The Social Security Administration (SSA) defines visual disorders as “abnormalities of the eye, the optic nerve, the optic tracts, or the brain that may cause a loss of visual acuity or visual fields.” Visual impairment can mean blindness, but it can also mean the loss of the ability to distinguish details, read, perceive visual stimuli, and loss of peripheral vision. Healthcare professionals determine blindness by measuring your ability to see through your best eye. If you have 20/20 vision in one eye and total blindness in another, you probably don’t officially qualify for federal long-term disability benefits. Your best eye, using corrective lenses, has to be 20/200 or less to be considered blind.
We often think of blindness or visual impairment as the quintessential disability. However, it’s not that simple. Some visually impaired individuals can live and work in the same capacity as those with perfect vision.
Whether you can reliably perform the important duties of your occupation with reasonable continuity and in the usual and customary way is the measure of whether you qualify for individual or group long-term disability benefits. Sudden visual impairment and/or blindness may qualify you for private individual or group long-term disability benefits, but a preexisting impairment might not. To make the matter more confusing, individual and employer-sponsored long-term disability insurance may deny disability payments and award benefits for federal Social Security Disability Insurance (SSDI).
America’s top-rated long-term individual disability attorneys and award-winning group ERISA lawyers at DarrasLaw know how complicated the disability claims process can be—especially with group ERISA claims. A sudden loss in vision may leave you completely unable to perform the important duties of your occupation, but your individual or group long-term disability insurer may disagree.
At DarrasLaw, our award winning long-term individual disability lawyers and seasoned group ERISA attorneys can analyze the facts of your case in combination with your disability policy, free of charge. We can help you claim all of the benefits to which your individual or group long-term disability policy entitles you after our completely free claim consultation. Call us at (800) 458-4577 or contact us online to schedule your free disability claims review.
Understanding Individual and Group Long-Term Disability Benefits for Visual Impairment
Individual and group long-term disability insurance provides income-replacement benefits if you can’t work due to a disabling illness or injury. Your condition must limit and restrict your ability to perform the important duties of your occupation to qualify for individual or group long-term disability benefits.
Seeing is an essential function for most occupations, so it’s difficult to understand how blindness doesn’t automatically qualify you for individual or group long-term disability benefits. Total blindness may, especially if its onset is sudden or the result of a traumatic injury. You will have to learn to read and function without sight, which can take years. However, partial blindness may not qualify you for individual or group long-term disability benefits. Losing vision in one eye may mean you can’t drive, but it doesn’t mean you can’t perform the material and substantial duties of your occupation, unless driving is essential to your occupation. Unfortunately, if it’s not, then has your ability to work really changed?
Your Long-Term Disability Insurer is NOT on Your Side
Private, for-profit disability corporations often provide individual and group long-term disability benefits. They are designed to replace a certain percentage of your income, but only that percentage. Most individual or group long-term disability insurers actually reduce your benefits if you have other income. This includes federal SSDI benefits, which you may qualify for if you’re legally blind. Group disability offsets can include what you are eligible to receive or what you received from:
- Personal injury settlements, third-party settlements, or judgments
- Wrongful termination settlements
- Workers’ compensation benefits
- SSDI for your dependents under age 19
- Other group disability coverage
- A. benefits or pensions
- State disability benefits
The visually impaired, especially those impaired later in life, often qualify for multiple forms of disability benefits. For example, assume you sustained a severe traumatic brain injury in a car accident that causes visual impairment. This injury may qualify you for federal Social Security disability benefits if you meet the statutory definition of blindness. It may also prevent you from working, qualifying you for employer-sponsored group long-term disability benefits. Finally, you may recover a personal injury or auto-insurance settlement from the accident, and you might have individual disability insurance to collect on as well.
If you made $5,000 per month before the accident and you’re entitled to 60 percent of your income through your employer-sponsored plan, you’ll receive $3,000 per month in basic group long-term disability benefits. If you’re granted federal SSDI benefits thereafter in the amount of $1,500 per month, your insurer may reduce your group benefits to $1,500. Your group long-term disability insurer may also reduce your benefits even further if you win a lost income settlement through a personal injury lawsuit if your group coverage offsets for third party settlements.
Most group long-term disability insurers will require visually impaired claimants to apply for SSDI in an attempt to force an offset.
Common Causes of Blindness and Severe Visual Impairment
Your eligibility for individual or group long-term disability benefits depends on the nature of your visual impairment. The following injuries and illnesses commonly cause total or partial blindness:
- Macular degeneration: Age-related macular degeneration (AMD) is the most common cause of visual impairment in the United States. The macula is the central portion of your retina, located directly in front of your optic nerve. Wet AMD occurs when blood vessels grow under the retina. When these blood vessels break, they leak, causing the macula to bulge, completely distorting your central vision. When small deposits under the macular form with time, causing the macula to thin and dry, the result is dry AMD. These deposits cause vision loss and impairment.
- Glaucoma: Glaucoma causes fluid to build up in the front part of your eye. This fluid puts pressure on your optic nerve, causing permanent damage. Glaucoma causes everything from blindness to blind spots. Certain acute attacks can also cause nausea, headaches, and vomiting. This is the second most common cause of visual impairment.
- Stroke: One in three stroke survivors suffer from vision loss. A stroke can damage the nerve connections between your brain and eye. You may suffer from partial obstruction of your vision in both eyes depending on the area of your brain that the stroke damaged.
- Diabetes: Diabetes is the leading cause of blindness among working-age adults. Diabetic retinopathy occurs when the blood vessels in your retina are damaged, causing them to leak or bleed, compressing the eye and resulting in vision loss. These vessels may also cease carrying needed nutrients to the eye and create scar tissue that causes retinal detachment. This can lead to permanent loss of vision if not treated immediately.
- Physical damage: Combat injuries and chemical burns can literally destroy your eyes. This damage is purely physical, and is not the result of an underlying medical condition. Your cornea, the outer portion of your eye, is often damaged after a trauma. Cornea transplants are possible with the right donor, and this may restore your sight. Waiting on the donor list for the right donor, however, can leave you unable to work in your normal occupation for years.
- Birth defects: Children born before 31 weeks are at risk for developing a retinal condition that leads to lifelong blindness. Blood vessels do not form properly in premature children, leading to retinal deformities or detachments.
- Tay-Sachs disease: Tay-Sachs disease is a serious genetic disorder that destroys the nerve cells in your brain and spine, including the optic nerve that controls vision.
- Traumatic brain injury/brain aneurysm: You don’t need to suffer physical damage to your eye to experience vision loss. Your brain takes what’s seen by your eyes and interprets it, allowing you to perceive the world around you. Your brain also controls eye movement. Traumatic brain injuries to the area of your brain that controls vision processing can also lead to blindness.
- Retinal damage: Your retina is the tissue at the back of your eye that senses light, allowing you to see. It converts the light into signals that the brain interprets as images, allowing you to see. As you age, your eye compresses, occasionally pulling at the retina. Sometimes your retina can tear or detach from the back of your eye. You’ll see a shadow that seems to eclipse your eye, and it will cause blindness unless repaired.
- Blood clots: Blood clots may cause retinal vascular occlusion. They may block blood flow to the retina and prevent it from processing and filtering light. Blood clots can cause sudden vision loss by blocking the light from reaching your retina, and in turn, your brain.
- Optic neuritis: Optic neuritis is the result of inflammation of the optic nerve at the back of your eye. The inflammation will interrupt both vision and the signals to your brain. Infections and immune diseases such as lupus and multiple sclerosis can cause this type of inflammation. Patients may experience different visual events like flashing lights, visual field loss, pain, colorblindness, and vision loss in one eye or both. This disorder is often temporary and will disappear when the swelling lessens, but if it’s the result of an underlying autoimmune disorder, it may reoccur.
Not all vision loss is sudden. Many disorders cause a gradual loss of eye function. You may see spots in your field of vision, streaks, stars, flashes, loss of color vision, inability to see at night, double vision, blurry vision, loss of peripheral vision, and tunnel vision. Any of these eye conditions can prevent you from reliably performing the important duties of your occupation. However, some conditions may lead to total or partial blindness without medical intervention.
Long-Term Individual or Group Disability Benefits and Pre-existing Conditions
Sudden, traumatic, or unexplained blindness is rare. The majority of vision loss claimants suffer from diabetic complications, age-related degeneration, glaucoma, or genetic disorders. This means many visually impaired claimants were suffering from a known disorder before working age.
These claimants may find claiming benefits difficult because individual and group long-term disability insurance companies may consider them “pre-existing conditions”—that you contracted, treated or developed them before you obtained long-term disability benefits. The majority of individual and group long-term disability insurers severely restrict coverage of disabilities arising from pre-existing conditions.
For example, a standard individual or group long-term disability policy may state that it will not pay benefits for any disability caused, contributed to by, or resulting from a “pre-existing condition,” which is an injury or illness for which an otherwise eligible employee treated or should have treated for prior to obtaining coverage.
Accordingly, even if you never suffered from vision loss related to diabetic complications before you obtained individual or group long-term disability insurance, because diabetes contributed to or caused your vision loss, you may face a wrongful denial of your individual or group long-term disability benefits.
Vision loss and blindness are often permanent conditions that entitle you to years of individual or group long-term disability benefits, and long-term disability insurers may wrongfully classify your condition as “pre-existing.” They may claim you should have known you had a genetic disorder, which contributed to your vision loss. At DarrasLaw, our stellar individual disability attorneys and skilled group ERISA lawyers are familiar with these tactics and know how to get our clients the individual or group long-term disability benefits to which they are legally entitled.
Blindness and Vision Loss
You don’t need an underlying preexisting medical condition for an individual or group insurer to attempt to deny your long-term disability benefits. Remember, some conditions like cataracts are generally surgically correctable. Your individual or group long-term disability insurance company may expect you to undergo a corrective procedure even if your health insurance company refuses to pay for it. Medicare, for example, will only pay for this surgery when the cataracts are severe and will not pay for laser correction.
Contact an Award-Winning Individual Disability Lawyer or Top-Rated Group ERISA Attorney at DarrasLaw Today
Total or partial blindness are serious medical conditions that can prevent you from performing the important duties of almost any occupation, especially if the vision loss is traumatic or unexpected.
At DarrasLaw, our nationally respected individual disability lawyers and preeminent group ERISA attorneys know the many ways your individual or group long-term disability insurer will try to delay, deny, terminate, and offset your disability benefits. Led by America’s top-rated long-term disability lawyer, Frank N. Darras, our team of experienced individual disability attorneys and skilled group ERISA lawyers know how to fight individual or group long-term disability insurers that try to avoid paying out benefits—and win.
Call the prominent individual disability attorneys and award-winning group ERISA lawyers at DarrasLaw at (800) 458-4577 or contact us online to schedule your completely free disability policy analysis and free claim consultation. Frank N. Darras and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits. We want to help you no matter the size of the claim or where you live.