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Tips for filing a long-term disability insurance claim for migraines

Tips for filing a long-term disability insurance claim for migraines

Migraine headaches can be a real problem for many Americans, and these painful headaches can become so unbearable that sufferers are unable to reliably work. Despite their incapacitating limitations, headache disability claims are often fraught with claim hurdles.

Here are some facts and tips to consider before filing an individual or group long-term disability insurance claim for migraines.

What is a migraine?

More than 37 million Americans suffer from migraines, which are neurologically based headaches that range from mild to severely debilitating. The causes of a migraine can also vary widely from person to person. However, common migraine triggers can include hormonal fluctuations, high stress, poor sleep, certain foods and/or smells, alcohol, and environmental stimuli like weather or bright lights.

According to some studies, approximately 13 percent of American adults have migraines, and 2-3 million of them have chronic migraines. Migraines most often occur in people between the ages of 35 and 55 and affect women more frequently than men

Common symptoms

While migraine symptoms can present differently in each case and in each person, a mixture of the following are most common:

  • Throbbing, pulsing pain
  • Light sensitivity
  • Sound sensitivity
  • Nausea
  • Vision changes, such as blurred vision
  • Vomiting
  • Aura, or a visual disturbance in the form of flashing or shimmering lights, zigzagging lines, stars or blind spots

These symptoms can last anywhere from 4 to 72 hours and longer in some cases.

Migraine treatment troubles

Although there are migraine medications available, they are not always effective, and can have severe side effects.

For example, triptans – the class of drugs most commonly prescribed for recurring headaches – can cause nausea, dizziness, drowsiness, difficulty thinking, and fatigue.

Some people may be left choosing between the debilitating symptoms of their migraine or from the medication that is supposed to treat it.

Other migraine-related conditions

Migraines may create other unexpected health problems, all of which can contribute to their disability. According to the American Migraine Foundation, those who experience migraines are more likely to have depression, anxiety, sleep disorders, other pain conditions and fatigue.

People with a history of experiencing aura have also been shown to be at an increased risk for stroke and heart attack.

Migraines as a disability

The World Health Organization has named migraines among the 10 most disabling medical illnesses on the planet and chronic migraines have even more severe impact.

The more severe symptoms of recurring migraines can make it challenging to reliably function on a daily basis. Many sufferers may find themselves unable to do more than rest in a dark room for hours or days at a time.

Migraine symptoms can make it difficult or even impossible to continue working in almost any occupation, particularly if you experience limitations with focus, sustained attention, communicating with others, understanding instructions, lifting, standing and walking.

While migraines can be disabling, the variation in symptoms and the subjective nature of the pain they cause, make it challenging to collect your disability benefits.

Beware of the “self-reported condition” limitation

Group disability insurance policies are riddled with limitations, including one related to “self-reported” conditions like migraines. As the term implies, self-report refers to the insured saying that they have a headache and now must try to prove it with objective testing.

Policyholders should pay special attention to this self-reported condition limitation, which restricts payment of benefits for certain “subjective” physical disabilities that are not supported by objective medical testing.

Rather than denying the existence of these conditions, many insurers have decided to acknowledge that policyholders may be diagnosed with these disabilities, but will cut off benefits after a brief amount of time.

Carriers argue that migraines rely on subjective reporting of symptoms, so they fall under this limitation, which may limit payment of benefits to anywhere from 9 to 24 months.

Tips for filing a disability claim

Chronic migraines are not easily diagnosed, causing many disability claimants to be denied benefits because they cannot provide evidence that migraines limit their ability to work.

Record everything in a detailed migraine journal.

Migraine pain may be subjective, but keeping a daily headache journal to record your history of migraines can strengthen your claim for benefits.

Document all of your symptoms thoroughly and truthfully, including frequency, severity, intensity, treatment and the level of impairment you experience. Make sure your detailed entries include dates and times. If you had to go to the hospital, get injections, or change medications, or suffered from side effects, documentation is key in presenting your claim.

A detailed record of your symptoms may support the information in your medical records and fill in any alleged subjective reporting gaps.

If your treating physician includes a review of your entries in their patient chart, your journal may be considered as some evidence. Since insurance companies often seek objective evidence of your diagnosis, this may be crucial to strengthening your disability claim.

Be sure to document the side effects of your preventative and abortive medications, which are objective evidence of your disability.

Listen to your treating physician.

It is imperative that your treating physician supports your claim for benefits subjectively and objectively, and that you listen to your doctor’s instructions.

If you were prescribed medication to prevent migraines or were given directions for managing your symptoms or aborting your migraines, be compliant.

If there is a valid reason you cannot follow your doctor’s orders, make sure to communicate these concerns with them. Your medical records should reflect that you are working with your doctor to manage your migraines as best as you can.

Gather supporting documentation.

The more written evidence you provide in support of your disability claim, the better. Seek further documentation such as witness statements (before the disability and after), letters, and a functional capacity evaluation and attending physician statements from your doctors.

You should also make sure your medical records are complete. They should include:

  • Physicians’ notes about the frequency, intensity and severity of your migraines
  • Results of any tests to rule out other conditions
  • The medications and other treatments you tried, as well as their outcomes and side effects
  • Records of any ER visits or hospitalizations related to your migraines

Make sure you have clear documentation of how many hours and days of work you missed because of your migraines.

Seek an experienced, national disability litigator or ERISA counsel.

A seasoned disability attorney experienced in handling migraine-related cases can help you gather the necessary documentation and file a properly completed claim, strengthen any subsequent appeals and/or file a lawsuit if your claim is wrongfully delayed or denied. Learn more about why legal advice is essential to successfully completing your disability claim forms.

Do you have individual or group disability claim questions?

If you have filed or are preparing to file an individual or long-term disability insurance claim for your migraines – or if your benefits have been wrongfully delayed or denied – contact DarrasLaw’s top-rated insurance attorneys and long-term disability lawyers for a free consultation.

If you have individual or long-term disability insurance questions, our legal team is here to help, no matter where you live.

By: Lauren Creiman

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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