Successfully Navigating ERISA Claims For Chronic Conditions & Invisible Illnesses

In this article, you can discover…

• Common chronic disorders covered by ERISA
• How to effectively document your invisible illnesses for ERISA.
• How an ERISA attorney can help you overcome filing challenges.

Can I File An ERISA Disability Claim If I Have A Chronic Illness Or Autoimmune Disorder?

Absolutely. Regardless of the nature of the medical condition, if it prevents you from being able to perform the duty of your occupation or your job, you can file an Employee Retirement Income Security Act (ERISA) disability claim with your employer.

What counts as a chronic illness? Frequently seen chronic illnesses include… 

• Rheumatoid arthritis
• Sjögren’s syndrome
• Lupus
• Multiple sclerosis
• Chronic pain
• Degenerative gist disease, and 
• Fibromyalgia

What Are The Challenges Of Filing A Mental Nervous Claim or Chronic Conditions And Invisible Illnesses Claim?

The biggest challenge you may face is the fact that there is no objective evidence of the impairment. Rather, your physician relies on your subjective report or their clinical exam to make the diagnosis. 

For example, with fibromyalgia, there are no X-rays or blood tests that can prove you have this condition. Likewise, one of the newest conditions our clients are dealing with is long COVID. There’s no blood test to prove that you have long COVID and the condition won’t show up on X-rays, either.

Your physician must rely on your symptoms, clinical exam findings and your history in order to make those diagnoses. That can be challenging for the insurance company as they tend to look for objective proof of the condition and how it affects you.

What Role Does Medical Evidence Play In ERISA Claims For Chronic Conditions Like These And Invisible Illnesses?

Your medical record is key. Without medical evidence of your impairment, you can’t establish your claim or provide proof of your ongoing disability. Be sure you see the doctor and report your symptoms in detail. Your doctor can then determine whether or not those symptoms are consistent with certain illnesses or conditions. 

While it can sometimes be a process of elimination, you must have medical documentation in order to support your claim.

Attorney Claudeth Henry is a caring, skilled attorney serving Florida. For over 25 years, she’s helped clients just like you document chronic and invisible injuries and petition for the ERISA benefits they’re entitled to.

Unsure how to document a chronic or invisible illness? In need of guidance after a claim denial?
Reach out to the CJ Henry Law Firm at (352) 577-7746 for a free initial consultation today!

How Can I Effectively Document My Chronic Condition Or Invisible Illness For An ERISA Claim?

Keep a log of your symptoms and the triggers. For example, if you suffer from migraine, keep a migraine log. There are a variety of smartphone apps and websites that can help you document your condition.

You may also want to keep a pain journal, documenting where and how intensely you experience pain on a day-to-day basis. You then share those documents with your physician at each visit and ask them to make them a part of your medical record. This officially records the chronic or invisible illness and becomes evidence that you can submit with your claim.

Keeping these journals helps immensely. It allows you to document day by day, as recalling these incidents days, weeks, or months later can be impossible. It also gives insurance companies documented evidence of your condition, making them less likely to reject a claim.

How Can I Digitally Record My Symptoms?

If you don’t like the idea of carrying around a paper journal, there are various apps that can be downloaded on an Apple or Android phone to document symptoms. The notes app on your phone can be used in a similar way, or you could use a microphone and digital audio app to speak and record your symptoms if you’d rather not type. 

What Should I Do If My ERISA Claim For Chronic Illness Or Autoimmune Disorder Is Denied?

Immediately get a copy of your employer’s disability insurance policy, get a copy of your claim file, and reach out to an ERISA lawyer for a consultation. 

Do this all before you attempt an appeal, as it’s crucial to have an attorney’s help in gathering and presenting evidence during the appeal process. 

How Can An ERISA Attorney Help Me Reduce Risk When Filing?

A knowledgeable ERISA attorney can assist you with documenting your impairment. They can also recommend appropriate testing to establish how the impairment impacts your function. An ERISA attorney can also review your medical record and conduct medical research as needed for the presentation of your claim or your appeal to the insurance company.

How Do You Approach Chronic And Invisible Illness Claims?

The first step I take during an initial filing is to get a copy of your employer’s insurance policy. I then request your medical records, making sure these records document all previous and current conditions, not just the one you’re identifying as a disability. 

I like to go back six months to one year prior to the disability onset to determine if it’s a chronic condition and to get a sense of its progression. 

If corrections need to be made to your medical records, I’ll get in touch with your physician and request those changes be made. If the policy requires certain medical tests to be run, we’ll be sure to recommend that our client have them done. This helps reduce delays and ensures the insurance company has everything that they need to make a fair judgment.

If we’re appealing a denial, I obtain the claim, your medical reports, and the insurance company’s evaluation reports. I review and analyze every aspect of these documents to see what we need to do to counteract their claims. 

This could involve hiring an expert to provide an opinion or running more tests to help verify your condition. I also do my own medical research on the condition if needed, write up the appeal and submit all records and research to the carrier. 

For more information on ERISA Claims For Chronic Conditions & Invisible Illnesses, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (352) 577-7746 today.