Can I Get Long Term Disability For HIV/AIDS?

Many people might assume that a diagnosis of HIV/AIDS automatically qualifies you for long-term disability insurance benefits. Not so. Establishing your HIV status is only the first step toward obtaining benefits. The more difficult task lies in proving that your condition is “disabling.”

As explained below, the experienced New York disability attorneys at Riemer Hess can help you gather the evidence you need to present a compelling disability claim.

Getting Long Term Disability for HIV/AIDS

HIV, or human immunodeficiency virus, is a virus that attacks the body’s immune system. It is a progressive disease, with AIDS (Autoimmune Deficiency Syndrome) being the final stage of the HIV infection.

Generally speaking, to qualify for long term disability you must prove that your medical condition prevents you from working (either in your own occupation or in all occupations, subject to your policy).

Disabling Symptoms of HIV/AIDS

Whether or not your HIV is considered a “disability” in the eyes of your insurance company depends on your symptoms, their severity and frequency, and how they interfere with performing your job duties.

At the onset of HIV infection, a person may experience few symptoms. Over time, however, the symptoms of HIV may include:

• • • Fatigue
    • Chronic pain
    • Headaches
    • Shortness of breath
    • Fever
    • Fatigue
    • Numbness or weakness in the limbs
    • Nerve damage
    • Diarrhea
    • Difficulty concentrating and personality changes.

Progression of HIV

If HIV develops into AIDS, these symptoms may become more severe. Moreover, because a person with AIDS has a severely compromised immune system, they are more vulnerable to opportunistic infections and life-threatening diseases, such as pneumonia and certain types of cancer.

HIV/AIDS Medication Side Effect Symptoms

HIV/AIDS medications often have significant side effects that are similar to, or even more severe than, the infection itself.

Even if the majority of your disabling symptoms derive from the medications taken to treat your HIV/AIDS, these are considered part of your disabling condition. Make sure to account for all medication side effects when filing your long term disability claim.

Proving Your HIV is Disabling

In general, there are three hurdles to proving that your HIV is disabling:

1. HIV is a progressive disease, and the rate of progression varies from individual to individual;
2. The effectiveness of antiretroviral therapy allows many individuals to remain productive members of the workforce for a significant period of time after their diagnosis; and
3. Pain and fatigue – two common and often debilitating symptoms of HIV – are subjective complaints, ripe for challenge by the insurance company.

In order to overcome these obstacles and obtain disability insurance benefits for HIV, you must demonstrate that your condition has progressed to the point that it prevents you from performing the material duties of your job.

Medical Evidence from Your Doctors

When evaluating your claim, your insurance company will weigh medical evidence most heavily. Medical evidence to substantiate your HIV claim can include:

• • • Your medical history;
    • Your medical records;
    • Clinical test results and lab results;
    • Treatment notes;
    • A written opinion from your treating doctor, detailing your symptoms and concluding you are disabled.

Evidence Provided By You

Your insurance company will also take into consideration your own information, documentation, and statements. Medical records do not always encompass all the ways your HIV symptoms interfere with your occupational duties. Other evidence you can submit with your claim includes:

• • • A job description, written in your own words, with notes indicating how your symptoms have impacted your ability to perform each required task.
    • A symptom diary, in which you detail the nature of your symptoms and the impact of those symptoms on your daily life, over an extended period of time.
    • A personal statement. To support your claim, you can write a personal statement explaining the onset of your HIV, your symptoms, and the ways they prevent you from working. For example, if your HIV-related fatigue is severe, you may have trouble focusing for extended periods of time, arrive late to work from oversleeping, miss deadlines, or make mistakes on projects you ordinarily wouldn’t. Make sure to cite specific examples of your symptoms impacting your ability to work. The more detailed, the better.

Information Provided By Third Parties

Beyond medical evidence from your doctor and your own statements, your insurance company will accept—and even seek—information from third parties regarding your HIV.

This third party evidence can include:

• • • Information your insurance company receives from your employer (your job title, standard job description, dates of employment, and the reason you stopped working);
    • Statements from your supervisor or co-workers describing their experience working with you as your illness progressed;
    • An opinion from a vocational expert as to whether you can perform your job duties.

A Long Term Disability Attorney Can Help

Filing for long term disability for HIV can be challenging; your insurance company may be skeptical of your symptoms and their severity, underestimate the effects of your medications, and not take into account both physical and cognitive impairments.

An experienced long term disability insurance attorney can help. While your insurance company will ask your employer to provide basic information, at Riemer Hess we will dig deeper to develop a detailed and accurate description of your actual job duties and the nature of the working environment.

Your insurance company will ask the doctor to fill out a pre-printed Physician Statement. We will help your doctor do better than that by providing him with a Residual Functional Capacity Questionnaire. The Questionnaire will provide us with much more detailed information about your HIV status, your symptoms and treatment, and your ability to function relevant to your specific job duties

Additionally, we can also substantiate your HIV claim through other testing, such as a Neuropsychological Evaluation. We have experience with HIV cases and know what evidence your insurance company requires to approve disability benefits.

If you are suffering from HIV and considering long term disability, or if you have already been denied disability benefits but have HIV, our New York long term disability lawyers can help.  Call Riemer Hess LLC at (212) 297-0700 for a consultation on your disability case.