Lupus and ERISA Long Term Disability Benefits


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Lupus is a chronic inflammatory disease where your body’s own immune system attacks your tissues and organs. Your immune system is supposed to attack viruses and bad bacteria. But when you have lupus, it can’t tell the difference between the good tissues and bad viruses and bacteria. So it just attacks everything. Your joints, skin, kidneys, brain, lungs, and heart.

Some are born with a propensity to develop lupus, which can be triggered by infections, drugs, etc. There is no cure, just treatment.

Long Term Disability Caused By Lupus

In order to qualify for LTD benefits, you have to prove you can no longer work. First you have to prove you can’t perform the duties of your existing job. And mostly likely, after 24 months, you have to prove you can’t perform the duties of any occupation.

Those suffering from lupus suffer from:

  • Fatigue
  • Fever
  • Pain, stiffness and swelling in their joints
  • Photosensitivity (skin lesions that show up or worsen with sun)
  • Shortness of breath
  • Chest pain
  • Headaches, confusion and memory loss
  • Raynaud’s syndrome (cold and numb body parts when exposed to cold)
  • And many other symptoms.

Lupus Flareups Fluctuate

The fluctuating nature of lupus makes it more difficult to apply for LTD benefits. Your symptoms and signs may be mild when a doctor exams you, or you undergo a Functional Capacity Exam. This may cause the insurance company to argue you can work part of the time, so you are not totally disabled.

Therefore it is imperative you treat with well qualified doctors who can effectively summarize your condition and disability in the medical records.

Filing for Long Term Disability Benefits When You Have Lupus

The most important part of filing for a LTD claim for lupus, is the medical evidence to support your claim. Successful claims usually contain medical documentation showing that one or more major organs or body systems is affected to a significant level by lupus.

Other evidence will show repeated flareups of lupus with major symptoms like severe fatigue, fever, malaise, etc. Records showing limitations in your daily activities.

You need all of these records for a successful LTD claim. Even if you have all the supporting documentation, you still face an uphill battle against the disability insurance companies. If there is just a shred of evidence that doesn’t go your way, your insurance carrier will hang onto that thread and deny your claim. That’s when the appeal process kicks in and the clock starts ticking.

Appealing LTD Claims Denial or Termination For Lupus

Once your application for benefits is denied, or your existing benefits are terminated, the clock starts ticking. Once you receive the denial/termination letter, you only have a certain amount of days from then to file an appeal. This is important because:

  • If you don’t file the appeal in time, you may lose your rights forever. The usual deadline is 180 days but it can vary.
  • Your appeal is your last chance to introduce evidence.

If your appeal is denied, you can file a lawsuit in federal court. You must file an appeal first. And whatever you include in that appeal will be allowed as evidence in your case, but that’s it. You cannot introduce any more evidence after the appeal. So you need to ensure your appeal is as thorough as possible.\

Lupus Long Term Disability Claims Attorney

If you need to apply for benefits because of a lupus disability, we want to assist you. We will gather the proper documentation, send you to the right doctors if needed, file your appeal, and if necessary, litigate your case in court. Contact us today to schedule your free consultation and denial letter review.