Claiming Disability Benefits for Invisible Disabilities

When you think of a disability, visible conditions such as mobility impairments or the use of a wheelchair may come to mind. But not all disabilities are immediately and visibly obvious. Millions of Americans live with invisible disabilities—health conditions that significantly affect their daily lives but aren’t immediately obvious to others. These can range from chronic illnesses to mental health disorders to neurological conditions – all of which can affect a person’s ability to work.

What Are Invisible Disabilities?

Invisible disabilities are medical conditions that are not easily seen or physically felt but can be just as limiting as more visible impairments. Common examples include fibromyalgia, Ehlers-Danlos syndrome, chronic pain, or Lyme disease. Here are a few more examples, along with more detailed explanations of the challenges faced in disability claims.

Chronic Pain (e.g., Fibromyalgia, Arthritis)

Chronic pain conditions involve persistent pain that lasts for months or even years and significantly interferes with daily activities. Conditions such as fibromyalgia, which causes widespread pain, fatigue, and cognitive difficulties, are often misunderstood because they have no visible symptoms. Similarly, arthritis, especially in its early stages, may not have visible swelling or deformities but can cause severe joint pain and stiffness.

People with chronic pain often face skepticism because the pain can’t always be measured by standard diagnostic tests. This creates challenges both in daily life and in obtaining disability benefits, as insurance companies and Social Security may require objective evidence of pain severity.

Mental Health Conditions (e.g., Anxiety, Depression, PTSD)

Mental health conditions are among the most common invisible disabilities. Anxiety disorders can cause intense feelings of fear, dread, or panic that interfere with concentration and decision-making, while depression can result in overwhelming fatigue, difficulty concentrating, and a persistent sense of hopelessness. These conditions can make it difficult to maintain employment, perform daily tasks, or interact with others.

Post-Traumatic Stress Disorder (PTSD), which often affects veterans and survivors of trauma, can cause flashbacks, nightmares, severe anxiety, and emotional numbness. Despite their debilitating effects, mental health conditions are often stigmatized, and many sufferers are reluctant to seek help due to societal perceptions or fear of being labeled as weak. In the context of disability benefits, mental health claims are often scrutinized more closely due to their subjective nature.

Autoimmune Disorders (e.g., Lupus, Multiple Sclerosis)

Autoimmune diseases occur when the body’s immune system mistakenly attacks healthy cells. These conditions can cause a wide range of symptoms, from extreme fatigue to chronic pain, inflammation, and organ damage. Lupus, for example, can affect the skin, joints, kidneys, brain, and other organs, causing unpredictable and debilitating flares.

Multiple sclerosis (MS) is another autoimmune disease in which the immune system attacks the protective covering of nerves, disrupting communication between the brain and the body. This can lead to a variety of symptoms, including vision problems, muscle weakness, and cognitive difficulties. Both conditions can be unpredictable, with periods of remission followed by severe flare-ups, making it difficult for people to maintain regular work schedules or perform daily tasks. The variability of symptoms often makes it difficult to prove the extent of the disability to insurers or the Social Security Administration.

Neurological Conditions (e.g., Epilepsy, Migraines)

Neurological disorders affect the brain, spinal cord, and nervous system, causing significant impairment. Epilepsy, for example, is characterized by recurrent, unprovoked seizures that can vary in intensity and frequency, making it dangerous to work in certain environments or to perform regular job duties. Even when seizures are controlled with medication, the unpredictability of their occurrence can still disrupt daily life.

Chronic migraines, while often dismissed as “just a headache,” can cause severe throbbing pain, sensitivity to light and sound, nausea, and visual disturbances. Severe migraine attacks can last for days and make it impossible to work or do normal activities. Because migraines don’t show up on standard medical tests like X-rays or blood work, proving their disabling nature can be a challenge when filing for disability benefits.

Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (ME/CFS), is a debilitating condition characterized by extreme fatigue that doesn’t improve with rest and worsens with physical or mental exertion. Other symptoms include joint pain, muscle weakness, sleep disturbances, and cognitive difficulties (often referred to as “brain fog”).

ME/CFS is still not fully understood by the medical community, and there is no definitive test to diagnose the condition. This has led to a lack of recognition and support for those affected. Many people with ME/CFS struggle to maintain employment, but because the condition is so poorly understood, they may have difficulty proving their disability to disability insurance companies or the Social Security Administration.

Heart Problems (e.g., Heart Disease, Arrhythmias)

Heart problems can be debilitating, even if they aren’t immediately visible. Coronary artery disease (CAD), congestive heart failure, and arrhythmias (irregular heartbeats) are examples of conditions that can severely limit a person’s ability to perform physical tasks, maintain stamina, or cope with stress. People with heart disease may experience fatigue, chest pain, shortness of breath, and dizziness.

Although heart problems can be detected by medical tests, the limitations they cause—such as the inability to walk long distances, perform manual labor, or manage stress—are not always apparent to others. This can make it difficult to prove disability to an insurance company or the SSA, especially if the person appears outwardly healthy during brief interactions.

Respiratory Problems (e.g., Asthma, COPD)

Respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD), can severely impact a person’s ability to function, even if their symptoms aren’t always visible. Asthma can cause shortness of breath, wheezing, and chest tightness, especially during exercise or in environments with allergens or pollutants. COPD, which includes emphysema and chronic bronchitis, progressively impairs lung function, making breathing difficult and limiting exercise capacity.

While people with respiratory problems may look fine at rest, they may experience sudden flare-ups that leave them struggling to breathe. These conditions may require frequent medical treatment and may make it impossible to work in certain environments or perform physically demanding tasks.

Bone and Joint Disorders (e.g., Osteoporosis, Degenerative Disc Disease)

Bone and joint disorders are often invisible but can cause significant pain and mobility problems. Osteoporosis is a condition that weakens bones, making them brittle and more susceptible to fractures. It can cause chronic pain, loss of height, and postural changes, although these symptoms may not be immediately apparent to others.

Degenerative disc disease (DDD) is the gradual deterioration of the intervertebral discs in the spine, resulting in back pain, stiffness, and difficulty moving. These conditions can limit a person’s ability to sit, stand, or walk for long periods of time, making many types of work difficult or impossible. Despite the pain and physical limitations these conditions cause, they can be difficult to prove without extensive medical documentation, especially if the effects are not immediately visible.

Filing a Long-Term Disability Claim with an Invisible Disability

Filing a long-term disability (LTD) insurance claim for an invisible disability can present unique challenges. These conditions may not be visible to others, but they can still significantly impact your ability to work. Insurance companies often scrutinize claims for invisible disabilities more closely, so it is important to understand both the criteria for qualifying and the obstacles you may face.

Qualifying Criteria for Long-Term Disability Insurance

To qualify for long-term disability benefits, you must meet several key criteria, which may vary depending on the specific policy you have through your employer or a private insurer. However, the following general requirements are common to most LTD policies:

• Proof of Disability: You must show that your medical condition prevents you from performing the essential duties of your job. For “own occupation” policies, this means you are unable to do the job you were hired to do, while for “any occupation” policies you must show that you are unable to do any job for which you are reasonably qualified by education, training, or experience.
• Elimination or Waiting Period: Most LTD policies have a waiting period, usually ranging from 90 to 180 days, during which you must be continuously disabled before benefits begin. During this time, you may need to rely on short-term disability insurance, if available, or personal savings.
• Ongoing Medical Treatment: Your insurer will probably require that you receive regular medical treatment for your condition. Ongoing treatment shows that your condition is serious and that you are taking steps to manage it.
• Proof of Continuing Disability: Even after initial approval, you will need to provide ongoing evidence that your condition continues to prevent you from working. Insurers may review your case periodically to ensure that your disability continues.

RELATED POST: 10 Tips to Maintain Approval of Your LTD Benefits

Applying for Social Security Disability Benefits with an Invisible Disability

In addition to long-term disability benefits from a private insurance company, you may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) if your invisible disability prevents you from working. However, qualifying for Social Security benefits can be just as challenging—if not more so—than filing a private disability claim.

Criteria for Qualifying for Social Security Disability

The Social Security Administration (SSA) maintains a “Blue Book” that lists medical conditions that automatically qualify for disability if they meet certain criteria. Even if your condition isn’t listed, you may still qualify if you meet the following criteria:

1. Your disability must be severe enough to prevent you from engaging in substantial gainful activity (SGA), which means that you are unable to perform work that will earn you more than a certain amount of money. For 2024, the SGA limit is $1,470 per month for non-blind individuals.
2. Your condition must either be expected to last at least 12 months or be terminal. This is sometimes referred to as the SSA’s one-year rule.
3. You must have earned enough work credits through past employment. This is based on your work history and your age at the time you became disabled. SSI, on the other hand, is a needs-based program, so work credits are not required, but income and resource limits do apply.

Strengthening Disability Claims for Invisible Disabilities

Whether you’re applying for long-term disability insurance benefits or Social Security Disability Insurance for an invisible disability, the challenges of proving your condition can be significant. Both private insurance companies and the Social Security Administration (SSA) require substantial evidence to demonstrate that your condition prevents you from working. Because invisible disabilities often don’t have obvious physical signs or clear diagnostic tests, you must approach your claim with careful documentation and strategic planning.

Here are key steps to strengthen your case for both LTD and SSDI claims:

Gather Detailed Medical Records

Thorough and consistent medical records are critical to proving the existence and severity of your invisible disability. Your records should:

• Include regular treatment visits with your doctor that show a consistent pattern of care.
• Outline your diagnosis, symptoms, treatments, medications, and how your condition affects your ability to function.
• Include information about your ability (or inability) to perform certain work-related tasks, such as sitting, standing, or concentrating for long periods of time.

For both LTD and SSDI claims, consistent medical documentation from a licensed healthcare provider helps build credibility and demonstrates the ongoing effects of your condition. Gaps in treatment or inconsistent visits may cause insurers or the SSA to question the severity of your disability.

Consider a Functional Capacity Evaluation (FCE)

A functional capacity evaluation (FCE) is an objective assessment of your physical and/or mental ability to perform work-related tasks. This type of evaluation measures your limitations in areas such as lifting, walking, sitting, and standing, as well as your cognitive and psychological abilities.

An FCE is particularly useful in demonstrating the impact of invisible disabilities such as chronic pain, fatigue, or mental health disorders, which may not show up on typical medical tests. It provides hard evidence of how your condition affects your functional abilities, which can support both LTD and SSDI claims.

Document Your Symptoms Consistently

Keeping a daily or weekly dairy of your symptoms and how they affect your ability to function can provide a clear picture of the daily challenges your condition presents. For example:

• Document the frequency, intensity, and duration of symptoms such as pain, fatigue, dizziness, or anxiety attacks.
• Note how these symptoms prevent you from performing daily tasks or performing work-related activities.
• Note any fluctuations in your condition, such as “good” days and “bad” days, and how often the bad days occur.

This diary can serve as additional evidence, showing that your condition is ongoing and severe enough to qualify for disability benefits. Although subjective, this detailed personal account can help insurers or the SSA understand the full extent of your limitations.

Obtain Supporting Letters from Health Care Providers

In addition to medical records, ask your treating physicians to provide written statements or letters explaining how your condition affects your ability to work. These letters should:

• Provide specific examples of how your disability affects your daily activities and your ability to perform your job duties.
• Highlight any limitations that may not be apparent on medical tests, such as chronic pain, fatigue, or cognitive impairment.
• Address the frequency of flare-ups and how they prevent you from maintaining steady employment.

For SSDI, these statements can be critical in establishing that your condition meets the SSA’s requirement of preventing substantial gainful activity (SGA). For LTD claims, strong medical testimony will help overcome any doubts the insurance company may have about the legitimacy of your disability.

Undergo Psychological or Neuropsychological Evaluations (If Applicable)

For claimants with mental health conditions (e.g., depression, anxiety, PTSD) or cognitive impairments (e.g., due to multiple sclerosis or chronic fatigue syndrome), undergoing a psychological or neuropsychological evaluation can provide objective evidence of the severity of your symptoms. These evaluations measure your cognitive function, memory, concentration, and decision-making abilities, which can directly affect your ability to work.

Both LTD insurance companies and the SSA give significant weight to objective evaluations, so these tests can be instrumental in proving the limitations caused by invisible mental or cognitive disabilities.

Submit Objective Test Results (If Available)

Although many invisible disabilities don’t show up on standard tests like X-rays or MRIs, there may be other objective tests that can help prove the severity of your condition. For example:

• Blood tests can show markers for autoimmune diseases such as lupus.
• Pulmonary function tests may indicate respiratory problems such as asthma or COPD.
• Cardiac stress tests can show heart-related problems such as coronary artery disease.

Even if your condition doesn’t have specific diagnostic tests, providing any relevant objective medical evidence can strengthen your claim and make it harder for insurers or the SSA to dispute the validity of your disability.

Consider Legal Representation

Invisible disabilities are often more difficult to prove because of the lack of outward physical symptoms, and both insurers and the SSA tend to be skeptical of conditions that are not easily measurable. An experienced disability attorney can greatly improve your chances of success. An attorney can:

• Help ensure that all necessary medical documentation is submitted correctly.
• Communicate with your doctors to obtain detailed, supportive letters.
• Prepare you for hearings or appeals if your claim is denied.
• Challenge insurance companies that unfairly deny claims based on insufficient evidence.

Legal assistance is especially valuable if your claim is denied, as disability attorneys are skilled at identifying weaknesses in insurance company or SSA arguments and addressing them during the appeals process.

Prepare for Potential Surveillance or Independent Medical Examinations

Insurers often use surveillance or require independent medical exams (IMEs) to challenge LTD claims, especially for invisible disabilities. Be prepared for this possibility by:

• Strictly following your doctor’s prescribed treatment plan closely.
• Avoiding activities that may contradict your claimed limitations (for example, if you claim you can’t walk long distances, avoid strenuous activities in public).
• Attend all IMEs and be honest about your symptoms, without exaggerating or minimizing them.

In SSDI cases, the SSA may also require you to attend a consultative examination with a doctor of their choice. It’s important to attend this exam because missing it could result in your claim being denied.

By following these steps and gathering comprehensive evidence, you can strengthen both long-term disability and Social Security disability claims for invisible disabilities. These strategies will help you prove the severity of your condition, even if it doesn’t have visible symptoms.

Was Your Disability Claim Denied? The Ortiz Law Firm Can Help You Get the Benefits You Deserve

At the Ortiz Law Firm, we understand the unique challenges that individuals with invisible disabilities face when seeking both long-term disability and Social Security disability benefits. Attorney Nick Ortiz has extensive experience in helping clients with chronic illnesses, mental health conditions, and other invisible disabilities secure the benefits they deserve. We understand that just because a disability is invisible doesn’t mean it isn’t real or debilitating.

If you’re struggling to get your disability claim approved or have been denied benefits, we encourage you to contact us for a free case evaluation. We’re here to fight for your rights and help you navigate the complex disability claims process. We represent claimants nationwide because you do not need to hire an attorney in your state for ERISA long-term disability or Social Security disability claims. Call us at (888) 321-8131 to schedule a case evaluation today.