Major Dysfunction of a Joint

Posted on behalf of Goldberg Finnegan, LLC on Apr 11, 2017 in Long-Term Disability

doctor examining kneeMajor dysfunction of a joint occurs when medical problems in one of the body’s main joints (shoulder, elbow, wrist, hip knee or ankle) impede your ability to move or function effectively. The dysfunction can generally happen due to any cause. For example, you may have bilateral osteoarthritis in your knees, requiring knee replacement, or you may have a chronic rotator cuff tear in your shoulder. In analyzing major dysfunction of a joint for a long-term disability (LTD) case, the main factor is function – how does the dysfunction affect your ability to work?

It is important to note that disability cases are often more complex than singular dysfunctions of one body part. Our office understands that it is quite often the full combination of various impairments – for example, diabetic neuropathy making it difficult to use the right arm, among other areas of the body – which lead someone to seek LTD benefits. However, to paint the full picture one must still document each contributing factor.

To that end, you must document your joint dysfunction through medical testing. If you have knee osteoarthritis, for example, x-rays and MRIs are essential to prove your case. It will be impossible to convince an already-unwilling insurance carrier that a disease is impacting your ability to work without objective evidence. Thus, medical testing is the first priority.

Next, have a specialist evaluate your function. To continue with the knee osteoarthritis example, your doctor should evaluate your knee motion, walking, and ability to stand and sit in a work-like position. They should be able to give a reasonable evaluation of the limitations caused by the joint dysfunction, expressed in written form.

If you experience pain connected to the joint dysfunction, a doctor’s opinion connecting your subjective pain to the medically-verifiable evidence can strengthen your case tremendously. If you experience bone-on-bone pain in one or both knees, it is much harder for the insurance company to discredit you if your doctor writes an opinion that you have x-rays indeed showing bone-on-bone rubbing in the knee, and that such a condition is likely to cause knee pain. Your word alone will unfortunately not carry the day against your insurer.

Often, in severe cases, your doctor may believe that surgery is your best option to repair the joint. You may need to undergo a knee replacement or hip replacement, or carpal tunnel release. When this happens, it is critical to get an evaluation of your functioning after the surgery. This is best after you have gone to physical therapy and your doctor believes you are at maximum improvement for the joint. It is crucial to show the insurance carrier (if this is the case) that you indeed still have significant functional limitations despite the surgery.

Ultimately, your LTD case comes down to whether you can function in your former job (for the first two years of the policy) and whether you can perform other work in the economy (most policy language changes after the first two years). The way to show this is through your medical documentation and by being vocal to doctors about your impairments. Make sure they understand exactly what pain you are feeling and evaluate your limitations. Joint dysfunction can certainly have a major impact on one’s ability to work. It often makes standing, walking and sitting much harder than before, and can lead to other problems such as depression. For each problem connected to your joint dysfunction, make sure you seek the proper care. For example, if pain leaves you depressed, find a psychiatrist and therapist to help you address the mental counterpart to the physical condition.

It helps to have an experienced attorney handle your long-term disability case. Each unique policy has a different set of legal obstacles to overcome to get benefits. Moreover, an experienced attorney can help gather the medical documentation you need and secure the doctors’ opinions needed to prove your disability to the insurance carrier.

Our attorneys can help. If you need to secure Long-Term Disability Benefits, please contact Goldberg Finnegan today at (888) 213-8140.  

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