Tinnitus is characterized by noises in the ear(s), such as ringing, buzzing, clicking or hissing. These noises can range from low to high pitch. Severe symptoms can cause impaired concentration, inability to follow conversations, poor memory, poor sleep, extreme fatigue, depression, and anxiety. The condition is often accompanied by hearing loss and/or other ear, throat and nose issues. Even with treatment and therapeutic management, tinnitus can cause debilitating limitations and long term disability.
There are several things you need to know before filing your long term disability claim for tinnitus.
The type of tinnitus you have is important.
There are two types of tinnitus - “subjective” (most common) and “objective” (less common). To identify the appropriate type, your doctor will listen for sounds within your ear in a process called auscultation. If your doctor can hear noise in your ear(s) or detect a pulsating motion from the surrounding structure, then she will identify the condition as objective. If your doctor cannot hear the sound, then she will identify the condition as subjective.
The type of tinnitus you have makes a significant difference in how the insurance company will view your claim. Insurance companies typically demand objective proofof a disabling condition, such as abnormal clinical signs upon examination. While claimants with objective tinnitus can meet this burden, those with the more common subjective tinnitus often face more difficulty. Claimants with subjective tinnitus may need other forms of proof, such as cognitive testing results, hearing and/or audiological testing, sleep studies, and supportive statements from physician to satisfy the insurance company.
Claimants with subjective tinnitus should also be aware that their long term disability policy may contain a limitation on benefits payable for a condition based primarily on subjective symptoms. A qualified long term disability attorney will be able to tell you if your policy contains a limiting provision.
The insurance company will focus on your hearing.
You must be prepared for the insurance company to focus on your hearing loss (or lack thereof). This is an extremely common problem that most long term disability claimants with tinnitus face.
Time and time again, insurance companies erroneously deny legitimate tinnitus long term disability claims due to lack of substantial hearing loss. Yet, the most disabling cases of tinnitus often have nothing to do with hearing loss. Rather, the most disabling cases are usually due to an inability to concentrate, focus, sleep, or other cognitive difficulties. In some cases, the condition may even be disabling due to secondary depression and/or anxiety.
The insurance companies’ tendency to focus on hearing loss is extremely difficult to avoid. A long term disability attorney can highlight your more disabling symptoms to prevent improper focus on hearing loss. If the insurance company persists in questioning your hearing loss (or lack thereof), your attorney may recommend additional neuropsychological testing or elicit a written narrative response from your doctor.
You must be compliant and receiving appropriate treatment.
Most long term disability insurance policies require proof that: (1) you are receiving medical treatment; and (2) the treatment you are receiving is “appropriate.” However, tinnitus typically presents as a very complicated cluster of symptoms that varies dramatically between different individuals, so it can often be difficult to determine what treatment is “appropriate.”
In some cases, treatment may focus on a known underlying cause or condition, such as blood pressure issues, cardiovascular disease, temporomandibular joint syndrome (TMJ), dysfunctions of the eustachian tube, balance disorders, metabolic dysfunction, vitamin deficiencies, Lyme disease, etc.
However, the underlying cause of tinnitus is often never identified or simply not treatable. For example, it may be useless to treat the underlying cause of tinnitus if it was related to aging, exposure to loud noise over a period of time, traumatic exposure to loud noise, etc. In those circumstances, or where no treatable underlying cause can been identified, doctors typically focus on symptom management. Management of tinnitus symptoms can range from cognitive behavioral therapy, white noise machine therapy, Neuromonic device therapy, avoidance of certain food or substances, annual audiological and hearing testing, physical therapy, vestibular rehabilitation, use of hearing aids, etc.
Compliance with your doctor’s recommended course of treatment and consistent follow-up is key to satisfying the insurance company’s “appropriate treatment” requirement. Typically, the insurance company will want proof that you are following through with all treatment recommended by your doctor, regardless of whether you personally find it helpful.
The insurance company will require proof of an ongoing disability.
Thankfully, it is possible for symptoms to improve with ongoing treatment and care. Even if symptoms don’t improve, it is also possible for patients to adapt to the tinnitus and function better over time. Of course, the insurance companies are aware of this. As a result, they will periodically require proof of an ongoing disability so long as you remain on long term disability benefits.
The frequency of required updates will vary depending on your insurance company and particular facts of your case. You should generally expect a request for updates at least twice per year. Failure to provide the insurance company with timely or sufficient updates is likely to result in benefit termination. An experienced long term disability attorney can help submit supportive and timely updates to protect your benefits.