Winning Isn't Easy Season 3 Episode 39: More on ERISA Disability Claims and MS

Welcome to Season 3, Episode 39 of "Winning Isn't Easy"! 🎙️

In this enlightening episode, your host, Nancy L. Cavey, continues to explore the intricacies of ERISA (Employee Retirement Income Security Act) Disability Claims, with a specific focus on multiple sclerosis (MS).

In this episode, you'll discover:

🔍 A deeper dive into the unique challenges and considerations when pursuing ERISA disability claims related to MS.
📋 The importance of comprehensive medical documentation and evidence in building a strong case.
🤝 Tips and strategies for effectively advocating for your disability claim, particularly in the context of MS.

Nancy will leverage her extensive expertise in disability law to provide valuable insights and guidance for individuals and their representatives who are navigating the complexities of ERISA disability claims linked to multiple sclerosis.

Whether you or someone you know is affected by MS or you're a professional assisting clients in similar situations, this episode offers essential information to help you navigate the often challenging landscape of disability claims.

Tune in to Season 3, Episode 39 of "Winning Isn't Easy" to gain a deeper understanding of ERISA Disability Claims and MS. 📻🔍

Resources Mentioned In This Episode:

LINK TO ROBBED: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO PROFESSIONAL BOOK: 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 free 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 and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Speaker 1: 0:00

<silence>

ERISA Attorney Nancy L. Cavey: 0:11

Hey, I'm Nancy Cavey national ERISA, and individual disability attorney. Welcome to Winning Isn't Easy. Before we get started, I've gotta give you a legal disclaimer. This podcast is not legal advice. The Florida Bar Association says I have to say it, so I have said it. However, nothing is gonna prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to know to get your disability benefits. So off we go. Today I'm gonna be exploring more about Multiple sclerosis , uh, and I get a , a lot of multiple sclerosis questions and claims. I work closely with the Multiple Sclerosis community , uh, here in Florida, and I want you to , uh, understand the basis of an MS claim because I think there's always more to discuss. Uh, and so let's get started. Um, I'm gonna talk about three specific topic topics, what you need to know about the Multiple Sclerosis Impact Scale Motor Component, and the Multiple Sclerosis Walking Scale, and your ERISA disability claim. The bowel symptoms of multiple sclerosis and your claim and relapses that are found to drive disability claims in the first year of ms. Got it. We've got a lot to talk about today, but we're gonna take a short break.

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ERISA Attorney Nancy L. Cavey: 2:00

Welcome back to Winning Isn't Easy. What you need to know about the Multiple Sclerosis Impact Scale Motor Component and the Multiple Sclerosis Walking Scale and your ERISA disability claim, progressive Multiple Sclerosis MS is characterized by impairment of motor and walking function, and it gets worse over time. If you have an ERISA disability claim , uh, you are going to start out by filing a claim where you have to prove that you can't perform your own occupation. And I think that it's very important that you review your medical records before you stop work and apply for benefits, and of course, that you have the support of your doctor. That's crucial because the disability carrier is part of an application process, is going to closely review your application, your medical records, and the attending physician statement form that your doctor has completed. Now, what's important about this I is that disability carriers are always looking for an objective basis of the diagnosis of MS and testing that corroborates the extent and nature of your functional restrictions and limitations. Now, there are two tests that the disability carrier might look for in your claim. The first is the meta , the Multiple Sclerosis Impact Scale motor component m ms IS dash 29, and the multiple Sclerosis Impact Scale Motor component MSS WS dash 12. And this is part of the ex , uh, expanded disability status scale EDSS . You may know that EDSS is a clinical tool that's used to evaluate ms , uh, and, you know , regularly used by , uh, doctors in not only the diagnosis, but in determining functional restrictions and limitations. Now, both of these tests are patient self-reported questionnaires, and they're used to try to get a sense of your reported disability and in particular, your motor function and how your motor function , uh, has deficits have progressed. This tool I think, is very helpful to understand the progression of MS and, and helps your doctor with treatment options, but I also think that it can help , uh, prove to a disability carrier the progression of your motor function issues. However, I'm gonna flip it a little bit in that sometimes disability carriers, I think, are looking for these kinds of tests so that they can create a reason to deny or terminate claims. They're gonna cherry pick your medical records and your reports of activity of daily living looking for inconsistencies. So if you say to your doctor or report that you have trouble walking, but you say on your a DL forms that you go golf or you walk the dog, the carrier's gonna be scratching their head saying, isn't this inconsistent? Now that's important because your doctor is relying in part on your self report in assigning the restrictions and limitations. And if you're inconsistent, the carrier's gonna say to the doctor, you know , look, this person isn't truthful, and change those restrictions and limitations. So honesty and consistency is the key to getting your benefits, but I think honesty and consistency in reporting to your doctor when you're doing these self-reporting testing, it is important because the doctor is going to be relying not only on your report , uh, and your exam findings to, to consider whether there's been a progression and to come up with a treatment , uh, regimen. Again, consistency is is crucial. So please be truthful and your self-report to your physician and of your symptoms and the progression of those symptoms. Got it. Let's take a break . Welcome back to Winning Isn't Easy. Let's talk about the bowel symptoms of MS and an ERISA disability claim. Now, many long-term disability policy holders who have MS are often reluctant to talk about the bowel symptoms. There's a stigma associated with bowel control. I mean , we've had it drilled into our heads since we were little kids that we have to maintain bowel control and, you know, if you've had an accident, you're embarrassed about it. Uh, and so you may be reluctant to talk about it. Uh, but that's important because two thirds of MS patients have bowel symptoms that can include constipation, diarrhea, a reduced ability to control bowel movements. All of those things are important. Now, research shows that bowel symptoms are 4.6 times higher among women with MS than men. But regardless of your sex, these symptoms can impact your ability to perform your own occupation or any occupation , uh, uh, so you might therefore have a ERISA disability claim. If you've covered, I know that you don't like to talk about those issues. Nobody wants to tell their doctor about these problems that they can't control their bowels. Um, but it's really crucial for several reasons. One, bowel symptoms are , uh, just one of the disabling many disabling symptoms of ms. And your doctor needs to know about that, not only because of the progression of the disease, but for treatment options. But from an ERISA disability claim, you might have to use the restroom frequently. You might be in the restroom for more than five minutes at a time. You may have to stop presentations or meetings or even bring a change of clothes because of the nature of your , um, bowel problems. All of that is really important , uh, in a , in an ERISA disability claim. And of course, it's important for your doctor. There is a self-reported questionnaire form called the Neurogenic Bowel Dysfunction Test, NEBT , that's used by physicians to help screen patients who have bowel symptoms. And it can be a tool that can be used to avoid having that face-to-face conversation with your doctor. Now, I think from a health standpoint and from a disability insurance claim that it's really important that you're being honest with your physician about the nature of these problems and that you're giving an interval history between each visit of your symptoms and how those symptoms are impact your ability to function. And it can get pretty detailed. It might be that you, and quite frankly, you should be giving a doc your doctor a history of whether you're having problems with diarrhea, how often you're having those problems, what the symptoms are before you have those episodes, how long the episode lasts, whether or not you eat or not eat before you have a symptom. Uh , the symptoms , um, how long you're in the restroom , uh, whether you continue to have pain after you've had a bowel movement, what impact that has on your ability to do things around your house. Do you have to take breaks? Does it impact your ability to go to the grocery store? Um , do you have pain that impacts on your ability to concentrate? Um, how long does it take to clean yourself up? Do you have to use protective devices? Like depends . All of this, I know, I know it's difficult to talk about, but your doctor is gonna wanna know about that to help formulate a treatment plan and it will support your eris a disability claim. So I think it's very important to be giving a good interval history of your symptoms. If possible, write this information down and give it to your physician and keep a copy for your ERISA disability carrier. Please don't let the embarrassment of bowel problems , um, prevent you from being truthful with your doctor or being truthful with a disability carrier. Look, the this is just part of the disease process and being honest will help you get your disability claim , uh, and your benefits a , a approved. Got it. So let's take a break.

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ERISA Attorney Nancy L. Cavey: 10:53

Welcome back to Winning Isn't Easy . I wanna talk about relapses that are found to drive disability worsening in the first years of a multiple sclerosis diagnosis and how that can impact your eris a disability claim. I will tell you that people who have relapsing remitting MS can have a difficult time getting eris a disability benefits because of the nature of the disease or their flares, their symptoms will suddenly worsen with periods of remission where their symptoms can ease or even disappear entirely. Disability carriers are quick to take the position that during a remission, you're not disabled, you're not entitled to your benefits and voila, we're denying the claim. So how do these relapsing and remitting episodes play into a disability carrier's hands? Um, this can be confusing in that relapses can directly cause a worsening of disability and you might have worsening symptoms or you might have new symptoms. And those symptoms, regardless of whether they're old or new, can last for a longer period of time after the relapse has ended, or the whole MS disability picture can worsen independent of a relapse activity. So there's no apparent rhyme or reason to when the symptoms ease or disappear. That plays again into this issue of are you disabled or not ? And they're gonna take advantage of the relationship between the nature and frequency of the relapses and flares because they expect everybody's gonna have a continuous longitudinal disability or progression and life doesn't work that way . I think there's a recent study that is helpful , uh, in these , uh, relapsing , uh, remitting MS claims, and particularly in the early years. Um, this study shows an association between disability progression, relapses, and treatment. Uh, and it's , uh, called , uh, is a rather a study that was published in Scientific reports. Uh, Australian scientists analyze data on patients' relapse activity and disability progression. And according to this article , uh, which is found in Multiple Sclerosis News dated July 31st, 2023, they say that relapses that occur in the first few years after the disease develops has a strong impact on the rates of disability worsening. But after two and a half years, more relapses don't consistently result in a greater worsening of disability. So this study is showing , uh, that patients who have more disability worsening are likely to experience relapses and associations, and that doesn't change over time. The number of , uh, episodes that occur within the first two and a half years of the MS onset are a strong indicator of the dis disability worsening. So how does that work? Well, obviously you may not be quote unquote disabled under the terms of the policy when you're initially diagnosed. You wanna work as long as you can and , and you're physically and cognitively able to do. But at some point as the disease progresses, you may be thinking about applying for your ERISA disciplinary benefits. Obviously, it's important that you're reviewing your medical records to see what your doctors have to say, and part of that review involves a review of your report of the symptoms and how those symptoms are progressing, how often you're having the relapsing remitting episodes, whether there are is a worsening of the old symptoms, or those old symptoms last longer before , um, they , uh, remit. It might be that you have new symptoms and you need to discuss with your doctor what those new symptoms are, how long they've lasted, and what impact that has on the old, if you will, symptoms that you've had. And you also are going to be wanting to talk about the impact of treatment that you are getting , um, uh, and what impact that's having on these episodes, how long they're lasting, not lasting, and any side effects of medication. Obviously, it's the frequency of these episodes is important as documented in , uh, this particular study. So please give a very careful , uh, and thorough interval history because we don't want the disability carriers to seize on a period of time in which your MS symptoms have relapsed as a reason to justify a claims denial. I hope you've enjoyed this week's episode of Winning Isn't Easy. If you've enjoyed this episode, please like our page . Please leave a review, please share it with your family and friends, and of course, subscribe to this podcast. That way you're gonna get notification of every new episode. I look forward to having you tune in next week for another insightful episode of Winning Isn't Easy.