Disability Insurance Benefits for Neurodegenerative Diseases: Claimant’s Guide

Neurodegenerative diseases, such as Alzheimer’s, Parkinson’s, and multiple sclerosis, can severely impact an individual’s ability to work. Neurodegenerative diseases make up a significant percentage of disability claims. Understanding how to navigate the process of filing for disability insurance benefits is key for those affected and their families.

Types of Types of Neurodegenerative Diseases

The term “neurodegenerative diseases” or “neurodegenerative disorders” encompass a variety of different neurological conditions, including:

Dementia-causing Conditions

• Alzheimer’s disease:  A progressive condition that destroys memory and other important mental functions.
• Lewy body dementia:  Associated with abnormal protein deposits in the brain, leading to impaired thinking, movement, and mood.
• Frontotemporal dementia:  Affects personality, behavior, and language due to the degeneration of the brain’s frontal and temporal lobes.
• Chronic traumatic encephalopathy (CTE):  Caused by repeated head injuries, leading to cognitive decline and behavioral changes.

Demyelinating Disorders

• Multiple sclerosis (MS):  The immune system attacks the protective sheath (myelin) covering nerve fibers, causing communication problems between the brain and the rest of the body.

Parkinsonian Disorders

• Parkinson’s disease:  Affects movement, causing tremors, stiffness, and slowing of movement.
• Multiple system atrophy (MSA):  A rare condition that causes symptoms similar to Parkinson’s disease but progresses more rapidly and affects multiple body systems.

Motor Neuron Diseases

• Amyotrophic lateral sclerosis (ALS):  Also known as Lou Gehrig’s disease, it causes the death of neurons controlling voluntary muscles, leading to muscle weakness and atrophy.
• Progressive supranuclear palsy (PSP):  Affects movement, control of walking (gait), balance, speech, swallowing, vision, mood, and behavior.

Prion Diseases

• Creutzfeldt-Jakob disease (CJD):  A rare, degenerative, and fatal brain disorder caused by prions, leading to rapid mental deterioration.

Genetic Conditions

• Huntington’s disease:  An inherited condition that causes the progressive breakdown of nerve cells in the brain, affecting movement, cognition, and emotions.

For more detailed information on these conditions, visit the National Institute of Neurological Disorders and Stroke (NINDS).

Diagnosis & Symptoms Challenges: Treating With the Right Specialist

Since a diagnosis alone may not qualify someone for disability insurance benefits as of the date of diagnosis, individuals make disability claims for neurodegenerative diseases when the condition progresses to cause functional limitations that interfere with their ability to do their job or prevent them from working altogether.

In some instances, neurodegenerative diseases affect cognitive functioning; in others, they impair movement, while in others, they have a global impact on both physical and mental functioning.  Neurologists, as well as sub-specialists in neurology who focus on movement disorders such as Parkinson’s disease, demyelinating conditions such as multiple sclerosis, or motor-neuron diseases such as amyotrophic lateral sclerosis (ALS), primarily treat neurodegenerative conditions.

Filing a Disability Claim for a Neurodegenerative Disease

Receiving a diagnosis of a neurodegenerative disease while working immediately prompts thoughts about filing a claim for disability benefits.

Related Article:  What Are the Top Ten Mistakes Disability Insurance Claimants Make When Seeking Disability Benefits?

You need to address several concerns before submitting a claim:

Pre-Existing Conditions

The Affordable Care Act eliminated exclusions for pre-existing conditions in ACA-governed health plans, but disability insurance plans still maintain such exclusions.  If you were diagnosed shortly before starting a new job, be aware of potential exclusions.  However, seeing a doctor for generalized symptoms, even if later linked to a neurodegenerative disease, usually does not trigger a pre-existing condition exclusion.

In group disability plans, once you have worked for at least a year, any exclusion for a neurodegenerative disease diagnosed shortly before starting a new job generally becomes inapplicable.

In individual disability insurance, though, the failure to disclose a doctor visit on an insurance application that could be attributed to a neurodegenerative disease could be problematic.  This issue could arise for two years following the policy’s effective date and potentially longer if there was a deliberate attempt by the insurance company to conceal material information.

When to File a Disability Benefits Claim for Neurodegenerative Disease

Prospective disability claimants should discuss applying for disability benefits with their treating doctor before starting a claim to ensure they have their doctor’s support.  Some neurodegenerative conditions are relatively benign initially, making it premature to file a claim shortly after receiving a diagnosis.  However, claimants should not wait too long to file. Disability insurance policies all have strict provisions about when notice of claim is required.  In some jurisdictions, these provisions are strictly enforced.

Prospective claimants should also be mindful of their earnings. Claimants typically need to show at least a 20% decline in earnings to file a successful disability insurance claim.  A gradual decline in earnings over several years, but less than a 20% drop in any single year may postpone the start of disability benefits and significantly reduce the benefits when a claim is finally submitted.

Seeing the Right Specialist

If possible, claimants should see a sub-specialist who focuses on the specific type of neurodegenerative disease at issue before filing a claim.

What You Need to File a Claim for Disability Benefits

As noted above, every disability insurance benefits claim requires a certification by a treating doctor that their patient has functional limitations that preclude working at a specific job or from working in general.  Providing objective evidence to support the diagnosis of a neurodegenerative disease is critical.  Such evidence includes:

• Multiple Sclerosis –MRI findings revealing plaques characteristic of MS is usually required and patients sometimes also have cerebrospinal fluid testing as well.
• Parkinson’s Disease – a DaT scan has become the gold standard test for Parkinson’s disease
• Amyotrophic lateral sclerosis – ALS is typically diagnosed by electrodiagnostic testing
• Alzheimer’s disease – new biomarkers and other tests are emerging as tools to definitively diagnose Alzheimer’s disease
• Other conditions – there are tests for other conditions as well, but to assess cognitive impairment, neuropsychological testing is typically performed

What Obstacles Do Claimants Face in Seeking Disability Benefits

Unlike other conditions such as migraine headaches or fibromyalgia, for which there is usually not a specific objective test available, claimants seeking disability benefits for neurodegenerative diseases or neurodegenerative disorders usually have objective testing that confirms their diagnosis.  However, it bears emphasizing that a diagnosis alone is typically not enough to qualify for disability benefits, especially for neurodegenerative disorders that progress slowly.

Disability benefit claimants need to correlate their condition with their work duties and be able to show their disability insurer that their symptoms are interfering with their daily lives, their ability to work, or their ability to work and stay on task through the course of a workday or work week.  Keeping a log or diary of symptoms can be helpful, and patients should mention specific problems occurring at work at their doctors’ appointments.  Neurologists also often employ standardized measures of functionality such as the Kurtzke Expanded Disability Status Scale for monitoring the progress of multiple sclerosis or the Hoehn and Yahr Scale for Parkinson’s disease.  That data is extremely useful and may be decisive in getting a disability claim approved.

What Happens if a Disability Claim Is Denied

Disability benefit claims are complex, and appealing a claim denial is even more challenging.  Many people believe that they can appeal a disability insurance claim denial on their own and only seek legal assistance if the appeal is denied.  This approach is a huge mistake.  Claimants rarely understand their rights. Even if they are aware they have the right to request a copy of their claim file from the insurance company, they often fail to do so.  If they do request the file, they may not know how to read and understand the contents its content. Most claimants don’t know how they can overcome a denial and what steps to take next.

Denials often occur because the insurance company does not receive adequate documentation to support a disability claim.  Despite the ubiquity of electronic medical records, the insurance company may receive incomplete records if they do not specify exactly which records they need.  Another reason for denial could be the insurance company’s inadequate understanding of the claimant’s occupation.  You need to provide the missing documentation to the insurance company during the claim appeal.  Failure to do so may prevent a court from considering critical documentation if the appeal is unsuccessful.

This is why it is so critical to get legal support from a knowledgeable and experienced disability insurance attorney, especially one familiar with neurodegenerative diseases. Waiting until the insurance company denies the appeal may be too late.  An experienced attorney will immediately recognize what may be missing from the claim and know how to gather the necessary evidence to support it.  That attorney will also be well-positioned to succeed in court if the appeal is unsuccessful.

The attorneys at DeBofsky Law have the expertise and experience to help claimants with neurodegenerative diseases or conditions navigate through the disability claim process and assist claimants in getting the benefits they deserve.

Resources for Neurodegenerative Diseases Claimants and Their Families

For further information about neurodegenerative diseases, we suggest the following non-exhaustive list of resources:

1. National Institute of Neurological Disorders and Stroke (NINDS):
   Overview of various neurodegenerative diseases and research.
   • NINDS – neurodegenerative diseases
2. Alzheimer’s Association:
   Information on Alzheimer’s disease, care, and support.
   • Alzheimer’s Association
3. Parkinson’s Foundation:
   Comprehensive guides on Parkinson’s disease symptoms, causes, and treatments.
   • Parkinson’s Foundation
4. ALS Association:
   Resources and support for individuals with ALS.
   • ALS Association
5. National Multiple Sclerosis Society:
   Information and support for individuals with multiple sclerosis.
   • NMSS – https://www.nationalmssociety.org/