Disability Benefits and Chronic Illness: What to Include in Your Claim

Living with a chronic illness can significantly interfere with your ability to work, care for your family, and maintain your quality of life. Conditions like lupus, Crohn’s disease, fibromyalgia, and chronic fatigue syndrome may not be outwardly visible, but their effects can be life-altering.

If long-term symptoms are preventing you from working, you may qualify for disability insurance benefits. However, navigating the claims process, especially in Pennsylvania, can be complex. A knowledgeable Philadelphia disability insurance lawyer from Edelstein Martin & Nelson can help ensure your claim is backed by the right medical evidence and meets insurer requirements. Here’s what you need to include in your claim to improve your chances of approval.

Chronic Illness and Disability: Understanding the Connection

Many people suffering from chronic illnesses work for years before symptoms become unmanageable. Some try to push through fatigue, joint pain, digestive issues, or flare-ups, only to find that their condition gradually worsens. Whether you live in Center City or the Main Line, navigating daily life with a chronic condition can be challenging. When the illness prevents you from performing your job consistently and reliably, applying for long-term disability benefits may be necessary.

Disability insurers often scrutinize claims involving chronic illnesses, especially when the condition is considered “invisible.” That’s why the details of your application, and the medical and vocational evidence you include, can make or break your case.

Key Information to Include in Your Claim

When submitting a disability claim for chronic illness, the strength of your documentation is critical. Be thorough and specific, particularly in the following areas:

Detailed Medical Records

You’ll need comprehensive medical records from treating physicians who specialize in your condition. Include:

• Diagnosis history and progression of your illness
• Treatment plans and medications (e.g., biologics for autoimmune diseases)
• Imaging, lab work, and test results
• Notes about how symptoms affect your functional ability (walking, concentrating, lifting, etc.)

If you’re receiving care at a Philadelphia-area facility like Penn Medicine or Jefferson Health, request treatment summaries that clearly explain the chronic and disabling nature of your condition.

Symptom Impact Descriptions

Include a detailed description of how your symptoms interfere with daily tasks, including those at work and home. Examples may include:

• “Brain fog” that prevents you from concentrating during client meetings
• Unpredictable flare-ups that make it impossible to maintain regular work hours
• Chronic pain that limits your ability to sit or stand for extended periods

Supporting Statements and Vocational Evidence

In addition to your own account, it helps to include statements from doctors, coworkers, or family members who have witnessed how your illness affects you. These third-party statements add credibility to your claim.

Also consider including:

• Functional Capacity Evaluations
• Neuropsychological evaluations if cognitive symptoms are present
• A vocational expert’s opinion on your inability to perform your job, or any job, given your limitations

In some cases, insurers will argue that you can still perform sedentary work. Including evidence from a vocational expert can help demonstrate that even desk jobs in offices from Old City to University City are not a realistic option given your condition.

Common Reasons Chronic Illness Claims Are Denied

Insurance companies may deny chronic illness claims for reasons such as:

• Lack of “objective” medical evidence (e.g., no visible injury on scans)
• Inconsistent treatment history or missed doctor appointments
• Social media activity that contradicts the severity of your reported symptoms
• Reliance on outdated job descriptions or biased medical reviewers

A knowledgeable Philadelphia disability insurance lawyer can help you respond to these tactics by building a well-supported claim and, if necessary, appealing a wrongful denial.

Speak to a Philly Disability Insurance Lawyer from Edelstein Martin & Nelson

If your chronic illness has left you unable to work, you deserve the full protection your disability insurance policy provides. An experienced attorney can help you gather the right evidence, present a strong claim, and deal with aggressive insurers who try to delay or deny your benefits. For trusted legal support, contact Edelstein Martin & Nelson at (215) 731-9900 to speak with a skilled Philadelphia disability insurance lawyer about your case.