Autoimmune diseases are a complex group of conditions characterized by an abnormal immune response, where the body’s immune system mistakenly attacks its own healthy cells and tissues. There are numerous autoimmune diseases, each with its own unique set of symptoms and effects. These conditions can significantly impact an individual’s ability to maintain full-time employment due to the chronic nature of the diseases and their wide-ranging effects on physical, mental, and emotional well-being.
Autoimmune diseases occur when the immune system, which is designed to protect the body from harmful invaders like bacteria and viruses, becomes overactive and targets healthy cells and tissues. The exact cause of autoimmune diseases is not fully understood, but factors such as genetics, environmental triggers, and hormonal imbalances may contribute to their development.
Insurers and courts focus on the symptoms of a disability rather than the diagnosis when determining if a claimant is disabled. At least, they are supposed to look at symptoms. All too often, when faced with a little-understood diagnosis like most autoimmune diseases, insurers take the opportunity to deny the claim due to the diagnosis rather than the symptoms. Courts do not support this approach.
With autoimmune diseases, insurers may be more likely to question the diagnosis itself. But even if the diagnosis isn’t clear or well known, if you can demonstrate disabling symptoms, the diagnosis itself should not be a reason to deny the claim. Just like any other claim, an insured with an autoimmune disease must be able to demonstrate evidence of why the disease’s symptoms restrict and limit abilities to the point where the insured can’t work. Any available testing is important to obtain, as are all objective, observable evidence of your doctors and peers. Keep a symptom journal. Let the insurer know what is happening on a given day and how it affects your physical and cognitive abilities.
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