Gastrointestinal Diseases in Disability Claims

Welcome to Season 3, Episode 14 of Winning Isn't Easy, the podcast that delves into the complexities of disability insurance claims. In this episode, we have a special focus on a critical topic: Gastrointestinal Diseases in Disability Claims.

Hosted by Nancy Cavey, a renowned disability attorney and your guide through the world of disability claims, this episode provides invaluable insights into the challenges faced by individuals with gastrointestinal diseases when navigating the disability claims process.

Join Nancy Cavey as she explores the intricacies of gastrointestinal diseases in disability claims. Drawing from her extensive experience, Nancy will share her expertise, knowledge, and strategies for successfully advocating for individuals with conditions like Crohn's Disease, Ulcerative Colitis, Irritable Bowel Syndrome (IBS), and Celiac Disease.

Throughout the episode, Nancy will discuss the medical evidence required to support a disability claim, the challenges of obtaining an accurate diagnosis, and how the symptoms of gastrointestinal diseases can impact an individual's ability to work. She'll provide guidance on how to effectively present your case to the insurance company and maximize your chances of a successful claim outcome.

Whether you are personally dealing with a gastrointestinal disease and considering a disability claim, or simply seeking a deeper understanding of this topic, this episode offers valuable information that can help you navigate the complexities of the disability claims process.

Tune in and join Nancy Cavey as she sheds light on this important subject, empowering you to navigate the challenges and secure the disability benefits you deserve.


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

Transcript

Nationwide ERISA Disability Attorney Nancy L Cavey: 0:12

Hey, I'm Nancy Cavey , national ERISA Disability and Individual Disability Attorney. Welcome to this episode of Winning Isn't Easy. Before we get started, I've gotta give you a legal disclaimer. This podcast isn't legal advice. The Florida Bar Association says I have to say this. So now that I've said it, I will tell you that nothing will ever prevent me from giving you easy to understand information about the disability insurance, world Games, the disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Now, today I'm going to be talking , uh, about Crohn's disease, celiac disease, and other gastroenterological diseases, how they interact with other disorders, and how they can impact your ERISA disability insurance claim. And I'm gonna touch on two things. The first I'm gonna touch on it are the six symptoms of Crohn's disease that ERISA disability carriers just don't get. And two, the relationship between celiac disease and autoimmune thyroid disorders and your long-term disability insurance claim. Before we get started on all that great information, I'm gonna take a quick break.

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Nationwide ERISA Disability Attorney Nancy L Cavey: 1:46

Welcome back. Let's talk about the six symptoms of Crohn's disease that ERISA disability carriers or plans just don't get. Now, Crohn's disease is a chronic condition that causes inflammation of your small and large intestines of the digestive tract. It's a type of inflammatory bowel disease i b s, and unfortunately it's not curable. Crohn's symptoms can wax and wane with periods of no symptoms, mild symptoms and severe flareups. This waxing and waning can be problematic from a proof standpoint. Disability carriers like to terminate or deny claims when policy holders or planned beneficiaries have a period of no symptoms or just mild symptoms. Keeping a diary of your symptoms is crucial. You're gonna wanna keep a log of the symptoms, the nature of the symptoms, the frequency of the symptoms, the duration of the symptoms, and how those symptoms impact your ability to function. So what I wanna see, for example, and the carrier is gonna wanna see is stomach pain, stomach cramps, diarrhea, whether or not you have bloody stools, fever , uh, and uh, whether you've got problems with fatigue. Now, when you are keeping a diary, I think it's crucial that you use a 24 hour day document when you have stomach pain and cramps together with what medication you took and your response to that medication. Now, if the pain or cramps were severe and you had to lie down, I think you should document that what you had to do, how long you were down, whether you were able to nap, and if so, for how long. Now, if you're having problems with fatigue, that's game two diary frequency and the nature of your stools can be embarrassing, but I think it's important because if you can't meet the pace and production requirements of work because you're running to and from the bathroom, then that's crucial. Now, if you're also using, depends , you wanna document that, but also discuss in your diary how that might modify your running errands or , uh, impact your ability to function. If you have episodes of fever, you should note those episodes with the temperature and what you did to try to bring that fever down. Now, I think that if you are having problems with all of your symptoms combined that impact your ability to sleep, we wanna document that. And particularly your need to nap documentation in my view is key. And I think you should be giving a copy of that document to your doctor at each visit asking them to keep a copy for their records. And you need to keep a copy of it because ultimately you're gonna be submitting it to the disability carrier. We don't want them to make unfound assumptions about your symptoms, how those symptoms impact your ability to function or how your symptoms impact your ability to do your own occupation or any occupation. It takes teamwork to get your disability benefits. Now, as I have said, the disability carriers don't understand this. And that's why it's important that not only in your medical records you are documenting these symptoms , uh, and you're giving this to your physician, but that you're also submitting it to the disability carrier. You're gonna be asked to complete activity of daily living forms, and the disability carrier is going to be looking at your medical records, your diary, and your activities of daily living forms. If there's inconsistency here, the disability carrier is gonna see on this as a reason to deny your disability claim. So we're looking for consistency and those activity of daily living forms don't , uh, exaggerate because exaggeration is just , uh, grounds for the disability carrier to argue that your physician is relying on the accuracy and completeness of your history and your symptoms. And if you are exaggerating, then your doctor's opinions about your restrictions and limitations , uh, is gonna be thrown out the window. So disability carriers and plans don't understand these symptoms that we've just discussed. They don't understand how they impact your ability to just do things around the house, and they certainly don't impact or understand how they impact your ability to do your own or any other occupation if you're at the own occupation stage. I think it's crucial that in your documentation that you're submitting either , uh, to your physician or in your statements to the disability carrier that you're talking about your occupational duties and how those symptoms impact your ability to do those. As I said, if you've gotta run to the restroom , uh, you are not gonna be able to keep on task or meet the production requirements of , of your , uh, occupation. If you're having severe symptoms, you may not even be able to go to work. If you're having problems with fatigue, you may also be having some issues with concentration. So we want to document, you wanna document how those symptoms impact your ability to function in your own occupation. If you're at the any occupation stage, I think there still needs to be a tie in between your symptoms and your functionality and your inability to do any occupation. Now at that stage, the disability carriers are trying to show that you can well work and do work in a sedentary position, which means sitting down all day. But if you've gotta get up and move around because of pain , uh, if you've gotta change positions, maybe get on the floor, maybe go take a nap, that's a problem. If you have to use the the restroom, obviously that's gonna impact your ability to do a sedentary job. So think about those symptoms that you have that would make it difficult, if not impossible for you to do a sedentary job. Make sure that those are documented in your medical records, in the information you're giving your physician, and of course, any statement or contact you're having with the disability carrier. Got it. Let's take a break.

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Nationwide ERISA Disability Attorney Nancy L Cavey: 8:08

Welcome back to Winning Isn't Easy. In the next segment, I'm gonna talk about the relationship between celiac disease and autoimmune thyroid disorders and your long-term disability insurance claim. Now, celiac disease CD is a small intestinal inflammatory disease that's immune mediated , uh, and it's a response that you will see in genetically predisposed individuals who consume gluten gluten's, a complex found in wheat and related grains such as barley rhinos . 1% of the Western population has celiac disease, which typically presents with gastroenterological symptoms apparent mal or uh , absorption, weight loss, even things like dermatitis. Now, many disability carriers or plans denies celiac disease claims on the basis that it can be controlled by diet and therefore it's not disabling. However, it's also associated with autoimmune thyroid disorders such as Hashimoto's thyroids, graves Disease, and other forms of thyroid disease. It's a multifactor disorder that's caused by immune system dysfunction. Now, there's epidemiological evidence of the interplay between genetic susceptibility and environmental triggers, such as infections, diet, iodine, smoking, and there seems to be a common genetic background , uh, between those who have these problems and immunological issues. Now, often the diagnosis of celiac disease will come before a diagnosis of autoimmune disorders , uh, and ultimately serological testing small intestine biopsies, genetic testing, E M A I G A I G C class , uh, antibody testing can help tease all of this out and it can prove whether you've got celiac disease and or thyroid disorder. So how does this all play into an ERISA disability claim? Well, when you apply for disability benefits, the carrier's gonna wanna see an objective basis for the diagnosis of the celiac disease and an autoimmune thyroid disorder. Since celiac disease is not in and of itself considered to be disabling, it's important that we're developing other medical conditions caused or contributed to by the celiac disease, or alternatively that the thyroid disorder has caused the celiac disease. So in addition to proving the diagnosis, we wanna prove the disabling symptoms of the celiac disease and any kind of thyroid disorder individually, and then in combination, because we wanna prove that you can't do the material and substantial duties of your own occupation or any occupation, that means you also gotta understand the definition of disability and occupation as defined by your policy or plan. Think backwards. What are the occupational duties that you have difficulty doing or can't do because of either disorder? And we wanna create a diary of those symptoms , uh, so that when you're asking the doctor to complete forms, they have a description not only of your occupational duties and the problems that you would be having doing those duties, but then they can connect that with the symptoms that you're having. They can correlate that. In fact, the symptoms are caused by the celiac disease or an , uh, autoimmune uh , disorder. They can provide an objective basis for that diagnosis. They can confirm that the symptoms you're having are causally related, and then they can in turn address the restrictions and limitations that you're having , uh, or require because of the combination of both disorders. Now, I think it's important that you keep a diary about your symptoms, what you're eating , uh, the fact that you are having di difficulty , um, regulating the disease , um, and so that the disability carrier plan can't, can't argue that it's controlled by diet, when in fact it can't necessarily be controlled by diet. And there are other factors that are , um, working together with that celiac disease. As I said, the autoimmune disorders , uh, that, that in combination make it difficult, if not impossible for you to perform your occupational duties or those of any , uh, occupation. You can see that it takes a teamwork work , uh, with you and your physician and if necessary, a disability attorney to help you get the disability benefits you deserve. Now, if your claim for celiac disease or uh , autoimmune thyroid disorders or any autoimmune disorders have been denied, remember under the ERISA statute you'll only have 180 days in which to file an appeal. That appeal is the trial of your case. It's important, I think, at that stage to retain the services of an experienced ERISA disability attorney. That attorney is gonna get a copy of the carrier's file. And what's important in that file, of course, are the adjusting notes statements that they've taken from you. Uh, but it's just as important are the, what I call liar for hire peer review medical reviewers who have reviewed your medical records and given the disability carrier plan a reason to deny your claim, no objective basis of the diagnosis, the restrictions and limitations aren't supported. This disease can be controlled by diet or modified lifestyle. You need to be able to address these objections in your appeal letter. Writing a letter that says I appeal doesn't cut it. You and your lawyer are gonna have to be working together to document, as I said, the objective basis of the diagnosis, the objective basis of the symptoms, establish why those symptoms are disabling, rebut the opinions of the liar for hire , peer review doctors, and then tie it all together with a vocational rehabilitation report that explains why it is you can't do one or more of the material and substantial duties of your occupation or how that term might be defined or the material and substantial duties of any occupation. You just can't throw it against the wall and say, here's my appeal. That's not gonna work because the disability carrier's gonna have 2 45 day periods in which to review your claim and either approve your claim or deny your claim. Maybe you have the rights to another appeal letter , uh, uh, and if you do, obviously you want to exercise that. But ultimately, a federal judge only gets to review what's in that carrier's claim file, their file materials, your file materials, including your appeal. So it all goes in. But once the record is closed, the appeal process is ended , nothing new can go in unless there's a court order by the judge, then maybe a social security decision. But you need to understand that it's crucial if your claim has been denied, that you're using this time to hire an attorney, have that attorney , uh, basically create the evidence that's needed to , uh, rebut the basis of the denial and submit a , a winning appeal because after that, it's too bad. So sad. I hope that you have learned a lot in , um, this episode and you've enjoyed it. If you have enjoyed it, please like our page, leave our review, share it with your friends and family, and of course subscribe. We love to have our viewers make comments. So if you have any questions or issues, contact us at 7 2 7 8 9 4 3 1 8 8. I look forward to talking with you in the next episode of Winning Isn't Easy. Thanks.