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Early-Onset Dementia & Long-Term Disability Insurance

The most recent statistics from the CDC estimate that around 5.8 million Americans are currently living with Alzheimer’s disease, the most common form of dementia. While the vast majority of these individuals are past retirement age, a significant number are younger than 65.

Early-onset dementia can be devastating for patients and their families. While some sufferers of the condition manage to maintain a relatively normal life, for others, it quickly rises to the level of disability, rendering them unable to carry out full- or part-time work.

For people in the latter position, long-term disability insurance often provides a critical financial lifeline.

What Is Early-Onset Dementia?

Dementia is an umbrella term referring to conditions that cause a decline in cognitive functioning over time. It’s much more common in older people, and its symptoms can get progressively worse as patients age.

Symptoms include:

  • Memory loss and confusion
  • Difficulties with basic communication
  • Trouble managing important day-to-day tasks, such as personal finance
  • Asking and repeating questions multiple times
  • Physical issues like loss of balance
  • Emotional instability
  • Erratic or impulsive behavior
  • Delusions and/or hallucinations

These symptoms will usually be relatively mild at first, but will progress to a point where they can be entirely disabling. The rate of this change varies from patient to patient, and there are steps you may be able to take to slow the progression of dementia after diagnosis.

What’s the Difference Between Alzheimer’s & Dementia?

Dementia is a term that refers to degenerative cognitive conditions as a group. Alzheimer’s disease is the most common of these conditions, affecting an estimated 60-70% of dementia patients worldwide. Alzheimer’s causes shrinkage in the brain along with the death of brain cells, a process that leads to a decline in cognitive functioning. Once Alzheimer’s disease reaches its most advanced stages, loss of brain function can cause lethal complications, such as malnutrition or dehydration.

Other forms of the condition include:

  • Vascular dementia
  • Lewy body dementia
  • Frontotemporal dementia

Early-Onset Dementia & Long-Term Disability Insurance

Individually purchased and employer-sponsored group long-term disability insurance policies usually only provide income replacement benefits until the age of retirement, which is 65 or 67 in most cases. So, for traditional cases of dementia in which symptoms only become apparent in later years, long-term disability insurance benefits may not be available. However, when Alzheimer’s or a similar condition emerges in younger patients, it may lead to a successful monthly disability insurance claim.

In order for this to happen, you’ll need to be able to show evidence of your disability and the functional limitations it imposes on you in terms of your occupational performance.

The first step in this process is to visit your physician for analysis, evaluation, and comprehensive treatment. Once they diagnose you with dementia and outline the challenges the condition will pose in terms of your working life, you’ll be in a position to file a disability insurance claim.

You should also be able to demonstrate the specific limitations the disease imposes on your profession. For example, if your occupation requires you to engage in a lot of in-depth conversation and your loss of cognitive ability has compromised your ability to do that, that will be relevant to your disability claim.

You may not be eligible for long-term disability insurance benefits from the day of your diagnosis. Different policies have different definitions of disability. If you have an “own occupation” policy, your insurance carrier will not regard you as qualifying for monthly benefits payments until your condition prevents you from carrying out the duties associated with the occupation you had at the onset of your disability with reasonable continuity.

If your policy has a less generous “any occupation” definition of disability, you will not be eligible for benefits until you’re unable to perform the duties of any occupation for which you are trained, educated, or suited. Most employer-sponsored group ERISA policies have “any occupation” disability definitions, though individually purchased plans can have these terms as well.

Depending on the provisions of your long-term disability insurance policy, you may be able to access partial benefits if you can carry out some, but not all, of the functions associated with your full- or part-time work.
Ultimately, in order to qualify for long-term disability insurance benefits, you will have to show:

  • That your physician has confirmed you have a disease or disorder like early-onset dementia, and you began an appropriate treatment protocol.
  • That your condition has advanced to a point at which you can no longer carry out the duties associated with your occupation.
  • That the elimination or waiting period your policy specifies has elapsed. These periods vary from one policy to the next; they are typically longer on employer-sponsored group plans, though that is not always the case.

Elimination periods for group or individual long-term disability insurance policies are generally no longer than 180 days.

Is Dementia a Mental Illness?

Most long-term disability insurance carriers impose limitations on benefits payments in relation to mental disabilities. The majority of group employer-sponsored ERISA policies will only pay monthly benefits for such conditions for a maximum of 24 months if the mental definition uses “caused by or contributed to” language.

Therefore, if you’re filing a claim in relation to early-onset dementia, you won’t want your insurer to treat your condition as a mental illness. Luckily, there are observable physical causes behind most of these conditions. For example, when neurological experts examine the brains of Alzheimer’s patients, they can show the decomposition and death of neurons, which are the nerves that allow for communication between the brain and other parts of the body. There are other physical changes in the brain as well to use to avoid mental/nervous limitations.

If your insurance carrier attempts to characterize your cognitive decline as a psychological condition and limit your monthly benefits, you need to take action. Consult with a disability insurance attorney to learn more about how to counter this strategy.

Life After an Early-Onset Dementia Diagnosis

Learning to live with a degenerative cognitive disability can be a hugely challenging process, particularly if the condition starts affecting you at a young age. Filing a claim for long-term disability insurance benefits after developing early-onset dementia can help you to ensure the condition doesn’t define your life.

To learn more about how DarrasLaw can help you with an initial claim, denial, or a claim appeal following a rejection from your insurer, contact us today. We can offer you a free initial policy and claim analysis.

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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