Did your insurance company deny your disability claim for epilepsy? An epilepsy disability insurance claim denial does not mark the end of your fight. Disability insurance companies often deny claims from first-time claimants. If your claim was denied, you can file an appeal to try to reverse the denial.
A disability attorney who has experience appealing epilepsy disability insurance claims denials can guide you through the appeals process to help you get approved for benefits.
What Is Epilepsy?
Epilepsy is one of the world’s most frequently diagnosed brain complications. People who have the condition frequently have sudden, recurrent seizures or convulsions. The Centers for Disease Control and Prevention (CDC) reports that around 3.4 million U.S. citizens have epilepsy.
Epilepsy can significantly limit the ability of the affected person to perform everyday activities or earn a living. Many jobs are inappropriate for even epileptic individuals who can manage their seizures or convulsions with medications or surgeries. You will need disability insurance benefits to pay for your medications and daily living expenses if you cannot return to work because of your epilepsy.
Is Epilepsy a Disabling Condition?
Insurance companies usually consider multiple factors before classifying epilepsy as a disabling condition. They consider the physical and cognitive symptoms of your epileptic condition, and they assess the severity and persistence of these symptoms. The insurance company will also consider how significantly your symptoms affect your ability to keep working in your current job.
An epilepsy diagnosis alone is not sufficient grounds for obtaining benefits through an epilepsy disability insurance claim. You must show how symptoms severely limit you from performing everyday activities, including work-related tasks.
Recurrent seizures or convulsions are primary symptoms of epilepsy. Symptoms vary from one individual to another. The most common symptoms include:
- Convulsions
- Temporary loss of consciousness
- Severe headaches
- Violent movement or flipping of limbs or entire body
- Recurring fainting spells accompanied by loss of bladder or bowel control
- Short blackout spells
Physical impairments should not be the only focus when building your epilepsy disability insurance claim. Be sure to include a detailed description of any cognitive symptoms and their impact on your ability to function.
Qualifying for Disability Insurance Benefits if You Have Epilepsy
You must provide sufficient evidence to show that your epileptic condition severely affects your ability to work to qualify for disability insurance benefits. Insurance companies are profit-making organizations. They strive to reduce the number of claims they pay to increase their profit margins. You must gather strong, compelling evidence to lower the chances of an epilepsy disability insurance claim denial.
Start by noting the specific ways in which your epilepsy impacts your job performance. Unpredictable, recurrent seizures, for instance, can make you an unreliable employee. For example, they can strike while pitching a business idea to potential investors on your employer’s behalf or occur in the middle of an in-person meeting with a new client.
Uncontrollable movements or flipping of limbs can keep you from completing your work-related tasks. For instance, these epilepsy effects sometimes cause trouble with activities such as handling tools, typing, or taking down minutes during meetings. You might also take time off from work due to severe headaches and fatigue caused by your epilepsy. The side effects of epilepsy management medications may also hurt your performance at work.
Workplace conditions might worsen your epilepsy. An exhausting job can cause stress, increasing the severity and frequency of your seizures. Lack of sufficient, restful sleep can also trigger seizure activity. An occupation involving many working hours with little rest could compromise your health and expose you to more epileptic seizures than usual.
You may also develop psychological problems, such as anxiety and depression, from your epilepsy. These issues can significantly impact your job performance. Be sure to document them in detail, as well.
Your insurance company may fail to accord your claim the seriousness it requires even after you have documented all your symptoms. The company may intentionally cause unnecessary claim process delays or use other bad faith insurance practices to deny you benefits. For this reason, you should work closely with a lawyer with an impressive record of handling insurance bad faith disputes. The lawyer can help you collect enough evidence to show you are entitled to epilepsy disability insurance benefits.
Did You Receive an Epilepsy Disability Insurance Claim Denial?
Insurance companies usually deny epilepsy disability insurance claims from many first-time applicants. They use numerous reasons to justify denial. Your insurance company, for instance, may argue that your epileptic condition is a pre-existing health problem.
The company may question the validity of your epilepsy disability by claiming your symptoms do not meet the requirements of a disabling condition. The insurer may claim that medications or surgical procedures can manage your epileptic condition.
An insurer may deny your epilepsy disability insurance claim if you have gone a whole month without experiencing a seizure. As such, the insurer may claim that your epilepsy does not interfere with your ability to work, and you should start working as soon as possible.
An insurer may also use the language of your policy to deny your claim. The insurer may argue that your epilepsy does not satisfy the requirements of a disabling condition as spelled out in your policy terms.
You still have legal options even after receiving an epilepsy disability insurance claim denial. Your insurer may deny your claim or deliberately delay processing your claim to frustrate you into abandoning your claim altogether. The fact is that you have the right to appeal a claim denial.
A disability attorney can review your original claim to determine if you have valid reasons for appealing. The attorney will guide you through every step of the appeal to avoid any errors that might jeopardize your claim. The attorney can then sharpen your claim to maximize the chances of getting the benefits approved.
How to Get Long-Term Disability Insurance for Epilepsy
Epilepsy can disrupt your everyday life and significantly limit your ability to perform your job functions. You need to file a long-term disability insurance claim if you have an epilepsy condition that prevents you from working. Take the following steps to increase your chances of getting your long-term disability insurance claim approved:
Review Your Original Disability Insurance Policy
Get a copy of the full version of your original disability insurance policy from your provider if you don’t have it already. Carefully go through the terms of the policy to determine how it describes a disabling condition. Gather the forms of evidence you need to prove your epilepsy qualifies as a disabling condition.
Obtain Evidence of Epilepsy Diagnosis
Evidence of epilepsy diagnosis is an essential part of getting your claim approved. Your doctors may perform a neurological exam to diagnose and identify the type of your epileptic condition. This test involves assessing your behavior, motor skills, and cognitive function.
Your doctor may also perform a blood test to diagnose your epilepsy. This test involves examining a blood sample for infectious agents, genetic conditions, or other health complications that might trigger seizures.
Electroencephalogram (EEG) is another test doctors frequently use to diagnose epilepsy. This test involves placing electrodes on your scalp to monitor your brain’s electrical activity. EEG can detect abnormal brain waves if you have epilepsy, even when you are not experiencing seizure activity. Your doctor may record any unusual brain waves you experience by observing you on video while performing an EEG.
Obtain Evidence of Additional Tests to Determine Your Type of Epilepsy
Additional testing may be necessary to determine the specific epileptic condition you have. It may also help rule out other seizure-causing conditions like cysts or tumors. You will need to provide your insurer with documentation of these additional tests. A correct diagnosis of the type and severity of your epilepsy can improve the odds of your long-term disability insurance claim getting approved. The following are the most common additional epilepsy tests:
High-Density EEG
Your doctor will perform this test to identify the parts of your brain significantly impacted by seizures. The doctor then analyzes the findings to determine the best treatment option for your epilepsy.
Computerized Tomography (CT) Scan
This test creates a cross-sectional view of your brain using X-rays. CT scans can show any abnormalities in your brain, including cysts, tumors, and bleeding. Any of those abnormalities could cause seizures.
Magnetic Resonance Imaging (MRI)
An MRI can help detect epilepsy caused by traumatic brain injuries. This test utilizes a strong magnetic field and radio waves to generate highly detailed images of your brain. A review of these images may show brain lesions or abnormalities that could be triggering your seizures.
Single-Photon Emission Computerized Tomography (SPECT)
Your doctor may opt for SPECT if MRI and EEG fail to detect the exact area of the brain affected by seizures. This test involves injecting a tiny amount of low-dose radioactive material into your vein. Your doctor then visualizes the blood flow in the affected areas of your brain during seizures.
A Supportive Medical Report from Your Treating Doctor
You stand a better chance of getting long-term disability insurance benefits if you provide a supportive medical report from your doctor. The report should describe your cognitive and physical symptoms. It should specify the frequency and severity of those symptoms. It should also highlight the specific limitations that impact your ability to do your job duties.
Obtain Evidence of Receiving the Right Treatment
Proof of obtaining the right treatment is instrumental in building a strong epilepsy disability insurance claim. So, ensure you attend all your doctor’s appointments, take the recommended medications, and follow instructions strictly. Your insurer will not have any valid reason to justify a claim denial if you receive the right treatment. Medical records can serve as evidence of obtaining the required treatment.
Keep A Written, Detailed Description of Your Symptoms
Besides your medical records, you should also submit a written, detailed description of your symptoms to strengthen your claim. Your description should outline all your symptoms. It should list your job duties. It should then explain the impact of each symptom on your ability to perform those duties.
Keeping a symptom diary is the best way to document your epilepsy. Your diary should include all your epilepsy episodes and the specific date and time when they happened. It should also include your other epilepsy symptoms, what triggers them, and how they impact you.
Symptom diaries are essential supportive forms of evidence. They can help prove that an accident or incident is the direct cause of an injury or illness. For instance, they can help establish a link between auto accidents and epilepsy.
Involve a Long-Term Disability Attorney
Getting a long-term disability attorney involved early in the process can maximize the chances of an epilepsy disability insurance claim approval. The attorney can review your medical records and doctor’s report to ensure they capture accurate information regarding your epilepsy disability. The attorney can also gather other forms of evidence, organize them properly, and file a strong claim.
A long-term disability attorney can help you navigate the confusing laws that affect your claim. The Employee Retirement Income Security Act (ERISA) law, for instance, will impact your claim if you are pursuing long-term disability benefits from your employer.
ERISA law bars you from introducing new evidence to support your claim after the administrative appeal. Your attorney will ensure you have provided enough evidence during the administrative appeal to avoid surprises down the road. The attorney will also ensure you have followed the correct steps for appealing an epilepsy disability insurance claim denial and met all the deadlines.
A long-term disability attorney can ensure your insurer is handling your claim fairly and as per your policy terms and applicable regulations. The attorney will collect evidence of non-compliance with your policy terms and initiate a bad faith insurance suit against your insurer if necessary.
