Multiple Sclerosis (MS) is a chronic medical condition that is characterized by brain fog, fatigue, muscle weakness, and many other debilitating symptoms that limit a person’s ability to function on a daily basis1. For many people living with MS, the hardest part can often be the uncertainty that follows. While symptoms can vary from person to person, these symptoms can often make sustained employment difficult. When that happens, employer-provided short- and long-term disability benefits plans may be necessary to maintain income while continuing treatment.
Understanding Multiple Sclerosis
Multiple sclerosis is an autoimmune disease that attacks the brain and spinal cord. The immune system mistakenly attacks the protective sheath around nerve fibers causing them to be exposed, which disrupts communication between the brain and body.1
Although symptoms vary depending on the person, they can include:
- Fatigue
- Muscle weakness
- Numbness or tingling
- Vision problems
- Cognitive impairment or “brain fog”
- Difficulty walking or maintaining balance
- Numbness or tingling
- Vertigo
1https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
- Mood changes2
One of the biggest challenges with MS is its unpredictability. A person may appear healthy one day and be unable to function the next. Symptoms can flare without warning, and many are invisible to others. This unpredictability can create major obstacles in the workplace.3
Many people with MS continue working for years after diagnosis. However, as symptoms progress, even routine tasks can become exhausting, and regular work attendance can become difficult due to frequent medical appointments, relapses, and fatigue. Eventually, many individuals may not be able to continue working and will need to apply for long-term disability (LTD) benefits.
Why Long-Term Disability Claims for MS Are Frequently Denied
Unfortunately, an MS diagnosis does not automatically get you approved for LTD benefits. When insurance companies look at claims they focus heavily on whether you can still perform the material duties of your occupation or any occupation, as determined by your policy. This creates problems because many MS symptoms are difficult to measure objectively and are rather based on your subjective experiences. Symptoms can also be difficult to prove if you are going through a remission period.
Insurance companies may argue:
- The medical records are “insufficient”
- The claimant can still perform sedentary or other work
- MRI findings do not match the reported limitations
- Symptoms are exaggerated
Insurers will also frequently rely on brief file reviews conducted by doctors who never examine the patient in person.
The Importance of Medical Documentation
2https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269; https://www.who.int/news-room/fact-sheets/detail/multiple-sclerosis; https://my.clevelandclinic.org/health/diseases/17248-multiple-sclerosis
3https://mncenterforms.com/understanding-the-hidden-challenges-of-multiple-sclerosis
Medical documentation is essential in an MS disability claim. Insurance companies frequently look for detailed explanations about how symptoms prevent full-time work, not simply confirmation of a diagnosis. Therefore, you should tell your doctor all your symptoms at each visit.
Helpful documentation often includes:
- MRI results: Magnetic resonance imaging (MRI) is useful for MS because it allows healthcare providers to identify and evaluate what is happening in the brain and spinal cord, and allows them to monitor and treat MS.4
- Neurological evaluations: Neurological exams allow your medical provider to measure your brain and nerve functioning and allows them to document your physical limitations.5
- Functional capacity evaluations: A functional capacity evaluation (FCE) is a comprehensive test that examines your physical abilities to determine whether you can resume work or if limitations need to be established.6
- Neuropsychological testing: Neuropsychological assessments evaluate your cognitive strengths and weaknesses across different cognitive domains. It can guide treatment decisions and help determine how cognitive deficits affect work performance. It is also useful for identifying and describing cognitive changes related to relapses or disease progression.7
- Treating physician statements: A letter or statement from your doctor that ties the clinical findings to your symptoms can be helpful to connect the dots between diagnosis and disability.
5https://my.clevelandclinic.org/health/diagnostics/22664-neurological-exam
- Consistent medical records: Continuing treatment as recommended by your providers is critical to ensuring that there are no gaps in the records that could cause your claim to be denied.
- Symptom journals documenting daily struggles: Keeping and maintaining detailed journals of your symptoms and flare ups may provide additional insight into the debilitation nature of your MS symptoms that are simply not captured by most doctors’ office visit notes.
Need Help with a Long-Term Disability Claim for MS
For individuals who are no longer able to work due to multiple sclerosis, LTD benefits can provide critical financial stability and help ensure continued access to necessary medical care and treatment. Whether you are preparing to file an LTD claim for MS or appealing a denied claim, understanding how these cases are evaluated can make a significant difference in the outcome. While the disability process can feel stressful and overwhelming, an attorney can help by guiding you through the process and helping you gather important evidence to support your claim. Please contact us today to learn how we can help.