabilities.  To solidify the claim, Riemer Hess arranged for Amelia to undergo a Functional Capacity Evaluation (“FCE”).  The FCE provided detailed, objective data on her physical limitations, clearly illustrating how her symptoms prevented her from performing her job effectively.

Furthermore, a vocational assessment was conducted, which thoroughly documented the specific demands of Amelia’s role as a graphic designer.  The assessment detailed the extensive physical and cognitive efforts required, such as prolonged computer use, which exacerbated her joint pain, and the need for sustained concentration, which was hindered by her cognitive symptoms.

With a robust compilation of medical and vocational evidence, Riemer Hess was able to present a compelling case to the insurer.  The comprehensive nature of the documentation left no doubt about the severity of Amelia’s SLE and its direct impact on her ability to work.  Convinced by the new evidence, the insurer revised their stance, acknowledging that Amelia’s disability was indeed primarily due to her SLE, thereby lifting the two-year limitation on her benefits.

Amelia, immensely relieved and grateful for the thorough and empathetic approach taken by Riemer Hess, decided to retain their services for ongoing management of her long term disability claim.  She felt reassured knowing that her case was in the hands of experienced attorneys who understood her condition and were committed to protecting her rights and livelihood.