More on Parkinson's Disease - Exploring Parkinson's Disability Claims Further

Welcome to Season 4, Episode 21 of Winning Isn't Easy.  In this episode, we'll dive into the complicated topic of "More on Parkinson's Disease." 

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses Parkinson's Disease further, including an overview of the illness, plus a dissection of the evaluation process used in every Parkinson's Disease disability claim. While Parkinson's Disease, on the surface, seems like a disease primed for an easy disability claim win, that couldn't be further from the truth. Much the same as any other illness, disability carriers do not make it easy for those with Parkinson's Disease, especially during the early stages of illness, to get the disability benefits they deserve. Today, your host Nancy L. Cavey discusses the must-knows of Parkinson's Disease disability claims.

In this episode, we'll cover the following topics:

1 - What You Need to Know About Parkinson’s Disease, and Steps One - Three of the Evaluation Process Used by Every Disability Carrier in a Parkinson’s Disease Claim

2 - Steps Four - Six of the Evaluation Process Used by Every Disability Carrier in a Parkinson’s Disease Claim

3 - Stress and Your Parkinson’s Long-Term Disability Insurance Claim

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


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

Speaker A [00:00:15]:
 Hey, I'm Nancy, KV, national ERISA and individual disability attorney. Welcome to Winning isn't easy before we get started today, I've got to give you a legal disclaimer. This podcast isn't legal advice. The Florida Bar association says I've got to say it, so now I've said it. But nothing will ever prevent me from giving you an easy to understand overview of the disability insurance company world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Now, I know that you've purchased a disability insurance policy through your employer or on your own to provide you and your family with peace of mind if you became disabled. That's what my dad did, and ultimately he had to apply for his disability insurance benefits because of leukemia.
 
 Speaker A [00:01:00]:
 So I've been where you're at. Unfortunately, I will tell you that disability carriers will rarely pay Parkinson's disease cases in the early stages of PD. We've done an episode earlier on Parkinson's disease, but this episode is going to provide you with some new and different information as the disease and its relationship to disability claims, like many other illnesses, is ever changing. And I'm going to talk about three things today. One, what you need to know about Parkinson's disease and steps one of the three evaluation process that the disability carriers will use in Parkinson's disease cases. And I'm going to then talk about steps four through six of the evaluation process used by disability carriers in every PD case. And then lastly, I'm going to talk about the impact of stress on your Parkinson's long term disability claim. So I'm going to pull back the curtain for you in this episode and explain to you the six steps the disability carriers will use in evaluating every PD claim.
 
 Speaker A [00:02:04]:
 Got it? All right, let's take a break for a moment before we get started.
 
 Speaker B [00:02:10]:
 Have you been robbed of your peace of mind from your disability insurance carrier? You owe it to yourself to get a copy of robbed of your peace of mind, which provides you with everything you need to know about the long term disability claim process. Request your free copy of the book@kvlaw.com today.
 
 Speaker A [00:02:29]:
 Welcome back to winning isn't easy. Ready to get started? What you need to know about the first three steps that disability carriers will use in the evaluation process to determine whether or not they're going to pay your PD claim. Parkinson's is a gradual but progressive disorder of the central nervous system, and it affects your movement. In the early stages. It may start with barely noticeable tremors in just one hand, little or no facial expression, or your arms may not swing when you work. Now, we know that PD can be difficult to diagnose in early stages because you've traveled down this diagnosis journey, but that will work to the advantage of disability carriers who are always looking for reasons to deny benefits. Now, of course, as your condition progresses, unfortunately your symptoms are going to worsen, but the progression will vary from person to person, and disability carriers rarely consider how these symptoms progress or how your symptoms have progressed. So let's talk about the evaluation process that's used by disability carriers in every PD case.
 
 Speaker A [00:03:35]:
 Number one, they're going to ask, is your Parkinson's disease a pre existing condition? Now, every disability policy or plan has a pre existing condition clause. This clause says if you become disabled within a certain period of time after you become covered under the policy, your disability is going to be considered a pre existing condition. This is called a look back period, and if you get treatment for your disabling PD during this period of time, the carrier legally does not have to pay your benefits. So it's crucial that you understand how this pre existing condition clause works because you can't pick the wrong date to become disabled. If you do, I can't fix it and no other ERISA disability attorneys can be able to fix it. So they're going to look at when did this policy become effective and what's the look back period? 60 days? 90 days? And whether or not you got treatment in that period of time. If so, they'll use that as a legal basis to deny your claim. And if we don't have this look back issue, then you're great.
 
 Speaker A [00:04:36]:
 But here's the step. That is the next step. Step two, is there objective medical evidence that's the basis of the PD diagnosis. Now, many disability policies or plans require that there be objective medical evidence of the diagnosis, and preferably that diagnosis coming from a PD specialist. So it is crucial, in my view, that you give an accurate history of your symptoms at every visit. What are those symptoms that I would be looking for and that the disability carrier plan is looking for? Uncontrolled tremors, muscle stiffness, an inability to make voluntary movements, impaired posture or balance, the loss of automatic movements, including blinking or smiling, changes in your speech, changes in your handwriting, difficulty concentrating, cognitive issues and depression. The disability carrier is going to look closely at your medical records. They want to make sure that there's a history of your symptoms, but they're also going to look for the progression of the history of those symptoms.
 
 Speaker A [00:05:33]:
 They're going to look at the diagnostic findings and the exam findings, to ask whether or not there is consistency with a diagnosis of Parkinson's. Now, of course, they're also going to be looking for objective medical testing such as mris, to document the presence of PD. But of course in early stages you don't always see that. So remember that. Now what's step three? Your doctor may have given you restrictions and limitations. And at step three the question is, is there objective evidence, medical evidence? That's the basis for the restrictions and limitations assigned by your doctor. So the carrier says, okay, well, we've got a diagnosis, who cares? Because unless they have restrictions and limitations, it doesn't matter because the test is whether or not they're unable to do the material and substantial duties of their occupation. You'll see all over claims, denials and court decisions that a diagnosis alone is not sufficient to obligate the disability carrier to pay benefits.
 
 Speaker A [00:06:32]:
 So the question becomes, what are the restrictions and limitations? Your doctor is going to be asked to complete some forms called attending physician statement forms explaining and outlining your restrictions limitations. Unfortunately, there's no uniform AP's form. Every carrier has their own, but no carrier has one that's specific to any disease, much less PD. These forms are designed on purpose to have your doctor say that you can work in some capacity and certainly if you're at the any occupation stage, that you can do sedentary work. Why? Because if you can do sedentary work, you may not be disabled under the terms of your policy, when we get to paying any occupation benefits. Now the AP's form is going to ask your physician to explain the objective basis of the restrictions limitations that can be really tough based on the nature and progression of PD symptoms, the fact that you have good days and bad days, or your reaction to various medications. I think one of the ways to help your physicians complete the AP's form is to explain at each visit what your symptoms are and how those symptoms impacted your ability to function. And of course, I always supplement that AP's form with a Social Security disability residual PD form because that's the form that asks the right questions.
 
 Speaker A [00:07:51]:
 Got it? All right, now you understand the first two and three reasons why disability carriers will play the denial game in looking at a PD claim. Let's take a break. Back to winning isn't easy. We're going to talk about the steps four, five and six of the claims process, the claims evaluation process used by disability carriers or plans in a PD claim. Step four. Is there a causal relationship between the Parkinson's diagnosis and the assigned restrictions and limitations and your inability to do your own or any occupation. Now, this may sound stupid, but this is how the disability carriers or plans think. Look, the NFL is full of football players that have herniated discs in their neck or their back and they're still all playing football.
 
 Speaker A [00:09:22]:
 So who cares that you've got a diagnosis of a herniated disc? Or in this case, who cares? You have a diagnosis of Parkinson's disease because you have the burden to prove that there's a causal relationship between your PD diagnosis and the assigned restrictions, limitations, and your inability to do your own or any other occupation. In other words, you might have PD, you might have restrictions and limitations, but those restrictions and limitations do not preclude you from an inability to do your own or any occupation. So we've got to tie all of this together. The residual functional capacity form that I use in my Social Security PD cases, I think asks the right questions regarding these issues. The carrier's AP's form attending physician statement form doesn't ask the right questions on purpose because they don't want to know the right answer because if they know the right answer, they might have to pay your benefits. So I always ask my clients to give the doctor both the AP's form and the Social Security residual functional capacity form because I want to make sure it's accurate and complete. And I want you to be giving your doctor a history of your symptoms and functionality so that they can address the restrictions and limitations. Now, what the carrier is going to do is have their medical unit, their liar for hire doctors review the file and the AP's forms to determine your real restrictions and limitations.
 
 Speaker A [00:10:46]:
 They don't have to accept what your physicians had to say, and they will have a hired medical gun say there's no objective basis for the restrictions and limitations. Once they've done that, they're setting themselves up for the next stage of a carrier denial. They're going to send the file to their internal liar for hire vocational evaluator. They're going to try to determine what your occupation was at the time you became disabled, the physical duties or cognitive duties of your occupation, and whether or not you can perform those occupational duties based on the restrictions and limitations. Again, you've got to show that cause a relationship between the diagnosis and the restrictions and your inability to do your own or any occupation. In this analysis, what's also crucial is what's your occupation? Your policy may provide that the carrier gets to determine your occupation based on an outdated book called the Dictionary of Occupational titles. The definition may not be how you perform your occupational duties for your employer in the local economy. So you got to understand what the definition of occupation is that's being used because you're going to back into that in terms of your description to your doctor about your occupational duties and your symptoms.
 
 Speaker A [00:11:58]:
 But I also want to let you know that disability carriers often misclassify a person's occupation. So you need to be prepared for that. They may say that your duties don't involve. Well, let's say they may say that your job is sedentary in nature when in fact your job requires you to travel. So they will cherry pick the description of the occupation to either misclassify it or basically say it's a completely different occupation than the occupation you were performing. Now, you also need to understand that the definition of occupation is going to potentially change. And what do I mean by that? The definition of disability is going to change from an inability to do your own occupation normally it's for two years, to a definition of an inability to perform any occupation by virtue of your education, training, and experience. Many disability carriers actually have definitions of the terminal, any occupation.
 
 Speaker A [00:12:57]:
 So you need to get that definition out. You got to be familiar with both, because again, when the definition of disability changes from an inability to do your own occupation to any occupation, the carrier is going to re evaluate your whole claim. They're going to look at your diagnosis, your restrictions, limitations, whether or not there's this causal relationship between your inability to do your restrictions, limitations and an inability to do any occupation. And if they can plug you into a sedentary work capacity, that's going to mean a claims denial. Now, this is not a real world test, and often the carrier is going to determine that you can do sedentary work just to deny your benefits? Yes, just to deny your benefits. Step five. What do you say about your activities of daily living on your form? And is that consistent with your medical records or what you tell the adjuster during a call? Carriers are in the business of collecting premium dollars and not paying your benefits. They're going to look at what you put on that activity of daily living form, the ADL form, and they're going to compare that with what's in your medical records.
 
 Speaker A [00:14:05]:
 And don't be surprised if you get a not so friendly call on a regular basis from the carrier checking up, and they may even put surveillance on you. So if you're getting calls that are beginning to be annoying and harassing, if they want to take your statement where you suspect surveillance. It's time for you to call and experience the risk of disability attorney because you're getting set up for a claims denial. How about step six? Step six? Does the policy limit how long the carrier has to pay benefits? Now, this can be problematic because there are some policies that say, look, we will only pay you benefits for two years, and if your medical condition is based on a subjective medical condition, we're not legally obligated to pay any more benefits than two years. And sometimes that subjective condition limitation is so broadly drawn that it may have language that says that a medical condition is characterized by pain or stiffness is limited to just two years, or they may actually even list PDE as one of the conditions in which benefits are limited to just two years. And that's crap, but that's what the policy says. Additionally, there might be a mental nervous policy limitation that says, look, if your disability is caused or contributed to ever so small my version of the Monty Python wafer thin mint, then you have a situation where your benefits are only going to be limited to two years. If you've got that contributed to cause.
 
 Speaker A [00:15:44]:
 It's not uncommon for people who have PD to be depressed or anxious or to have other psychological issues. And if your disability is contributed to just so slightly by any of those conditions, your benefits are limited to just two years. So the disability carrier is going to use that policy limit in their toolbox of claims denial tools and their analysis to say, okay, well, maybe we'll pay benefits, but we're going to deny this claim in two years because of the subjective medical condition clause or the mental limitation clause. And sometimes they're even bold enough to tell you that got it? Let's take a break.
 
 Speaker B [00:16:21]:
 Are you a professional with questions about your individual disability policy? You need the disability insurance claim survival guide for professionals. This book gives you a comprehensive understanding of your disability policy, with tips and to dos regarding your disability application that will assist you in submitting a winning disability application. This is one you won't want to miss. For the next 24 hours, we are giving away free copies of the disability insurance claims survival guide for professionals. Order yours Today@disabilityclaimsforprofessionals.com. dot.
 
 Speaker A [00:17:18]:
 Welcome back to winning isn't easy stress and your Parkinson's long term disability insurance claim acute stress, be it financial, mental, or even physical stress, can worsen the motor symptoms of PDE. That means the stress can make the freezing of your gait, the tremors worse, and can even accelerate the progression of your PD. Chronic stress can also worsen the non motor PD symptoms that can increase your anxiety and depression. And of course, that can be problematic if you have a disability insurance policy or plan with a broadly written mental nervous condition limitation. What is a mental nervous limitation in a disability insurance policy or plan? Now, many disability policies or plans have a specific provision. Open up yours. You'll see it that say, look, we're only going to pay disability benefits for two years, and these policies or plans will come in two flavors. The first is the mental nervous condition limitation that limits the payment of disability benefits to just two years if your disability is caused by a mental or nervous condition like depression or anxiety.
 
 Speaker A [00:18:27]:
 Now, I know that it's often a combination of the motor and non motor PD symptoms that are disabling. And we can generally get around this type of a mental nervous limitation by establishing that the disability is caused by the organic physical findings. That's the disability. It's not the anxiety or depression. What's disabling are the physical manifestations of PDE. But the more problematic issue can be what I call the Monty Python mental nervous policy limitation that will limit the payment of benefits to just two years if your disability is caused or here comes the language contributed to by stress, anxiety or depression. It's the contributed to language that's problematic. And just the smallest contribution will result in the disability carrier terminating your benefits after two years.
 
 Speaker A [00:19:25]:
 In other words, if your stress, depression or anxiety is just 0.01% of your disability, that contribution can limit benefits to just two years. Now, there's been some recent medical literature on stress and Parkinson's that I want to address. There's a recently published study in the journal Parkinson's disease called stress and mindfulness in Parkinson's disease. It's a survey of 5000 patients and it was published by Vanderheide Speckins in 2021. And it addressed a number of topics that are relevant to a disability claim. So these include the topic of do people who have PD have more stress? What are the PD symptoms that are more sensitive to stress? And what strategies can help reduce stress if you have PD? Now, what this study revealed was that people with PD scored significantly worse than those without PDE in nearly every category, including anxiety, perceived stress and depressed mood. Now, unfortunately, practically every PD symptom, be it sleeping problems, depression, freezing of the gate, bradykinesia, can be made worse with stress. And according to the study, people with PD also added to the list of stress symptoms, things like cognitive impairment, loss of focus, emotional issues, confusion, impaired executive functions, speech and communication issues, and even pain.
 
 Speaker A [00:20:54]:
 Now, while the practice of mindfulness and physical exercise improve these PD symptoms. Nonetheless, if your doctor is saying in the medical records that your stress is contributing to your symptoms both physically and psychologically, that can play into this mental nervous limitations so what are the practical implications of stress on your disability claim? As I've said, more often than not we have to start with the policy plans or provisions regarding the nature of what this is. Is it the broadly drawn one or is it the one we really need to concern ourselves with? And that is the contributor to language. It doesn't matter that you're legitimately depressed or anxious because of your PD diagnosis or symptoms. Even that smallest contribution is going to limit your benefits. So you've got to be careful. Again, quite frankly, and unfortunately, I think in describing your symptoms and or having your doctor comment on the impact of stress, anxiety or depression, I would prefer, if it's accurate and true, that they say that your disability is not contributed to by these problems, but that your disability is caused by the physical or cognitive manifestations of PDE. Now this can also be problematic, of course, is going to be if you have a Social Security disability claim.
 
 Speaker A [00:22:20]:
 Many disability policies or plans require that you apply for disability, Social Security disability benefits. Many times disability carriers will suggest that they use a representative. I can't name them, but you know who they are. And unfortunately, what these providers will do is to provide you with Social Security assistance in, in developing your claim. And as part of that, in addition to developing the PD, they purposely develop psychiatric issues, depression, stress, anxiety. And certainly while that can be the basis of a Social Security disability claim, it's going to come back and bite you because the disability carrier will get that decision and say, oh, well, we have a caused or contributed to policy here. Social Security disability claim was on the basis of not only PD, but anxiety or stress or depression. And the judge or Social Security said that, you know, they were disabled in part because of that.
 
 Speaker A [00:23:12]:
 That plays in right into the carrier's hands, if you will, in denying a claim. So when I have a PD case and I have a contributed to policy language, I have to have a strategy decision with my client. Are we going to allege as part of the Social Security claim that any of these psychological issues are the cause of the disability? I generally don't suggest that we do that because I know that that's potentially going to result in a claims denial or termination by the disability carrier. And so they've got to do some strategy that involves looking at the policy or the plan, looking at the medical records as to what it says in terms of stress or anxiety or depression. That includes looking at any psychological records and then I having a discussion with your providers to see what their opinion is about caused or contributed. Is the psychological issues or the stress contributing to your disability, or is it all essentially organic? Obviously, this takes teamwork with not only your physician and you, but an experienced ERISA disability attorney. This is a challenge in PD cases and one that you should not take lightly because I don't want you to wake up two years into a claim and find that your benefits have been denied because of the mental nervous limitation. Got it? All right.
 
 Speaker A [00:24:39]:
 I hope you've enjoyed this week's episode of Winning isn't easy. If you've enjoyed this episode, consider liking our page. Please leave a review, please, or share it with your friends and family. Better yet, please subscribe to this podcast. That way you're going to be notified every time a new episode drops. I hope you tune in till next week's episode of Winning isn't easy. Thanks.