Cardiac disease is among the most prevalent conditions throughout the United States, but because a diagnosis does not always equal disability, it can be difficult to get your disability insurance benefits approved. From congenital defects of the heart people suffer their whole lives to coronary heart disease and heart attacks, there are so many different conditions and varying reactions to these conditions that most people don’t know if they will qualify for long term disability benefits.
In this video and the article below, disability attorneys Gregory Dell and Stephen Jessup explain what are some of the deciding factors to put you on the best path to get your disability insurance benefits approved (and keep the approved benefits from being denied) if you have a heart disease.
In this article:
What Is Required To Prove A Heart Disease Disability Claim?
First and foremost, the insurance company will look at your medical diagnosis and history: have you had heart attacks, stents, heart surgeries? The more severe the condition, the more credibility and weight it will carry for the insurance company to approve the claim. To overcome the requirement of proof to show that you are limited by your heart disease and can’t commit to the 8 hours a day, five days a week required of your job, you will need to show your medical history and what has currently changed making you unable to work.
This can sometimes be difficult, as your subjective claim may not be supported by objective evidence – there is usually no tangible measure of saying you have this specific heart disease, so you should be in this amount of pain or have this much of cognitive decline; all of this is very individual, and that is the area that the disability carriers tend to take advantage of.
It will also depend on the kind of work that you do. If it’s physically demanding, it is usually easier to prove disability than when someone has a sedentary type of work (computer programmers, office work, and so on). With physical work, if you cannot finish a stress test, that’s an indication of physical decline and the inability to have the endurance to be able to complete the work. Functional capacity evaluations can show how quickly the fatigue sets in, and extrapolated over a 40-hour work week, it’s obvious there’s no way this person could do the physical nature of their job.
However, if your work is sedentary, the disability is more difficult to prove, especially if you struggle with cognitive rather than physical decline. Neuropsychological testing that indicates there is a decline in the ability to concentrate, function, and handle cognitively demanding tasks in jobs can be helpful here.
Your medical condition and history, occupation, and the specific demands of your job are important when establishing context, and then you need to figure out what is the best testing and additional information to support your claim.
Is It Possible To Prove Stress Exacerbates Your Condition And May Lead To Disability?
In most heart disease cases, doctors advise to avoid stressful situations, and it’s indisputable that work can be stressful – let’s face it, not everybody loves their job, and work can often have a lot of stressful situations. There is a large body of scientific work proving that stressful environments will have a negative effect on a cardiac condition; when people get into stressful events or situations, they immediately have physical manifestations where they experience elevated heart rates, syncope episodes, and the like. Physical symptoms can develop, and there may be exacerbations of your cardiac condition. However, the disability carriers often say, look, that is what your job entails, and we don’t necessarily believe that you need to avoid those stressful situations in order to do your job.
This is a difficult situation, because you want to prove that stress worsens your physical condition rather than claiming mental health issues – this should be avoided, because insurance companies may try to pigeonhole you there. Most of the time, it’s a matter of potential testing, for example, the aforementioned neuropsychological tests or the functional capacity evaluation. The latter, especially, will elicit stress response from a physiological standpoint, and you can use that to show that if you can’t get through a test in a – realistically, not that strenuous, at the end of the day – for three hours without having physiological responses (increased heart rate, perspiration, lightheadedness) in a controlled environment, you’re not going to be able to manage this in a workplace setting.
There are also other things to consider: if you can do your job one day, does this mean you can do it every day of the week? Are you going to be able to work with a reasonable continuity and perform those job duties?
In addition to stress, there may also be issues like fatigue, side effects of medication, a recent heart attack, cognitive difficulties, and so on.
Because it’s hard to prove, it’s best to have a solid body of objective evidence: a detailed statement from your doctor and tests results showing clearly why you cannot do your job with this condition.
If I Have A Chronic Heart Condition, Will I Stay On The Claim Indefinitely?
Unfortunately, previously approved claims can be denied later. We have seen cases where claimants were on long-term disability for several years, but then, their claim was reviewed by some doctor who looked at just one indicator – for example, the ejection fraction rate – and, finding it has not changed, proclaimed that since the condition hasn’t gotten worse and is staying the same, you can go back to work.
Often, that creates absurd situations – for example, we handled a claim for an OB-GYN who was told to go back to work after eight years of being paid long term disability. He hasn’t done any practice in eight years, yet he was expected to go back to the OR and deliver babies. Shocking, isn’t it?
However, although most heart conditions, especially the chronic ones, do not get better over time – and if fact may worsen – a lot of insurance companies presume that if you’re not getting worse, you’re getting better, and you can go back to work. So the best thing that you as a claimant (who is on the claim) can do to avoid a denial is consult with an attorney and discuss the case. Think about what the long term perspective is, get a better idea of your policy, learn how your policy works, what the pitfalls may be for your specific insurance company. The next step is an evaluation of your medical records to make sure that you still have all your ducks in a row to be able to make a strong argument that you haven’t gotten to a point where you can go back to full-time employment, even if there is some level of improvement.
You always have to stay on top of your medical records, because your claim is only as good as the manner in which you look on paper. And frankly, if you don’t look messed up on paper, if you don’t have the objective evidence, if you don’t have the complaints in your medical records, then the disability carrier, at any time, may find a reason to deny that claim.
Unfortunately, the treating doctors treat the patient, not the chart, and doctors aren’t great at documenting everything in the records. So when the insurance company gets the medical records, they cherry pick out the information that they think supports the basis for a denial.
This is why you need to work closely with your doctors to make sure that everything is well-documented in your medical records, and that you’re getting the appropriate diagnostic testing and any other kinds of functional type testing that’s going to help support your claim.
If you need help with your claim, here at Dell Disability Lawyers, we’re happy to provide you with a free initial consultation. That involves reviewing your disability policy, or if you’ve been denied, reviewing a copy of your denial letter. We’re going to let you know immediately whether or not we can assist you. No matter where you live in the country, we’re available to help you, and we make it a very easy process just through you giving us a call or emailing us your information.
Lastly, be sure to take a look throughout our website. Search by your company, your occupation, or your medical condition: you’re going to find lots of summaries of lawsuits and cases throughout the country, reviews about your company, and lots of tips through articles and videos that we’ve done to help you with your claim, no matter what stage it’s at.
We look forward to the opportunity to speak with you in the future, and we’ll be here should you need us.