If you were diagnosed with a gastrointestinal disease and can no longer earn your usual income, you should contact Capitan Law immediately. You might be entitled to benefits to replace part of your lost wages while treating your medical problem.
Gastrointestinal (GI) diseases, such as inflammatory bowel disease and colitis, typically qualify for long-term disability (LTD) benefits. These medical conditions can become chronic and, as a result, severely limit a person’s ability to work. GI diseases require constant, ready access to a bathroom and can be debilitating for a person who suffers from symptoms, such as pain, cramping, and fatigue.
At Capitan Law, our long-term disability insurance lawyers understand the challenges you face. It can be a struggle to make the same amount of money you earned before your diagnosis.
GI diseases often lead to debilitating symptoms that prevent a person from performing their job adequately. Our legal team will pursue your claim and work hard to help you recover the maximum benefits you deserve.
Call Capitan Law at (267) 419-7888 today for your free consultation to learn more about how we can help.
When LTD Benefits Become Necessary
If a worker is fortunate enough to qualify for intermittent Family Medical Leave Act (FMLA) job protection, that can often extend a worker’s ability to function in his or her occupation. However, once those job protections expire, or once an employer’s flexibility will no longer accommodate the severity of the worker’s symptoms, the disabled person is often forced to apply for short term disability and long term disability insurance benefits.
In most workplaces, every worker is expected to be able to attend and complete his or her work duties regularly in order to satisfy an employer’s productivity expectations. Frequent and unpredictable bathroom breaks combined with a myriad of related GI symptoms can derail a worker’s best efforts to continue performing the duties of their own, or any, occupation.
Gastrointestinal diseases are often challenged by LTD insurers because GI impairments tend to be episodic and unpredictable in nature. There can be short periods of time where a person returns to a normal medical baseline only to be faced with the onset of another unpredictable flare-up a few days later. Disability insurance companies and their non-examining peer review physicians will often focus on a person’s “good days” while purposefully ignoring the “bad days” when disputing a long term disability insurance claim.
Gastrointestinal Diseases that Qualify for Long Term Disability
According to the Americans with Disabilities Act, a disability is:
- A mental or physical impairment, causing significant limitations to a person’s major life activities;
- A perceived or actual physical or mental impairment, whether it limits or is perceived to limit a person’s major life activity; or
- A record of physical or mental impairment.
Gastrointestinal diseases fall under the definition of a disability. They interfere with normal digestion and other processes. There are two main types of GI diseases – structural and functional. Structural gastrointestinal diseases refer to bowels that look abnormal and don’t function correctly. Functional GI diseases involve a normal-looking GI tract that doesn’t function properly.
Symptoms of GI diseases depend on the type of condition but commonly include:
- Abdominal pain, cramps, or bloating
- Nausea and vomiting
- Trouble swallowing
- Unintentional weight loss
- Constipation or diarrhea
- Loss of appetite
- Fecal incontinence
Many GI diseases qualify for benefits through long-term disability insurance, including:
- Irritable bowel syndrome (IBS)
- Crohn’s disease
- Ulcerative colitis
- Bowel incontinence
- Inflammatory bowel disease (IBD)
- GI hemorrhaging, requiring a blood transfusion
- Short bowel syndrome
- Celiac disease
- Gastroesophageal reflux disease (GERD)
- Chronic and acute pancreatitis
- Peptic ulcer disease
- Lactose intolerance
If you notice any symptoms of a GI condition, do not hesitate to contact Capitan Law. We can review the information you provide and determine whether you’re entitled to LTD benefits.
Benefits Available for Gastrointestinal Diseases
If your GI symptoms prevent you from returning to your job or earning your usual income, you could apply for benefits through your employer’s long-term disability insurance or an individual plan, if you purchased one. Your GI disease must meet the policy’s definition of a disability to receive benefit payments.
LTD benefits can replace between 50 percent and 70 percent of a worker’s monthly wages. Your GI disease must be due to a non-work-related event. If the condition resulted from any factors associated with your job, you might not qualify for benefit payments.
LTD policies require claimants to go through an elimination period before receiving the first payment. Insurance companies differ, but most require a 90-day elimination period. That means you must wait 90 days from the date your disability began to collect benefits. Some insurance carriers only require a 30-day elimination period, while others might make you wait up to one year before providing LTD benefits.
Your policy will determine your maximum benefit period. Some insurance companies allow coverage for up to two years, while others provide benefits until a person turns 65 years old. If your disability prevents you from maintaining any type of employment and your policy permits, you could collect LTD payments for life. Coverage for your GI disease will end once you return to your job or earn the same amount of money you made before your diagnosis.
Common Reason for Denied LTD Claims
Even if you qualify for LTD benefits, the insurance company could deny your claim. You must follow strict deadlines and procedures to collect benefit payments. Any error made during the application process could result in a denial of your claim.
The most common reasons LTD insurers deny claims include:
- Definition of disability – Your gastrointestinal disease might not meet the insurance policy’s definition of a disability. If your condition isn’t on the list of eligible disabilities, the insurer will deny your claim.
- Incorrect or incomplete application – You must fill out the application accurately and completely. If you submit anything with missing information or inconsistent details, you could face a denial from the insurer.
- Unmet deadline – Strict deadlines are in place when you apply for LTD benefits. You must notify your employer of your GI disease within a specific timeframe defined in the policy. You could lose your right to LTD coverage if you miss the deadline.
- IME results – Many LTD insurers require claimants to attend an appointment for an independent medical examination (IME). This exam is with a doctor the insurance company chooses. The doctor will examine you to determine whether your condition qualifies as a disability. If the physician disagrees with your initial diagnosis, it’s unlikely you’ll receive benefits.
You should reach out to Capitan Law if you received a denial letter from the insurance company. We have experience appealing denied claims and filing lawsuits when necessary. You can count on us to aggressively pursue the benefits you need to compensate you for your loss of income.
Capitan Law believes in fighting for the rights of injured and sick workers. When your disability prevents you from earning a living, you deserve an opportunity to seek benefits. You should receive the long-term disability payments necessary to replace a portion of your lost income so you don’t struggle to afford your medical bills and other expenses.
You can count on our team of dedicated and skilled long-term disability lawyers to be your advocate during this challenging experience. A gastrointestinal disease can interfere with your daily routine and diminish your quality of life. We’re here to handle the entire claims process for you so you can focus on treatment.
If you were diagnosed with a gastrointestinal disease that prevents you from earning your regular wages, call Capitan Law at (267) 419-7888 right now. We will be happy to meet you for a free consultation to discuss the details and determine whether you are entitled to LTD benefits.