LTD Claims for Multiple Sclerosis (MS)

Long-Term Disability Claims for Multiple Sclerosis (MS)

You have an undeniable, “objective” diagnosis. Your MRIs clearly show lesions. So how could your long-term disability insurer possibly deny your claim?

You would think that a diagnosis of Multiple Sclerosis (MS) would lead to an automatic approval. After all, it’s a serious, progressive neurological disease with clear, “objective” proof on an MRI. Unfortunately, insurance companies are not in the business of auto-approvals. They will fight even the most legitimate claims, and they have a specific playbook for MS.

They will not dispute your *diagnosis*. Instead, they will dispute your *limitations*. They will argue that your symptoms are not “severe enough” to prevent you from working. This is a common tactic that preys on the “relapsing-remitting” nature of the disease and the “invisible” symptoms that plague MS patients. At Uscher, Quiat, Uscher & Russo, P.C., we know this playbook, and we know how to beat it.

Why Multiple Sclerosis Is a Disabling Condition

An insurance adjuster sees an MRI report but has no concept of what it feels like to live with MS. They don’t understand that the disease is far more than just “lesions.”

MS makes a full-time, high-stakes career impossible by causing a cascade of debilitating symptoms:

• Overwhelming, Pervasive Fatigue: This is often the most disabling symptom. MS fatigue is not just “being tired.” It is a crushing, “paralyzing” exhaustion that is not relieved by sleep and is often triggered by minimal activity (both physical and mental).
• Severe Cognitive Dysfunction (“Cog Fog”): MS directly attacks the brain, causing significant cognitive impairment. This includes memory loss, slow processing speed, difficulty concentrating, and problems with executive function (planning and organizing). For a professional, “cog fog” is a career-ending symptom.
• Unpredictability (Relapsing-Remitting): The core nature of MS is its unpredictability. You may have a “good” week followed by a “bad” month. This makes it impossible to maintain the reliable, consistent attendance and performance required by any serious employer.
• Physical Symptoms: Numbness, tingling, and weakness in the limbs, loss of balance (vertigo), spasticity (muscle stiffness), and blurred or double vision (optic neuritis) can make it physically impossible to type, walk, commute, or even sit at a desk safely.
• Heat Sensitivity: A very common MS symptom is that a minor increase in body temperature (e.g., a warm office, a stressful meeting) can cause a dramatic worsening of all symptoms, known as Uhthoff’s phenomenon.

How They Deny “Objective” MS Claims

How does an insurer deny a claim when they have an MRI “proving” the disease? It’s a cynical strategy, but a common one.

Tactic 1: “Your MRI Doesn’t Correlate With Your Symptoms”

The insurer’s “paper-only” neurologist will review your file and write a report stating, “The claimant has a few small, stable lesions on their MRI, which do not correlate with the profound level of fatigue and cognitive fog they are reporting.” They are dismissing your most disabling symptoms (fatigue and cog fog) because they don’t “match” the scan, even though this is a classic presentation of MS.

Tactic 2: The “Good Day” Surveillance Trap

Because MS is a relapsing-remitting disease, insurers love to use video surveillance. They will film you on a “good day” getting mail or going to a doctor’s appointment. They will then argue this is “proof” that you are functional, deliberately ignoring the reality that you were in bed for three days recovering from that single outing.

Tactic 3: Ignoring the “Invisible” Symptoms

The insurer will focus on what you *can* do physically. They will say, “The claimant has no spasticity and can walk, so they can perform a sedentary job.” They will completely ignore your most disabling symptoms: the crushing fatigue and the severe cognitive fog, which make even a “sedentary” desk job impossible. These are the most important symptoms to prove.

How We Build a Winning Appeal for Multiple Sclerosis

When your insurer denies your claim, you have one chance to appeal. This appeal, governed by a federal law called ERISA, is your one and only opportunity to build your case. You cannot add new evidence later. This is why it is critical to build a fortress of evidence *now*.

We fight back by “objectifying” your “invisible” symptoms.

1. We Objectify Your Cognitive Fog

This is the most important step. We commission a **Neuropsychological Evaluation.** This is an extensive, multi-hour series of tests administered by a neuropsychologist. It provides hard, objective data on your memory, processing speed, and executive function. When this report shows your cognitive function is in the “impaired” range, the insurer can no longer claim your “cog fog” is just “subjective.”

2. We Objectify Your Fatigue and Limitations

We may commission a **Functional Capacity Evaluation (FCE)** to get objective data on your physical stamina. We also have you keep a detailed “symptom and activity log” for several weeks. This log documents your fatigue, pain, and cognitive struggles, and clearly shows the “crash” that follows activity (post-exertional malaise). This log, when certified by your neurologist, becomes critical medical evidence of your unpredictability.

3. We Get Medical Opinions That Matter

We work with your neurologist to write a comprehensive narrative report. This report doesn’t just list your diagnosis. It ties your MRI lesions to your symptoms. It explains *why* the fatigue and cognitive fog are direct results of MS. It explains the relapsing-remitting nature of your illness and states, in clear medical terms, why you cannot maintain a reliable, full-time work schedule.

4. We Prove Your “True” Occupation

We hire a vocational expert to write a report on the *actual* cognitive, stress, and stamina demands of your job. This report proves that your career required 100% reliability, concentration, and focus—things your MS has made impossible.

Your Diagnosis Is Clear. Your Claim Should Be, Too.

We understand the devastating and unpredictable nature of Multiple Sclerosis. You are not just fighting a disease; you are fighting an insurance company that is callously disregarding your reality. You should not have to do that alone.

If your long-term disability claim for MS has been denied, contact us today for a free, confidential consultation. Let us take on the legal battle so you can focus on your health and your energy. We know how to win.

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