Unseen Struggles: Invisible Injuries and Illnesses in LTD Claims

In Long-Term Disability (LTD) claims, so called “invisible” injuries or illnesses pose unique challenges for claimants. The term invisible injury or illness refers to physical or mental health conditions that are not immediately apparent to an observer and/or aren’t easily identified or quantified by traditional medical testing such as x-rays, blood tests, MRI’s and CAT scans. Invisible injuries or illnesses are nonetheless quite common, and significantly impact an individuals well-being and functioning. In this Insight, we discuss invisible injuries, exploring what they are, the reasons they are subject to litigation, and crucial strategies to protect your rights when navigating LTD claims.

Understanding Invisible Injuries:

Invisible injuries encompass a broad spectrum of conditions that may not manifest visible symptoms but can significantly impact an individual’s daily life and ability to work. These injuries often involve mental health conditions such as depression, PTSD and anxiety. There are a range of physical illness that also fit this characterization such as chronic pain, autoimmune disorders, lyme disease, post concussion syndrome, chronic migraines, and numerous other conditions. In fact, even when a person has an objective and measurable health condition, the symptoms that arise from this condition are often invisible and as such this term applies to a large percentage of disabilities on some level.

Challenges in LTD Claims:

1. Subjectivity of Symptoms: Invisible injuries can be challenging to quantify objectively, leading to skepticism from insurers who may question the severity or legitimacy of the claimed disability.
2. Stigma and Misunderstanding: Mental health conditions, in particular, may face stigma and misunderstanding, further complicating the claims process and potentially leading to denials.
3. Challenge to Diagnose: Invisible conditions can go undiagnosed or misdiagnosed indefinitely, leading to challenges in treating the condition and acceptance by your insurer.

Reasons for Litigation:

1. Claims Denials: Due to the subjective nature of invisible injuries, claim denials are common. In fact, they are the most litigated form of disability claim. Litigation may be necessary to dispute these denials and establish the validity of the disability.
2. Disputes Over Severity: Even when a condition is acknowledged insurers may contest the severity of invisible injuries, leading to legal battles over the level of impairment and the impact on the claimant’s ability to work. Your insurer may be asking you to objectively prove what can only be subjectively experienced.
3. Credibility Issues: Because these conditions and diagnoses are commonly assessed based on a persons subjective complaints or descriptions an insurer may seek to cast a claimant in a negative or unfavourable light, and suggest a person is exaggerating or misrepresenting their claim.

Strategies to Protect Your Rights:

1. Thorough Documentation: Comprehensive medical documentation is crucial. It’s important that your healthcare providers thoroughly document the symptoms, treatments, and impact of your invisible injuries on your daily life.
2. Treatment: The Policy of insurance will require an insured to seek treatment that is reasonable and appropriate for the condition and to seek out remedies for the disabling conditions.  There is often disagreement with your insurer as to whether and what treatment is “necessary and reasonable”. 
3. Expert Opinions: Seek expert opinions from specialists who can provide insights into the nature and severity of your invisible injury/illness. These opinions can strengthen your case in the face of skepticism.
4. Legal Representation: Engage an experienced LTD lawyer to guide you through the claims process and, if necessary, represent you in litigation. Lawyers with expertise in invisible injuries understand the nuances of these cases and can advocate effectively on your behalf.
5. Open Communication: Maintain open and honest communication with both healthcare providers and your legal representation. Transparent communication ensures that all parties are aligned in presenting the full picture of your invisible injuries.

Conclusion:

Invisible injuries in LTD claims demand a thoughtful and strategic approach. By understanding the challenges, recognizing the potential for litigation, and implementing proactive strategies to protect your rights, claimants can navigate the complexities of invisible injuries with confidence. Every individual deserves fair treatment and recognition of the unseen struggles they face, and with the right advocacy, it’s possible to secure the Long-Term Disability benefits rightfully deserved.