Diabetes is a growing health problem in America with over 26 million people suffering from the condition and another 79 million individuals suffering from pre-diabetes such as insulin resistance and Metabolic Syndrome. Only approximately 5 percent of diabetics suffer from Type 1 diabetes with the overwhelming majority suffering from Type 2 diabetes. While many of these individuals are able to work long and fulfilling careers, there are increasing numbers of people whose disease prevents them from continuing in their jobs and are forced to file claims for disability insurance benefits.
Insurance companies will often dispute and deny a disability claim based solely on a diabetic condition even if it’s shown that the condition was the root cause of the inability to work. It’s important to understand that technically, they may be correct. It’s not usually the diabetes that disables someone but one or more of the many complications that are caused by this disease. If you’re receiving regular care and treatment and are following the plan of your treating physician, being diabetic in and of itself is generally not disabling. If you find you’re unable to work and are filing a disability claim, you’ll want to document the nature and extent of the complications and the severity of their impacts on your work abilities.
- Cardiovascular disease. The most prevalent complication of diabetes is cardiovascular disease, which can directly result in many serious health issues. Individuals with diabetes are two times more likely to have a myocardial infarction (or heart attack) and five times more likely to have a stroke than non-diabetics. Diabetes can also damage capillaries, reducing blood flow to the extremities of your body. Having a heart attack, coronary bypass, stents, etc., do not guarantee that a long term disability claim will be accepted and approved. Coronary artery disease, including aneurysms, arrythmias, peripheral arterial disease, and other forms of ischemic heart disease, can be a medical basis for a disability claim to the extent that they specifically prevent the claimant from performing his or her job duties. The same holds true for peripheral vascular disease, including venostasis and atherosclerosis. Cardiovascular conditions often combine with the other complications listed below, creating a more challenging medical condition.
- Diabetic retinopathy. Retinopathy affects over 80% of those who have had diabetes for 10 years or more. It affects the formation of blood vessels in the eye and can potentially lead to spotting, blurred vision, and eventual blindness. This lack of vision prevents some people from performing their job duties. There is little early warning of retinopathy, and most diabetics experience this to some degree over the course of their lives.
- Diabetic nephropathy. The high levels of glucose in a diabetic’s blood along with other related medical conditions can result in damage to the kidneys. This damage leads to a wide spectrum of complications, from being medication and lifestyle controlled to end-stage renal disease, also known as chronic kidney disease, and kidney failure. Although nephropathy manifests almost no symptoms early in its onset, it can progress to cause edema, nausea, chronic fatigue, headaches, and excessive fluid accumulation. Nephropathy is chronic, in that there’s no permanent cure, but treatments can dramatically slow its progression. The general malaise caused by nephropathy often becomes intractable and overwhelming for many patients.
- Diabetic neuropathy. Neuropathy is the impact diabetes has on the nervous system, often causing numbness, tingling and pain in the feet, as well as increased risks of joint and skin damage. While neuropathy is often associated with feet, it can affect any peripheral nerves, causing unpredictable and intense pain and weakness, as well as all organ systems, specifically including gastrointestinal. Symptoms usually develop gradually over years, may be inconsistent, and can include incontinence, vision problems, burning pain, muscle weakness, and cognitive impairments.
As you can see, there are many complications from diabetes that can cause an inability to work. If you’re considering filing for benefits due to diabetes, refocus your thinking away from the broad, underlying condition and focus more specifically on the complication(s) that are preventing you from completing the duties of your job. It’s vital that your treating physician document the correlation between your diabetes and your disability by showing how diabetes caused these complications that prevent you from working. You can read more about this strategy here.
The other major issue with diabetes disability claims is the amount of claimants who smoke and/or are classified as obese. Some insurance policies contain a “self-inflicted injury” clause that limits or prevents benefit payments due to any injury or condition that was the direct fault of the claimant. If your policy includes a limitation on self-inflicted injuries, an overly aggressive claims person may try and assert that your smoking and/or obesity caused your health conditions and that those are self-inflicted. There are at least two ways to fight this claim defense.
The first is to question the insurance company’s reasoning. Injury and illness are two separate causes – and diabetes is an illness, not an injury. You can bring up this important distinction. You may also need to show any medical reason(s) for your obesity. Whether it be thyroid issues or an eating disorder, having documentation that provides the medical basis for your obesity prevents the disability insurance company from using a “self-inflicted” clause. You may also need to document the medical care and treatment you are receiving in the attempt to stop smoking. You can help your doctor by preparing these records and letters ahead of time. Almost all doctors are quite busy and have little problem reviewing these documents to see if they agree with the conclusions.
Dealing with diabetes is very difficult, and insurance companies don’t make the process any easier. Proving a disability due to this condition requires significant amounts of medical records and other evidence that can be challenging and time-consuming to obtain. Before you start submitting disability claim paperwork, make sure that all of your medical records and other documents present a thorough and complete basis for your claim. If you follow the prudent advice and show a clear trail from diagnosis to disability, you should have many fewer problems in getting the benefits you deserve.
If you have any questions about your diabetes and how you may qualify for disability insurance benefits, please call our offices toll-free at (855) 828-4100 or visit our website to sign up for a free consultation.
