Multiple sclerosis is a disease which can be slightly impairing, moderately impairing, or totally impairing. It is diagnosed with either a brain MRI that identifies lesions, or by a spinal tap. While one would assume total disability with this disease, insurers beg to differ and insureds may wind up fighting for their benefits.
As a disorder of the immune system, MS often manifests itself slowly in the form of fatigue. Insureds report not being able to work as many hours, or complain of being very tired in mid-afternoon. Frequently, insureds also report the inability to think clearly, the more fatigued they become. Those working in stressful jobs, or with a great deal of exposure to the public, often find themselves a victim to mental confusion and muscle fatigue in the afternoons.
Fatigue is a whole body inability to perform physical or mental tasks. However, insurance companies view “fatigue” as subjective, meaning it cannot be clearly defined, and is different from one person to the next. Insurers will tell you that there are many people who have MS but continue working, and while that may be true for some, it’s not for everyone. Those who file for disability after a MS diagnosis citing moderate to severe fatigue might have a challenge with the insurance company that may not consider fatigue impairing.
What is the diagnostic criteria for measuring “fatigue”? There isn’t one. Fatigue is usually diagnosed with clinical consultations with a physician. What is the diagnostic tool for measuring cognitive confusion, or in the inability to solve problems? At some point a neurologist may order a neuropsychology exam to determine the degree of cognitive deficit. And so will the insurance company if the insured claims cognition problems as a result of MS.
As indicated, depending on the specific kind of MS diagnosis, the disease begins by manifesting fatigue, and then over a period of time is progressive in accordance with the number and severity of exacerbations. Some patients can have MS for longer periods of time and not be affected, while for others with different types of MS, it is a short struggle. Insurance companies generally DO NOT have a problem paying for MS claims that have progressed to difficulty walking, imbalance, leg pain etc. However, in the early stages of the disease where fatigue and cognition problems are the only signs, insurers most often deny claims.
Supporting an early MS claim depends on the skill and thoroughness of the neurologist when filling out forms. It has always been my experience that neurologists are reluctant to be specific with their diagnosis, using words like “rule out….”, and particularly with their restrictions and limitations from work. It’s almost as though being “specialists” they don’t want to look like idiots should their patients suddenly get better.
I have always noticed that the problem insurance companies have with paying early MS claims is due to the lack of data provided by the treating neurologist. For some reason, these specialists just don’t to go on the record and say, “this patient is currently totally disabled from sustaining work.” Even when evaluating with a neuropsych test, neurologists drop the ball just short of certifying disability
I think it’s very important for insureds to speak candidly with their neurologist and make it clear they cannot work. I have always recommended taking a copy of your Job Description with you and pointing out exactly what you can and cannot do. But, please be aware that you may be in for a fight filing for disability when diagnosed with MS in its early stages.
If you are looking for assist you with your claim please feel free to contact me at: lindanee.dcs@gmail.com, or visit my website for more information.
http://www.disabilityclaimssolutions.com
