Lupus | Receive Long-Term Disability Benefits for Lupus

What is Lupus?

Lupus, formally known as Systemic Lupus Erythematosus (SLE), is a chronic autoimmune disease that can affect multiple organs and tissues in the body. A person’s immune system attacks the person’s tissue and organs, causing inflammation and pain. Symptoms can be mild to completely life altering. Here is an overview of lupus:

Causes and Risk Factors:

The exact cause of lupus remains unknown. Doctors believe the cause is from a combination of genetic, environmental, and hormonal factors. Certain genetic variations predispose individuals to lupus, and environmental triggers such as infections, sunlight exposure, medications, and hormones can provoke the immune system to attack healthy tissues. Women are more likely to develop lupus than men, with onset typically occurring during childbearing years.

Symptoms:

Lupus can affect various systems in the body, leading to a wide range of symptoms. Common manifestations include:

• Fatigue
• Joint pain and swelling.
• Skin rashes, often triggered or worsened by sunlight (butterfly-shaped rash across the cheeks and nose).
• Fever.
• Chest pain, especially on deep breathing.
• Hair loss.
• Mouth or nose sores.
• Raynaud’s phenomenon (fingers turning white or blue in response to cold or stress).
• Photosensitivity.
• Cognitive dysfunction (called “brain fog”).

Symptoms can flare up and subside over time, with periods of remission alternating with periods of increased disease activity.

Diagnosis:

Diagnosing lupus can be challenging due to its varied and nonspecific symptoms. Healthcare providers typically rely on a combination of medical history, physical examination, blood tests (such as antinuclear antibody tests and anti-double-stranded DNA tests), and imaging studies to confirm the diagnosis. The American College of Rheumatology has established criteria for diagnosing lupus, requiring the presence of certain clinical and laboratory findings.

Treatment:

Treatment for lupus aims to control symptoms, prevent flares, and minimize organ damage. Medications common in the management of lupus include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and inflammation.
• Antimalarial drugs like hydroxychloroquine can help control symptoms and reduce the risk of flares.
• Corticosteroids to suppress inflammation during severe flares.
• Immunosuppressants to modulate the overactive immune response.
• Biologic therapies target specific components of the immune system.

Along with medication, lifestyle modifications such as sun protection, regular exercise, stress management, and a healthy diet can help improve overall well-being and reduce the frequency of flares.

Prognosis:

The prognosis for lupus varies widely among individuals. While some people experience mild symptoms and lead normal lives with proper management, others may develop severe complications affecting vital organs such as the kidneys, heart, lungs, or brain. Close monitoring by healthcare providers is essential to detect and manage any complications promptly.

Research and Outlook:

Ongoing research efforts focus on better understanding the underlying mechanisms of lupus, identifying new treatment targets, and developing more targeted and personalized therapies. Advances in genomics, immunology, and precision medicine hold promise for improving outcomes and quality of life for individuals living with lupus.

In summary, lupus is a complex autoimmune disease characterized by inflammation and tissue damage affecting multiple organs and systems. While there is no cure, early diagnosis, prompt treatment, and ongoing medical management can help individuals effectively control symptoms and maintain a good quality of life. Continued research is crucial for advancing our understanding of lupus and developing more effective treatments.

Why Do Insurers Question Long-Term Disability Claims for Lupus?

When individuals with lupus file for long-term disability (LTD) benefits through their insurance providers, it’s not uncommon for insurers to scrutinize these claims. This scrutiny often arises from several factors mainly because Lupus is not fully understood. Here’s an overview of why insurers question long-term disability claims for lupus:

1. Lack of Objective Diagnostic Tests: One of the primary challenges in assessing lupus is the lack of definitive diagnostic tests. Unlike conditions with clear biomarkers or imaging findings, lupus diagnosis relies heavily on clinical evaluation, medical history, and laboratory tests. Yet these tests may not always provide conclusive evidence, leading insurers to question the validity of claims. The subjective nature of symptoms and the variability of disease presentation further complicate the assessment process. It’s easy to see a compound fracture of a bone in an  X-Ray. Diagnosing Lupus is just not as simple.
2. Fluctuating Symptoms and Invisible Disabilities: Lupus is characterized by unpredictable flares and remissions, with symptoms varying in intensity and frequency over time. Many symptoms, such as fatigue, joint pain, and cognitive dysfunction, are subjective and not easily quantifiable. Additionally, some manifestations of lupus, such as internal organ involvement or cognitive impairments, may not be readily visible or detectable during routine medical examinations. Insurers may struggle to assess the severity and impact of these “invisible” disabilities, leading to skepticism about the need for long-term disability benefits.
3. Misunderstanding of Chronic Illnesses: Insurers may lack a comprehensive understanding of chronic autoimmune diseases like lupus and their profound effect on individuals’ daily functioning and quality of life. Lupus is not a static condition but a dynamic and fluctuating disease that can severely impair a person’s ability to work and engage in routine activities. Without proper education and awareness, insurers may underestimate the disabling effects of lupus and question the legitimacy of disability claims.
4. Stereotyping: Just because many people with Lupus can work, does not mean that some people with Lupus are unable to work. Symptoms impact individuals differently. Some insurance companies downplay symptoms, because it’s true that not everyone with Lupus is unable to hold a job.
5. Fixation About Malingering or Exaggeration: Most people are honest. There are always some people gaming the system and trying to get something they do not deserve. But one bad apple does not mean the entire bushel is bad. Insurance providers sometimes focus too much on fraudulent or exaggerated disability claims. Unfortunately, this skepticism may extend to individuals with legitimate disabilities, including those with lupus. Some insurers may harbor unfounded suspicions that claimants are malingering or exaggerating their symptoms to get disability benefits they should not get.  As a result, individuals with lupus may face increased scrutiny and requests for additional medical documentation to substantiate their claims.
6. Complex Treatment Regimens and Medication Side Effects: The management of lupus often involves a multifaceted approach, including medications, lifestyle modifications, and regular medical monitoring. But the side effects of medications used to treat lupus, such as corticosteroids and immunosuppressants, can be debilitating and may exacerbate existing symptoms or lead to other health complications. Insurers may question the necessity of long-term disability benefits if they perceive that claimants could continue working despite the adverse effects of treatment. Additionally, the financial burden of ongoing medical expenses may underscore the need for disability support.
7. Inadequate Medical Documentation and Communication: A long-term disability attorney can help you manage effective communication and documentation between your healthcare providers and disability insurer for substantiating disability claims and ensuring that you receive appropriate support. That said, gaps or inconsistencies in medical records, incomplete documentation of symptoms and functional limitations, or delays in obtaining necessary information can undermine the credibility of disability claims. Insurers may request additional medical evidence or independent medical evaluations to clarify uncertainties and verify the extent of disability.
8. Legal and Regulatory Factors: The adjudication of disability claims is governed by complex legal and regulatory frameworks, including insurance policies, industry standards, and disability laws. Insurers must adhere to strict criteria and procedural requirements when evaluating claims to minimize legal liability and ensure compliance with applicable regulations.

In conclusion, the questioning of long-term disability claims for lupus by insurers is often rooted in the inherent challenges and complexities associated with the disease. From the lack of objective diagnostic tests and fluctuating symptoms to misunderstandings about chronic illnesses and concerns about malingering, several factors contribute to insurers’ skepticism regarding lupus-related disability claims. Efforts to improve education, communication, and awareness among insurers, healthcare providers, and individuals with lupus are crucial for ensuring fair and equitable treatment of disability claims in this vulnerable population.

How to Seek a Medical Diagnosis and Treatment for Lupus?

Seeking medical diagnosis and treatment for lupus is crucial for effectively managing the condition and improving quality of life. Lupus, being a complex autoimmune disease with varied symptoms and manifestations, requires a multidisciplinary approach involving healthcare providers specializing in rheumatology, dermatology, nephrology, and other relevant fields. Here’s a summary overview:

1. Recognizing Symptoms and Risk Factors: The first step in seeking medical help for lupus is recognizing the signs and symptoms of the disease. Common symptoms include fatigue, joint pain and swelling, skin rashes (especially a butterfly-shaped rash across the cheeks and nose), fever, hair loss, mouth or nose sores, sensitivity to sunlight, and cognitive dysfunction. It’s essential to be aware of these symptoms, especially if you have risk factors for lupus, such as a family history of autoimmune diseases, female gender (lupus is more common in women), and certain environmental triggers like exposure to ultraviolet light.
2. Consulting a Healthcare Provider: If you experience persistent or concerning symptoms suggestive of lupus, schedule an appointment with a healthcare provider, preferably one with experience in diagnosing and treating autoimmune diseases. Rheumatologists are specialists who often lead the diagnosis and management of lupus, but depending on the specific symptoms, you may also need to consult dermatologists, nephrologists, neurologists, or other specialists.
3. Medical History and Physical Examination: During your initial visit, your healthcare provider will conduct a thorough medical history interview to gather information about your symptoms, medical history, family history, and any potential triggers or exacerbating factors. They will then perform a physical examination, monitoring skin rashes, joint tenderness or swelling, oral ulcers, and other signs suggestive of lupus or associated complications.
4. Laboratory Tests: Laboratory tests help diagnose lupus and assessing disease activity. Your healthcare provider may order many blood tests, including:

• Antinuclear antibody (ANA) test: This test detects the presence of autoantibodies commonly found in lupus and other autoimmune diseases.
• Anti-double-stranded DNA (anti-dsDNA) antibody test: Elevated levels of anti-dsDNA antibodies are linked to lupus and may indicate more severe disease activity.
• Complete blood count (CBC): Abnormalities in blood cell counts, such as anemia, leukopenia, or thrombocytopenia, can occur in lupus.
• Comprehensive metabolic panel (CMP): This test assesses kidney and liver function, electrolyte levels, and other metabolic parameters that lupus may affect.
• Urinalysis: Proteinuria or hematuria (protein or blood in the urine) may show kidney involvement, a common complication of lupus known as lupus nephritis.

5. Imaging Studies: In some cases, imaging studies such as X-rays, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) may be necessary to evaluate specific organ involvement or complications associated with lupus. For example, chest X-rays or CT scans can assess lung impact, while kidney ultrasound or biopsy may be needed to diagnose lupus nephritis.
6. Diagnosis and Treatment Plan: Based on the findings from medical history, physical examination, and diagnostic tests, your healthcare provider will make a diagnosis of lupus and develop a personalized treatment plan tailored to your individual needs and disease severity. Treatment goals typically focus on controlling symptoms, preventing flares, minimizing organ damage, and improving quality of life.
7. Medications: Medications common in the treatment of lupus include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and inflammation.
• Antimalarial drugs such as hydroxychloroquine to reduce disease activity and prevent flares.
• Corticosteroids (e.g., prednisone) to suppress inflammation during severe flares.
• Immunosuppressants (e.g., methotrexate, azathioprine) to modulate the immune response and reduce the risk of organ damage.
• Biologic therapies targeting specific components of the immune system, such as rituximab or belimumab, may be recommended for refractory or severe cases of lupus.

8. Lifestyle Modifications: Along with medication, lifestyle modifications can help manage lupus and improving overall well-being. These may include:

• Sun protection: Avoiding prolonged sunlight exposure and using sunscreen with a high sun protection factor (SPF) to prevent skin rashes and photosensitivity.
• Regular exercise: Engaging in low-impact physical activities such as walking, swimming, or yoga to improve joint mobility, muscle strength, and overall fitness.
• Stress management: Practicing relaxation techniques such as deep breathing, meditation, or mindfulness to reduce stress and anxiety, which can trigger lupus flares.
• Healthy diet: Following a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to support immune function, maintain a healthy weight, and reduce inflammation.

9. Ongoing Monitoring and Follow-up: Lupus is a chronic condition that requires regular monitoring and follow-up care to assess disease activity, treatment response, and potential complications. Your healthcare provider will schedule periodic follow-up appointments, blood tests, and imaging studies as needed to adjust your treatment plan and ensure optimal disease management.
10. Supportive Care and Resources: Living with lupus can be challenging, both physically and emotionally. Seek out support groups, educational resources, and advocacy organizations dedicated to lupus to connect with others who understand your experiences and access valuable information and support services. Additionally, consider involving family members, friends, or caregivers in your care team to provide practical assistance and emotional support as needed.

In summary, seeking medical diagnosis and treatment for lupus involves recognizing symptoms, consulting a healthcare provider, undergoing diagnostic tests, receiving a personalized treatment plan, implementing lifestyle modifications, and engaging in ongoing monitoring and support. By actively managing the condition and partnering with your healthcare team, you can effectively control symptoms, reduce flares, and improve your overall quality of life despite living with lupus.

Why Recording Symptoms for Lupus is Important for Receiving Long-term Disability Benefits.

Recording symptoms for lupus is not only important for managing the condition effectively but can also help support long-term disability (LTD) benefit claims. Here’s why:

1. Objective Documentation: Maintaining a detailed record of lupus symptoms provides objective documentation of your medical condition, including the frequency, severity, and duration of symptoms, as well as their impact on daily functioning and quality of life. This documentation serves as tangible evidence to support your claim for LTD benefits, demonstrating the nature and extent of your disability to insurance providers, healthcare professionals, and disability adjudicators. Keep written records. Use a notebook. Try a calendar. Use an app on your phone. The key is to record your symptoms often.When applying for disability benefits, insurance companies may require comprehensive medical documentation, including records of lupus symptoms, diagnostic tests, treatment history, and functional assessments. A well-documented symptom log serves as valuable evidence during disability evaluations and appeals, helping to rebut denials or challenges to your claim. By presenting thorough documentation of lupus symptoms and their impact on your ability to work, you can strengthen your case and increase the likelihood of receiving the LTD benefits to which you are entitled.
2. Establishing Disability Severity: Lupus is a chronic autoimmune disease characterized by unpredictable flares and remissions, which can significantly impair your ability to work and perform essential activities of daily living. By recording symptoms consistently over time, you can establish the severity and variability of your disability, illustrating how lupus symptoms limit your functional capacity, productivity, and ability to sustain gainful employment. This information strengthens your case for receiving LTD benefits by substantiating the disabling effects of lupus on your ability to work.
3. Monitoring Disease Progression: Lupus is a progressive disease that can cause cumulative damage to multiple organs and systems over time. Regularly tracking symptoms allows you to monitor disease progression, identify emerging complications or comorbidities, and assess the effectiveness of treatment interventions. Documenting changes in symptoms, functional limitations, and treatment responses provides a comprehensive picture of your health status and helps healthcare providers and disability evaluators understand the long-term implications of lupus on your ability to work and engage in daily activities.
4. Facilitating Communication with Healthcare Providers: Maintaining a symptom log fosters effective communication with healthcare providers by providing them with detailed, accurate information about your symptoms, treatment history, and disease trajectory. This enables healthcare providers to make informed clinical decisions, adjust treatment strategies, and provide supportive documentation or medical opinions to substantiate your disability claim. Collaborating with healthcare providers to document lupus symptoms strengthens the credibility of your LTD claim and enhances the likelihood of a favorable outcome.
5. Demonstrating Compliance with Treatment: Insurance providers may require evidence of ongoing medical treatment and compliance with prescribed therapies as part of the LTD application process. Recording lupus symptoms and treatment adherence proves your commitment to managing the condition and maximizing functional abilities despite the challenges posed by lupus. This documentation reinforces your credibility as a conscientious claimant and reinforces the necessity of ongoing disability support to mitigate the effect of lupus on your daily life and livelihood.

In summary, recording symptoms for lupus is crucial for receiving long-term disability benefits as it provides objective documentation of disability severity, monitors disease progression, facilitates communication with healthcare providers, supports disability evaluations and appeals, and demonstrates compliance with treatment. By maintaining detailed records of lupus symptoms, you have some of the proof and documentation you need to secure the disability benefits needed to maintain financial stability and access essential healthcare services.

How Jonathan M. Feigenbaum, Long-Term Disability Attorney Will Help You Receive Long-Term Disability Benefits for Lupus.

Navigating the process of applying for long-term disability (LTD) benefits for lupus can be complex and challenging, especially when faced with denials, appeals, or disputes with insurance providers. As an experienced attorney specializing in disability law, I  can significantly improve your chances of successfully obtaining the benefits you deserve. Here’s how we can help you receive long-term disability benefits for lupus:

1. Evaluation of Eligibility: A disability attorney can assess your eligibility for LTD benefits by reviewing your medical records, employment history, insurance policy, and relevant documentation. They can determine whether your lupus symptoms and functional limitations meet the criteria for disability under your insurance policy or applicable disability laws.
2. Guidance in the Application Process: Applying for LTD benefits requires completing extensive paperwork, gathering supporting medical evidence, and adhering to strict deadlines and procedural requirements. An attorney can guide you through the application process, ensuring that all necessary forms are completed accurately and submitted on time. We can also help you compile comprehensive medical documentation, obtain supportive statements from healthcare providers, and address any potential gaps or deficiencies in your claim.

3. Representation in Appeals: If your initial disability claim is denied, we can represent you in the appeals process and prepare and submit appeals on your behalf and handle negotiations with insurance companies.
4. Representation in litigation: Make sure you retain an attorney who has a history of successfully litigating disability claims in court. This includes ERISA and individual disability insurance claims. Ask the attorney to show you a history of litigating cases. We have a great deal of experience in both.
5. Providing Support and Advocacy: Throughout the disability claims process, we provide you with support, guidance, and advocacy. We can answer your questions, address your concerns, and advocate for your best interests to ensure that you receive the benefits you deserve.
6. Providing Peace of Mind: Dealing with the complexities of the disability claims process can be overwhelming and stressful, particularly when coping with the challenges of living with life altering diseases or injuries. By enlisting help from a knowledgeable and compassionate attorney, you can gain peace of mind knowing that your case is in capable hands. We can provide guidance, support, and reassurance throughout the process, alleviating the burden on you and allowing you to focus on your health and well-being.

In summary, as an attorney specializing in long-term disability law Jonathan M. Feigenbaum can be a valuable ally in helping you receive long-term disability benefits for lupus. From evaluating eligibility and guiding you through the application process to advocating for your rights, representing you in appeals, and litigation, and maximizing benefits, we will provide assistance every step of the way. We will help you navigate the complexities of the disability claims process with confidence and improve your chances of securing the financial support you need to cope with the challenges of living with lupus.

Contact a Long-Term Disability Denied Claims Lawyer

Getting it right the first time is always best and can get you your much-needed benefits faster. Contact our skilled Denied claims lawyerJonathan M. Feigenbaum, Esquire, at 617-357-9700 today!