Winning Isn't Easy: Long-Term Disability ERISA Claims
Nancy L. Cavey, a seasoned attorney with over thirty-nine years of experience, explains the complex world of filing for Long-Term Disability benefits. Filing for disability can be a confusing, life changing event, so with her deft expertise, Nancy will guide you through:
- The ins-and-outs of ERISA (the Employee Retirement Income Security Act), which governs group Long-Term Disability Claims.
- Information regarding the process and lifespan of a claim, from the initial application to the request for hearing stages.
- Traps and tactics disability carriers (such as UNUM, The Hartford, Lincoln, and MetLife) use to hinder or deny your claim, including independent medical evaluations, surveillance, and arbitrary and capricious arguments downplaying the nature of your disability.
- Insights, overviews, and claimant stories regarding disease-specific content (ranging from commonplace ailments such as workplace injuries or accidents, to difficult to diagnose illnesses such as Fibromyalgia, Multiple Sclerosis, and POTS).
- Pertinent news happening in the disability world, and
- Much, much more.
Each episode of our podcast Winning Isn't Easy will expose you to invaluable tips and tricks for surviving the disability claims process (a system that is often wrought with pressures and pitfalls designed to encourage you to give up the benefits you rightfully deserve). As host, Nancy will often be joined by guest speakers who themselves are industry experts, ranging from lawyers specializing in related fields and doctors focusing on the diagnosis and treatment of specific diseases, to our associate attorney Krysti Monaco.
In her late teens, Nancy's father was diagnosed with leukemia. As someone who witnessed firsthand the devastating emotional and financial impact on both individual and family that being disabled and filing for benefits can have, Nancy is not just an attorney, but an empathetic presence who understands what you are going through.
Do not let disability insurance carriers rob you of your peace of mind. As a nationwide practice, The Law Office of Nancy L. Cavey may be able to help you get the disability benefits you deserve, regardless of where in the United States you reside. Remember - let Cavey Law be the bridge to your benefits.
Check out the links below to engage with us elsewhere:
Website - https://caveylaw.com/
YouTube - https://www.youtube.com/user/CaveyLaw
Winning Isn't Easy: Long-Term Disability ERISA Claims
ERISA Disability Claims - What Celebrities Can Teach You
Welcome to Season 4, Episode 25 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "ERISA Disability Claims - What Celebrities Can Teach You."
Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses what the disability cases of certain celebrities can teach you about the ERISA disability claims process. Celebrities; they're just like us. We might view celebrities or social influencers as being invincible, which simply isn't true. While they might be able to afford better medical care than the average man, celebrities are not impervious to illness or accidents; just see Lady Gaga discussing her struggles with migraines in Nurtec advertisements. In this episode of Winning Isn't Easy, Nancy L. Cavey will explore three celebrities and their illnesses to give you, the listener, an insight into claiming disability.
In this episode, we'll cover the following topics:
1 - What You Can Learn from Keala Settle, and Getting Your ERISA Disability Benefits for Moyamoya Disease
2 - What You Can Learn from Jimmy Buffett, and Getting Your ERISA Disability Benefits for Merkel Cell Carcinoma
3 - What You Can Learn from Natalie Merchant, and Getting Your ERISA Disability Benefits for Spinal Degeneration with OPLL
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/
Need Help Today?:
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.
Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.
Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.
Speaker A [00:00:15]:
Hey, I'm Nancy Cave, a national ERISA and individual disability attorney. Welcome to Winning isn't easy. Before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to tell you this. So now I've done that. And I will tell you that nothing will 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 the disability benefits you deserve. So off we go.
Speaker A [00:00:50]:
No one is immune from illness, sickness or disability. You might think that there are certain celebrities or cultural influencers that are invincible, but of course they are human and they're subject to being sick or being in accidents or becoming disabled. So today I want to look over three particular cases and discuss what you can learn about these celebrities who have different diseases and how the lessons are applicable to your ERISA claim. We're first going to talk about what you can learn from Chela settle and getting your erythidic ability benefits from Moya Moya disease, what you can learn from Jimmy Buffett in getting your ERiSA disability benefits for Merkel cell carcinoma, and what you can learn from Natalie Merchant and getting ERiSA disability benefits for spinal degeneration with op l l got it. Let's take a quick break before we get started.
Speaker B [00:01:48]:
Robbed of your peace of mind by 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 claims process. Request your free copy of the book@kvlaw.com today.
Speaker A [00:02:12]:
Welcome back to winning isn't easy. What can you learn from keyless settle and getting your EriSa disability benefits from Moya Moya disease? Great Showman star Key list was diagnosed with Moya Moya disease when part of her tongue. Now after taking anti seizure medication and undergoing brain surgery and physical therapy and cognitive therapy, she's got a new lease on life. I wonder though, if she had a disability policy and applied for her disability benefits. If you have a disability insurance policy, I want to talk with you about getting ERISA disability benefits from disease. Now Moyamoya disease is a rare but chronic progressive condition of the arteries of the brain that lead to disability. The narrowing of the blood vessels lead to blockage and that will cause ischemic strokes, hemorrhagic strokes and seizures, resulting potentially in a disability insurance claim. So what do you need to know about filing a claim for ERISA disability benefits.
Speaker A [00:03:17]:
If you have a disability policy through your employer, most likely it's going to be governed by a federal statute known as ERISA. Now, there are some exceptions. If you work for a governmental entity, be it a state, a county, a school board, or you work for a church that's covered under a church plan, most likely your policy is going to be governed under the ERISA statute. In those exceptions, you will have a claim which is really where you want to be. And if you have your own disability policy that you've purchased on your own, that's called an individual disability policy that will be governed by state law. But I'll tell you, regardless of what law governs, be it state law or ERISA law, disability carriers tend to take the same approach. So what's the approach that they would take in this case? Well, as I said, this is a rare blood vessel disorder that can cause blockage of the carotid artery. That blocked blood flow, can cause tiny blood vessels to develop at the base of your brain, and it's your body's way of trying to supply your brain with blood.
Speaker A [00:04:31]:
These tiny blood vessels are called moyamoya disease. Moyamoya is a japanese term that refers to a hazy puff of smoke or a cloud, and that's exactly what the blood vessels look like on a scan. The disability carriers, of course, are going to want to see a scan to confirm the diagnosis of Moya moya disease. One of the many complications of moya Moya disease is transient ischemic strokes, and a stroke, in turn, can result in a number of residuals. There could be a visual impairment, cognitive impairment, physical impairment, including problems with balance, coordination, any of which can be disabling. So it's often the complications of the stroke that will result in a disability claim. The disability carrier is going to get a copy of your medical records. And of course, they want to see the diagnosis of the Moya moya disease, or the complications of the Moya Moya disease, including stroke complications.
Speaker A [00:05:35]:
So let's talk about those. Not only should your medical records, as I've said, document the diagnosis of Moya Moya disease, but your records should also document that you've had a stroke and the complications of that stroke. I assure you that the carrier is going to closely review your medical records for the following. You're going to be looking for symptoms of weakness, numbness, or paralysis of your face, arm or leg, visual impairment, trouble speaking, which is known as aphasia, headaches, involuntary movements, and cognitive issues. It's these complications that will win your disability claim so you want to make sure that you're giving your doctor an interval history at each visit of each one of the symptoms that you have, and I how those symptoms impact your ability to function. Why? Well, as I said, the disability carrier is going to be looking at your medical records for the history of these symptoms. But giving your doctor an accurate history will help your physician document your medical records and ultimately complete what's called an attending physician statement form. That attending physician statement form, known as an AP's, is going to address your functional restrictions and limitations.
Speaker A [00:06:50]:
So your medical records should document, as I've said, the diagnosis, your symptoms, how your symptoms impact your ability to function. But that's not all. Your medical records should document your treatment and your response to that treatment. Well developed medical records can make all the difference in getting and keeping your benefits. Now, I also want to tell you that disability carriers have lots of tools in their denial toolbox. The ERISA statute over the years has been interpreted by federal courts in a way that makes it easy for disability carriers to deny or terminate benefits. And one of the tools that they will use is to cherry pick your medical records. And how does that happen? Well, as I said, they're going to be reviewing your medical records.
Speaker A [00:07:42]:
They're going to be looking for the diagnosis, the symptoms of Moyamoya disease, and the impact those symptoms have on your functionality. So they're going to be looking for, number one, the actual diagnosis. So they expect to see an MRI, a ct, a pet, or spect imaging that looks like that puff of smoke or a tangle of tiny blood vessels. They're going to be looking for an EEG. They're also going to be looking for a history of mini strokes, seizures and visual problems. They're also going to be looking for a cognitive decline and the diagnostic studies to confirm each one of these complications. So, for example, in the cognitive decline, they're probably going to be looking for neuropsychological testing to document a change in your cognitive functioning. So what's again crucial here is not only the medical records that document the diagnosis, the symptoms that you have, but the severity of the symptoms.
Speaker A [00:08:45]:
After all, it's your burden to prove that you can't do your own occupation, or any occupation. Now, you might have had a stroke that left you with paralysis, weakness, impaired vision, speech disturbance, balance, and coordination issues. The nature of these problems and limitations should be well developed in your medical records because you want to be able to tie that together with the definition of your occupation. Many times, occupation can be defined as how your occupation is performed in the national economy, or how your occupation is performed in the local economy or for your employer. The key here, obviously is going to be tying together whatever the definition of your occupational duties is with those symptoms. So in the example that I just gave, if you are, for example, a computer programmer and you have a stroke that left you with paralysis and weakness, you would probably have difficulty keyboarding. If you have impaired vision, you would probably have difficulty using that computer. You would also potentially have problems communicating with your supervisors or co employees.
Speaker A [00:10:03]:
This is an example of how you want to be able to tie the symptoms to problems that you have with the material and substantial duties of your occupation. Now, if you're at the any occupation stage, the game here is to prove that you can't even do a sedentary job. And that means, again, that you're going to have to tie together why it is you can't be sitting perhaps why you can't have be using your upper extremities to do things like keyboarding, why you might have trouble visually using a computer, the problems that you would have with coordination and maintaining pace and concentration, and the issue of absenteeism. So you want to tie again these symptoms back to an inability to do any occupation. Because Moyamoya disease is such a rare disease, carriers don't see many claims, and I will tell you, they generally don't understand the disabling impact on a policyholder. Developing the objective basis of the diagnosis, the symptoms, the complications, and the functional issues you are having on a daily basis is really key, but that can be supplemented by statements from not only your doctor, but from you loved ones and maybe even co employees who have observed you having difficulties. If you're working and if you're nothing, your functionality around the home. Depending on the nature of those symptoms, sometimes even a video might be appropriate.
Speaker A [00:11:39]:
The disability carrier is also going to be reviewing your medical records for the nature of the treatment that you're getting and the response. Why is that? Well, under a disability insurance policy, be it an ERISA or an individual disability policy, you normally have a duty to get ongoing medical care consistent with the nature of your medical condition. A diagnosis of Moyamoya disease obviously can be devastating, and the complications like the stroke or the seizure, the visual or cognitive impairment can lead to that disability claim. But the carrier wants to see that you're getting reasonable and appropriate care, and there is no kind of difference, if you will, between what the carrier expects in Moyamoya claim as compared to anything else. But they do know that there are specific types of treatment that are offered from Moyamoya disease. So they expect you to get treatment, but they also expect you to get treatment that is consistent with the nature of your disease and the symptoms. So what are they looking for? They're looking for your use of medication. You most likely have had a seizure, and the carrier will expect that you're taking anticonvulsant medication to prevent further seizures.
Speaker A [00:13:02]:
If, on the other hand, you've had a stroke, the carrier is going to expect that you to decrease the risk of further stroke. One of the complications of Moya Moya is headaches, and that certainly can impact your functionality, particularly given the unpredictable nature of headaches. So the carrier would expect that you're taking channel blockers and headache medication. The second broad type of treatment the carrier expects you to have undergone is surgery. Now, they really can't make you undergo surgery, but they will have expect that at a minimum, you will have undergone revascularization surgery if the brain scan shows low blood flow. Now, if the testing suggests that you're at risk for an aneurysm, they might review your records to see if you've undergone surgery to prevent or treat a ruptured aneurysm. So there is a surgical expectation. It sort of falls on the range of the nature and severity of your problem.
Speaker A [00:14:04]:
But again, they can't make you undergo surgery if you have a fear of the surgery. That's a reasonable excuse, if you will, or justification for not undergoing surgery. Now, the carrier is also going to expect that you would have therapy, including physical, occupational, and maybe even speech therapy, to address the complications from the seizures or the strokes. Now, complications of a cognitive nature aren't are common, and I will tell you that can be very tricky, particularly in an ERISA disability claim. The disability carrier will expect that you've undergone neurocognitive testing to corroborate your of memory loss or problems with executive functioning. Your complaints alone are not going to be sufficient if cognitive behavior will. Behavioral therapy has been recommended. The carrier will closely review the testing and the therapy records to make sure, one, you've complied with the recommendation, but two, and alternatively, they're looking for a reason to limit the payment of benefits.
Speaker A [00:15:10]:
Why would that apply with a neurocognitive issue? Well, unfortunately, it's pretty simple because there are many disability policies or plans that have two year mental nervous limitations. That means they'll only pay benefits for two years. So the language in your plan or policy is key. If benefits are limited to two years, you might see a clause that says well, we'll only pay for benefits if your disability is caused or contributed to by a psychiatric impairment. Now, that's problematic. You are probably depressed, but if your depression is contributing ever so slightly to your disability, your benefits could be limited to just two years. Obviously, this can be particularly tricky and it's dependent upon the nature of your policy. Wow.
Speaker A [00:16:01]:
We've just covered a lot of information. Let's take a quick break before we come back. Hey, welcome back to. Winning isn't easy. What can you learn from the late Jimmy Buffett and how you can get your risk of disability benefits for Merkel cell carcinoma? Jimmy Buffett, the legendary american musician and songwriter, recently passed away, and he was known for his laid back, island inspired tunes, including the iconic margaritaville. With his signature blend of country, folk and rock music, he created a devoted fan base known as parrot heads. Are you a parrot head? Now? Beyond music, he was also an accomplished author, businessman and avid sailor. He embodied the spirit of escapism and adventure.
Speaker A [00:17:24]:
And I have to confess, however, that before Jimmy Buffett's untimely death, I had never heard of Merkel cell carcinoma, known as MCC. MCC is rare, and it's an aggressive skin cancer that often returns and spreads within two to three years of the diagnosis. It's so rare that only 3000 new cases are diagnosed in the United States. And the risk factors are expected to be sun exposure. Being over age 50 and having a weakened immune system. Now, it usually appears as a painless, single lump of sun exposed skin. And that's how we get started here. Let's say you have a disability insurance policy and you've been diagnosed with Merkel cell carcinoma.
Speaker A [00:18:10]:
You are going to potentially have a disability insurance claim that could be covered under the ERISA statute, which is a federal law that governs policies issued by most employers. And if that's the case, you can be assured that you're going to be in for a fight. Why do I say that? Well, ERISA is not a friendly statute for policyholders, regardless of the nature of the disease. Now, again, they like to use all sorts of tools in their denial toolbox, and one of them, again, is cherry picking medical records. Let's talk about cherry picking medical records in the context of MCC. MCC grows fast and it spreads quickly to other parts of the body. The cells are found at the base of your epidermis and they're connected to nerve endings in the skin. Research has documented that the Merkel cell polyomial virus, and I'm sure I didn't say that, right, but it's a virus that lives on your skin, and it plays an unknown role in causing most cases of MCC.
Speaker A [00:19:23]:
Now, it's also thought that that is playing a role in the development of MCC. The carrier is going to get your medical records, and what they're going to be looking for is a fast growing painless nodule on your skin, excessive exposure to natural, artificial sunlight, a weakened immune system, perhaps a history of other skin cancers, and they're going to see whether or not the MCC is spread to nearby lymph nodes. Now, unfortunately, it can spread to your brain, bones, liver, lungs, and obviously, it can interfere with the functioning of those organs. As the carrier is reviewing your medical records, they're going to be looking at a PET scan because they want to also understand where this is at, and they're going to look at the nature and the extent of the treatment you received. This includes surgery to remove the tumor, radiation therapy, chemotherapy to avoid cherry picking. I think it's important that there is an objective basis of the diagnosis, the history of the exposure, the symptoms that you are having that would prevent you from doing your own occupation or any occupation, and, of course, any restrictions and limitations. Let's think about how that would play out. In Jimmy Buffett's case, he continued to tour even after the diagnosis.
Speaker A [00:20:44]:
The nature of his problems and the restrictions really didn't impact his ability to tour until it did. All right? And so in that particular case, if he had a disability insurance policy that he collected on prior to his death, the carrier would expect to see a history of the progression of his symptoms and how those symptoms impacted his ability to function. So, in other words, he might not have been able to do as many concerts. He may have shortened the length of the concerts. There might be a significant gap between tours, or he may have even stopped touring at all. So those are the kinds of things going to want to look at in terms of your medical records. They're also going to be looking at the complications from MCC or the spread of the cancer to the lymph nodes or organs. And again, that needs to be documented.
Speaker A [00:21:37]:
That will help explain the progression of the symptoms and the change in functionality. Again, a lot of information. Let's take a break before we come back to our next segment, professional with.
Speaker B [00:21:50]:
Questions about your individual disability policy. You need the disability insurance claims survival guide for professionals. This book gives you a comprehensive understanding of your disability policy, with tips and to dos that will assist you in submitting a winning disability application. This is one you don't want to miss. For the next 24 hours, we are giving away free copies of the disability insurance claim survival guide for professionals. Order yours Today@disabilityclaimsforprofessionals.com.
Speaker A [00:22:49]:
Welcome back to winning isn't easy. What you can learn from Natalie Merchant and getting Erisa disability benefits for spinal degeneration with Opll. Natalie Merchant is an american singer songwriter known for her work with the band 10,000 maniacs, as well as her own long standing solo career, during which she has produced such hits such as carnival. I have to tell you, I was shocked to learn that she had been diagnosed with spinal degeneration with osseification of the posterior longitudinal ligament, Opll that had impacted her career. In fact, it also almost ended her brilliant medical career. I had never really heard of Opll. So let's take apart each of these words so that we have a better understanding of the nature of the disease. Now, we all know what a ligament is.
Speaker A [00:23:40]:
It's that soft tissue that connects and supports the bones of the joints. You'll often hear of an athlete tearing a ligament. There are ligaments in different parts of your body, and some are longitudinal. You may have heard that term in geography or even in math class. Longitudinal means that something travels lengthwise, like the ligaments that run up and down your spine. Now, of course, everybody knows what the word posterior means, right? How about ossification? That's the process of changing something into a bony like substance or bone. So let's kind of make sense of this diagnosis. Let's take it apart.
Speaker A [00:24:17]:
Your posterior longitudinal ligament connects and stabilizes the bones of your spinal column that run the entire length of your spine. It runs from your neck all the way down to your sacrum on both sides of the spine. The OpL is attached to the spinal cord. So what happens in Opll is that the posterior longitudinal ligament becomes thicker and less flexible. It most often occurs in the cervical spine, and that means that you might have difficulties turning your head side to side. It can also cause tingling and numbness into your hands. If you're experiencing this in your lower spine, that might mean difficulty walking, difficulty with balance, or even bladder control. Now, as the symptoms progress, your ability to work, or, in Natalie Merchant's case, have a singing career, might make it impossible to tour.
Speaker A [00:25:13]:
She underwent spine surgery because, in her own words, of her unendurable pain as a post operative complication, she wasn't able to sing for over ten months. Wow. Now, if she had an arrested disability insurance policy or an individual disability policy, she could have filed a claim for benefits and I will tell you that disability carriers are always in the business of either denying or terminating benefits, and that begins again in medical records. So if you have an OPLl disability claim, the carrier is going to get your medical records and they're going to look at the history of your symptoms. Now, OPL is generally not noticeable until you have mild pain, tingling and numbness in your hands, or a funny sensation called anesthesia. It's an abnormal sense of touch. Now, as the disease progresses, the symptoms become more severe as the ligament thickens and squeezes the spinal cord. This can produce myelopathy and a compression of the nerve root.
Speaker A [00:26:20]:
It's this slow nature of Opll that can cause difficulty in getting disability benefits. Why is that? Well, disability carriers take the well you worked yesterday, but you can't work today approach what's changed, and the disability carrier is going to be looking from very specific things in medical records. And I really think it's important that you are giving a very accurate and thorough history, even if you don't know the diagnosis, even though you may not know that ultimately you have a disability claim, because it is this information that I think helps doctors make a diagnosis, but it helps the disability carrier understand not only the progressive nature of your symptoms, but how those symptoms impact your ability to function. So what are they looking for? They're looking for a history and a timeline of your symptoms. They want to know how those symptoms impacted your functionality as the symptoms progressed. So in Natalie Merchant's case, she may have had difficulty standing, difficulty using her upper extremities, difficulty singing, difficulties with just the things that she does as an artist. Just think about the functional problems she would have with just activities of daily living. Now, they're also going to be interested in reading in your medical records about what has changed about those symptoms that has made you unable to do your own occupation.
Speaker A [00:27:50]:
And they want to understand the nature of the, of the treatment. Now, I talked a little bit about the treatment, and generally it does require surgery. They're going to want to understand the progression of the symptoms, at what point you became surgical, if you had the surgery and your response to the, the surgery. Now, the other question they really want to know the answer to is why can't you work regardless of all the treatments you've had? So, for example, in an opll case, your symptoms may have started mild and you've responded well to pain, Medicaid medication, anti inflammatories, nonsteroidal anti inflammatories, and maybe even topical opioids. But as the opll progressed, your symptoms may have become more severe. So now your pain is. Your situation is you've got pain. You got tingling and numbness in the hands and it makes it difficult to do even the simplest of things like buttoning buttons or pulling up a zipper.
Speaker A [00:28:49]:
Hopefully you can see that it's crucial that your medical records document not only the diagnosis, but the symptoms and how those symptoms have progressed to the point where you can't perform your own occupational duties or those of any other occupation. It's the documentation of the progression of your symptoms, the increased and progressive restrictions, limitations, the limitations that have impacted your ability to do some or all of the material and substantial duties of your own occupation, or have impaired your ability at the any occupation stage to do even sedentary employment. That documentation can make or break your claim. Now, OPL is a rare disease and I will tell you that disability carriers don't see many claims and as a result they may not understand the disabling impact on a policyholder. It's the complications, the progressive nature of the symptoms, and the dysfunction in your medical records. It's also important that you are getting statements from your doctor, statements from family or friends. But it's also important that when you are filling out activity of daily living forms that the carrier wants you to complete, that you're not giving absolute answers because there's really nothing, in my view, absolute about Opll. It's a progressive condition, so you want to document your symptoms on a progressive nature and don't minimize your symptoms.
Speaker A [00:30:24]:
But on the other hand, don't exaggerate. In other words, don't say I can't do that or I never do that. Talk about how it's become progressively difficult, for example, maybe to stand, uh, for, for, you know, 30 minutes, and how now you can't even stand for five minutes. Or how you have difficulty using your upper extremities when before you know, you could sit at a computer for 8 hours. And now as the symptoms have progressed, your ability to sit and use that computer has declined to from 8 hours to maybe 1 hour. But over time. And you want to explain that in the context of your activities of daily living, it might be that from a personal basis, you have difficulty standing at the sink to cook a meal, or you have difficulty standing and folding laundry, or you have difficulty manipulating things with your hands. So you want to again explain the symptoms, the progression of the symptoms, and the functionality, and be consistent with what's in your medical records.
Speaker A [00:31:31]:
You're going to be asked to complete these active daily living forms on a regular basis. So you should go back and look at what you said in the last couple and then think about whether there has been a progression of your symptoms and explain in that next new activity of daily living form the progression of your symptoms and the impact it's had on your functionality. You know, reflecting I think Natalie Merchant's album keeping your courage really is a testament to her courage and a message of hope to those with OPL and a message of hope to those who are disabled. Now, again, in reviewing the medical records, the disability carrier is going to be looking for the objective diagnosis of the condition, and many times the policy will require not only an objective basis of a diagnosis, but that you're getting reasonable and appropriate medical care as a condition to getting and keeping your benefits. So the carrier is going to be wanting to look at the medical records for things like x rays. They're going to see whether or not there are any bony abnormalities in your spine. You might have undergone what's called a dynamic x ray that will help show any abnormal or excessive movement or instability in the spine, be it in your neck or your low back. They're also going to be looking for a ct scan or an MRI.
Speaker A [00:33:01]:
That's a form of imaging that uses a combination of x rays and computer technology to allow visualization of your bones, muscles, fat and organs. On the other hand, an MRI uses radio waves to create an image. Either way, your physician can then look at the results and determine the thickness of the posterior longitudinal ligament and any encroachment or pressure. I will tell you the disability carrier is going to want to see multiple scans to look at the progression of the thickening. Sometimes doctors, the peer reviewed doctors the carriers will have review of file will cherry pick the lack of that progression or the significance of that progression. You can expect that they will want to see an EMG or nerve conduction study test. If you're having complaints of tingling and numbness, particularly in your hands, you will also be expected to undergo testing to confirm any nerve impingement that will result in more severe restrictions and limitations. Now, they're also going to ultimately be looking at your medical records to determine your level of functionality.
Speaker A [00:34:12]:
Your doctor is going to be asked to complete attending physician statement forms that comment on the restrictions and limitations. Don't be surprised if the carrier's physicians disagree with the diagnosis or the extent and nature of your restrictions and limitations. And once again, it's going to be those well developed medical records and supportive diagnostic studies that will make all the difference in getting your benefits. I hope you've enjoyed this week's episode of winning isn't easy. We've covered some unusual and unique diseases. The disability carrier's approach to disability claims is fairly similar, regardless of the nature of your disabling condition. If you've enjoyed this episode, please like our page, leave a review and share it with your family or friends, and subscribe to this podcast. That way, you'll be notified every time a new episode comes out of let's see you next week.
Speaker A [00:35:03]:
All right. Please tune in to the next episode of winning isn't easy. Thanks.