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Thursday, December 18, 2014

New Treatment for Remitting Multiple Sclerosis: How Will It Affect my Long-Term Disability Claim?

The MS Society published a press release  regarding a new drug, Lemtrada, for relapse-remitting multiple sclerosis.  To quote from the MS Society's web site, "RRMS — the most common disease course — is characterized by clearly defined attacks of worsening neurologic function. These attacks — also called relapses, flare-ups or exacerbations — are followed by partial or complete recovery periods (remissions)."  Lemtrada raises two issues if you are applying for long-term disability benefits or appealing a benefit denial: how to prove disability when you sometimes feel fine; and will your chances of getting benefits be harmed if you don't take Lemtrada?

  • Disability resulting from RRMS can be difficult to prove in a claim for long-term disability insurance benefits, or an appeal of a long-term disability benefit denial.  While you are in the "remitting" phase, where symptoms may totally disappear, the lack of symptoms can give the insurance company an excuse to find that you are not disabled: the insurer may have surveillance where you show no physical symptoms; you may take a long business trip that they learn about through your employment or medical records that you could not during a flare-up.  If you only go to the doctor during the remitting phase, the doctor might not have any personal observations of your symptoms during a flare-up.  While you may tell you doctor about the difficulties you suffer during flare ups, the insurer may dismiss this as "mere self-report" and not objective medical evidence that the condition is impairing.  To prove disability with RRMS, do the following:
    • Try to see your doctor while suffering a relapse so the doctor can record his observations of your symptoms;
    • Keep a log during flare-ups to record as specifically as possible the effect of the condition on your ability to perform job-related tasks.
    • Make sure the doctor's medical records reflect that you suffer from RRMS.
  • Do you have to try Lemtrada?  Lemtrada has serious potential side effects, including sometimes fatal autoimmune conditions. Because of this, it is only recommended after other treatments have failed.  What if your doctor recommends it but you don't want to take it?  See my earlier post to avoid giving the insurance company an excuse to deny you benefits because you have decided not pursue a certain treatment option.  
We are lucky that Connecticut has a strong MS community, with great medical expertise among doctors, and strong advocacy and support services for patients and their families.  In representing MS patients who are appealing denials of long-term or short-term disability benefits in Connecticut, I have found many of the doctors serving the MS community understand that importance of disability benefits to their patients, and their own crucial role in their patients being initially approved for benefits, and appealing a denial of benefits, or a termination of benefits.  With planning and attention, your right to long-term disability benefits can be protected no matter what decision you make about taking Lemtrada.

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