Rheumatoid Arthritis, Fibromyalgia, and Chronic Fatigue - Exploring ERISA Long-Term Disability Claims

Welcome to Season 3, Episode 21 of Winning Isn't Easy, the podcast that delves into the complexities of disability insurance claims. In this highly informative episode, we focus on "Rheumatoid Arthritis, Fibromyalgia, and Chronic Fatigue - Exploring ERISA Long-Term Disability Claims."

Join us as we shed light on the unique challenges faced by individuals seeking disability benefits for conditions like rheumatoid arthritis, fibromyalgia, and chronic fatigue under ERISA. These conditions can significantly impact an individual's ability to work and lead a fulfilling life.

Our host, Nancy Cavey, a seasoned disability attorney, shares her expertise in handling ERISA LTD claims for these complex conditions. Nancy will discuss the specific medical evidence required to support a disability claim, common issues faced during the claims process, and strategies for effectively advocating for your rights as a claimant.

Throughout the episode, we'll explore the nuances of dealing with insurance companies and their evaluation of claims related to rheumatoid arthritis, fibromyalgia, and chronic fatigue. We'll provide guidance on gathering comprehensive medical documentation, understanding policy language, and preparing a strong claim to increase your chances of a successful outcome.

Whether you're personally navigating a disability claim, or seeking to deepen your understanding of these conditions and the claims process, this episode offers valuable information to help you navigate the complexities and secure the disability benefits you deserve.

Tune in to empower yourself with the knowledge needed to overcome the challenges and advocate for your rights effectively.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.    

Transcript

Disability Attorney Nancy L. Cavey: 0:11

Hey, I'm Nancy Cavey, national Individual Disability Attorney and ERISA Disability attorney. Welcome to Winning Isn't Easy. Before we get started, the Florida Bar Association says, I have to tell you that this isn't legal advice. But now that I've said that, I will assure you nothing will ever prevent me from giving you easy to understand information about the ERISA disability claims process, the games disability carriers play, and what you need to do to get the disability benefits you deserve. So off we go. Now, today I'm gonna be discussing three different types of illnesses, fibromyalgia, rheumatoid arthritis, and chronic fatigue. These diseases have in common many subjective complaints of pain, fatigue, and cognitive issues, and disability carriers just hate claims based on subjective , uh, levels of pain or fatigue or cognitive issues. Now I'm specifically gonna discuss two topics, what disability insurance companies don't get about the difference between fibromyalgia and rheumatoid arthritis, and why in some circumstances, you should not be tracking , uh, your , um, symptoms and functionality in a log sheet in a chronic fatigue claim. Got it. We've got a lot to cover today. But before we do that, let's take a quick break.

Speaker 2: 1:36

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Disability Attorney Nancy L. Cavey: 1:57

Welcome back to Whitney. Isn't Easy, what Disability insurance Companies Don't get about the difference between fibromyalgia and rheumatoid arthritis. Now, fibro and rheumatoid arthritis are a cause similar symptoms, but they're unrelated and they are different medical conditions. Each can be disabling on its own and both can be disabling. In combination. Medical research shows that RA can increase a person's likelihood of having fibromyalgia, and people can have both conditions at the same time. Yet, disability carriers don't understand the different causes, the different diagnostic methods, the different treatments , uh, and they just tend to disregard the unique causes, diagnostic methods and treatment for fibromyalgia and for rheumatoid arthritis, it kinda lump them into a big pot called subjective medical conditions. They don't take the time to differentiate them. Now, let's talk about different causes. Fibromyalgia is a chronic neurological condition that causes amplified body pain that can result in cognitive dysfunction, depression, and fatigue. On the other hand, rheumatoid arthritis is an autoimmune condition and that can cause damages to the synovial tissue lining your joints, for example, in your fingers or your hips or your knees. That in turn, can lead to inflammation and pain. RA can often cause permanent damage to the bones and to the connective tissues that can result in bony deformity of the impacted joints. Now, there are different, and there are shared symptoms. Let's talk about that. The common symptoms of fibromyalgia can include body wide pain, including the torso, the thighs, the buttocks, the arms, the back, the neck, even the head. There are also some specific spots of intense pain, and these are known as trigger points. There are also gastroenterological , uh, problems including constipation, diarrhea, there's even dizziness. There are headaches, there are sleep disorders associated with this. And of course there's that chronic fatigue and problems with concentration. Now let's talk about the common symptoms of ra. The common symptoms of RA include joint pain, joint tenderness, joint swelling, joint inflammation, joint stiffness , uh, loss of range of motion, for example, in the fingers or in the shoulders, joint deformity. Now, RA can occur either in one location or in multiple locations across your body, primarily as I normally see in the hands, the fingers and knuckles, the wrists, the elbows, the shoulders, the hips, knees, sometimes ankles and toes. RA is characterized by symmetrical symptoms and that can occur on both sides of the body. However, the symptoms can progress at different rates , uh, and the severity of the pain can also , uh, vary and it's not symmetrical. What are the shared symptoms? And those shared symptoms can obviously make it difficult for the disability carrier to figure out what the disabling medical condition might be. So RA and fibromyalgia have shared symptoms. There's pain on both sides of the body. There are pain in various parts of the body. There's morning stiffness, there's reduced mobility and range of motion in of the joints. There's stiffness that's wor worse in the morning or after periods of rest. There's cognitive impairment and secondary to pain. There's generally chronic fatigue. So while you might not be able to differentiate between the diagnosis of RA and fibromyalgia, I think it's important that you're describing your symptoms to your physician and how those symptoms impact your ability to function. Now, in my view, the disability carrier should be parsing this. They should be looking at each diagnosis separately and then in combination to decide whether or not you meet the applicable standard of disability in your policy or plan. They just tend to lump it all in one big pot. I don't think that's the right way to do it. Let's talk about diagnosis. As a rule, it is more difficult to diagnose fibromyalgia than ra 'cause there's no gold standard test to determine whether or not you have fibromyalgia. The diagnosis of fibromyalgia is a bit of a diagnosis of exclusion. The American College of Rheumatology has diagnostic criteria for fibromyalgia, and that in part can include widespread body pain. And there's something they use called the symptom severity scale. Uh , they wanna see that the symptomology has been at the same level for at least three months, and there's no evidence of any other disorder that would explain your pain. On the other hand, RA is based on a physical exam, the medical history, blood work and imaging testing. Now, the disability carrier will normally review your medical records closely, and it's not uncommon for the carrier to attack the diagnosis of fibromyalgia and rheumatoid arthritis. Um, why? Because the diagnostic CRI diagnostic criteria rely in part on the self-report of you. And if they're looking for a reason to deny the claim, they're going to deny the , uh, lack of objective testings or finding on physical examination. They're gonna argue that your complaints are inconsistent with your activity of daily living or as inconsistent with surveillance. And so that's what they're looking for in terms of attacking a the , uh, fibromyalgia case. It's lack of diagnosis , uh, lack of meeting the , uh, the , uh, criteria with the tender points , uh, that sort of thing. Uh, the , uh, reliance of your physician on your subjective complaints, inconsistent or inconclusive physical examination findings, and the , um, inconsistency between your complaints of pain or fatigue and your reported or observed activity. So let's contrast that with rheumatoid arthritis. There, the disability carrier is going to be attacking the results of the blood testing. Now, many people with RA have signs of inflammation in certain body antibodies on testing, sometimes the testing can be negative, notwithstanding the objective physical examination finding, which is consistent with ra. So the disability carrier is gonna sue seize on the negative , uh, blood testing to deny the claim, or they're gonna argue that the testing was inconclusive. Or sometimes I see the argument that the testing that was used just , just isn't reliable, isn't valid. Those are all some of the games that they're going to play with the , uh, diagnosis. I think it's really important that your doctor is diagnosing , uh, uh, documenting rather the physical exam findings, the blood work diagnostic studies, and explain how they arrived . What was their thinking in terms of how they got to this diagnosis. Now again, disability carriers think that blood work is the gold standard for the diagnosis of ra. So you've gotta explain that if you're testing is negative or equivocal. How about treatment for fibromyalgia and rheumatoid arthritis? They're going to expect that you got care from a rheumatologist and they're gonna poo poo home remedies and natural treatments. They are going to argue that the nature of the care that you're getting is inconsistent with the policy requirements and that you haven't gotten reasonable or necessary medical care at the level at which comports with , uh, your complaints. Now obviously, the medication for both conditions is designed to reduce pain, but in RA, you're getting medication to reduce the inflammation and slow the progression of ra. So regardless of the nature of the treatment, your medical records should be documenting your treatment, your response to the treatment, and any side effects of the treatment. It should be helpful or really helpful if the doctor can parse the treatment you're getting for each condition. If you've got both, often these claims are denied , um, in part because of the diagnosis , uh, the lack of symptoms or physical exam findings , uh, and the lack of appropriate treatment. So what should you do if your claim has been denied? I think that you have got to hire an experienced ERISA disability , uh, attorney immediately. You're only gonna have 180 days in which to file an appeal. And as I've said, we've gone through the laundry list of reasons why claims should be, are denied, and we need to make sure that we are , uh, getting the carrier file, figuring out all the reasons why the claim has been denied, or contacting your doctor, getting the necessary , uh, medical support or rebutting the opinions of the carrier or plans doctors if necessary, getting our own I m e if necessary, getting a functional capacity evaluation. So you can see that we've got a factual , uh, attack, a medical attack, and obviously that needs to be combined with the necessary legal arguments. In my situation, my appeal letters are 25 to 65 pages long, because that is the trial of your case in an ERISA disability case. Once the appeal process has ended, you can't add any new evidence. You don't get your day in court, you can't add new things in. The judge is stuck looking at that , uh, record. A record is your carrier's file at the time of the last denial. Now, the other thing you need to understand is that sometimes carriers will apply what's called a subjective medical condition limitation, if that's in your policy or plan. That clause lets the carrier plan legally limit the payment of benefits to just two years if it's caused by a subjective medical condition. It's not uncommon for the possible listed laundry list , uh, to include fibromyalgia, and sometimes I'll even see arthritis. Obviously, if your policy or plan and your care ultimately denies or terminates your benefits or applies an objective medical conditional limitation, it's really time to call an experienced a risk and disability attorney. We need to look at that policy or plan and see whether the medical condition you have fibromyalgia or RA is really a listed condition. And if it's not, then that's an attack. If it are , if you've got fibromyalgia and ra, then the issue's going to be well, is the RA excluded as a subjective medical condition? Uh, and if so, obviously you got a problem. But if not, then the argument's going to be that you're disabled because of the ra and that's gonna take additional medical proof. Sounds complicated. It is. I want you to be thinking about that while we take a break.

Speaker 2: 12:45

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Disability Attorney Nancy L. Cavey: 13:21

Welcome back to Winning Isn't Easy. Why you shouldn't track , uh, your symptoms in a chronic fatigue or long-term disability , uh, uh, claim. Now, I am sometimes equivocal about whether we should do this or not. Um, you have the burden to prove that you're disabled as that term is defined in your disability policy or plan. And one of the things that disability carriers generally demand is objective evidence of your restrictions and limitations. So the issue becomes, what are your symptoms? How do those symptoms impact your ability to perform the material and substantial duties of your own occupation or any occupation? Now, that can be hard to do without a functional capacity evaluation or a C P A test. Uh, and I think that one of the most important tools that you can use to help quantify your symptoms and the impact of your chronic fatigue syndrome sym symptoms, is a diary in the right circumstances. Now, in the right circumstances, the diary will help your doctor render an opinion about your restrictions and limitations that prevent you from performing your own or any occupation. In other words, it's gonna explain the nature of your symptoms, how those symptoms impact your ability to work, and we'll document relapses your response to treatment. However, you might be tempted to supplement this , um, on a daily basis and submit this whole chart as to why you can't work a full day of work or a a full , uh, week of work. And I think that's a bad idea. It's a bad idea in that if you say the wrong thing , uh, if you're tracking your symptoms on a di uh , daily basis, they may wax or wa depending on your activity, that may not necessarily be consistent with what you're reporting on the activity of daily living forms that you're giving. And it certainly may not be consistent with what your doctor is reporting. So my problem with keeping at least daily logs is the problem that you have with consistency. But I think that there is another problem, and that is disability carriers will tend to use surveillance , uh, and they will take that daily log sheet and they will try to put surveillance on you. And you might have a good day and you might have a bad day, you might have a cluster of bad days, but they may correlate your daily log sheet with that surveillance that they have. So it's a golden opportunity for them to assign surveillance. And generally what they'll do after they've done that is they'll take your statement , uh, and they will point out to you inconsistencies between your activity of daily living forms , uh, the logs that you have kept and , um, and what your doctors had to say. So I don't necessarily like daily logs if you're gonna do a log, I would prefer that you do a log , uh, on a weekly basis. Um, but what's important about that I think ultimately is that that needs to be correlated on an objective basis with the diagnosis and the restrictions limitations. And in chronic fatigue cases, I think that having a functional capacity evaluation or a C P E exam is the stronger way to document your restrictions and have them sort of be consistent, if you will, cooperative of your own , uh, report. Now why is that important? Because many times disability carriers will take , uh, your daily log , uh, surveillance that they have and say to the doctor, look, you know, they, she said that she couldn't do that, but here's film of her doing that type of activity. Um, she said that she had good days or bad days, but here's, you know, running days of her, of doing all sorts of this activity that's not consistent with good days or bad days. Uh, and what she told you doctor about what she could or couldn't do is not necessarily consistent with that log . So doctor, taking all of that into consideration, don't you think you're relying on the patient's subjective complaints and don't you think that they can actually do more? Particularly since we've got film that's inconsistent? Obviously doctors don't wanna be put in this type of situation, and more likely than not in that situation are likely to say, well, I agree with you. You know, I , I was wrong, I relied on their subjective complaints. Now, of course, if there's strong physical evidence on examination , uh, that's consistent with a diagnosis, then carefully, carefully complete the log, be consistent , um, expect potentially that you're gonna get surveillance , uh, but again, be be, be thoughtful about keeping that daily log. As I said, I would prefer at best a weekly log, and I would actually really prefer a cpet or a functional capacity examination. All of this is factually dependent and case dependent. Uh , and that's why I sometimes hesitate about diaries, not doing diaries, what you should do, because I think it's on a case by case basis. And when I have a claim that's been denied or terminated , um, we're talking about the law, keeping a law . If I represent somebody at the early stages of the case or their own on claim, we have that discussion about keeping a log. Should I, what should I do? That sort of stuff. So I'm sorry I can't give you ex , you know, a strong answer about keeping a , a diary, but you've got the benefit of my thoughts and again, case by case basis. I hope you've enjoyed this week's episode of Winning Isn't Easy and I would love it if you went and left a review that you liked our page, that you share it with family or friends, that you subscribe to this podcast. I look forward to talking with you in our next insightful episode of Winning Isn't Easy. Thanks.