Traps in Activity of Daily Living (ADL) Forms

Welcome to Season 4, Episode 38 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Traps in Activity of Daily Living (ADL) Forms."

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, explores the various traps buried throughout the infamous Activity of Daily Living form that claimants can fall into. The Activity of Daily Living (ADL) form is a form that claimants will be asked to complete at interval times during the course of their claim. While the purpose of the form is to establish your daily activities, it can also be used as a tool by disability carriers to deny, or terminate, a claim. Some questions covered in the ADL form are designed to be leading, ambiguous, or confusing. Today, your host, Nancy L. Cavey, will walk through some of the common pitfalls that can be found in this disability denial tool. 

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

1 -  How Should I Answer the Question “What Keeps You from Working?”

2 - How Should I Answer the Question “How Bad Is Your Pain?”

3 - Tips for How to Answer the Question “What Do You Do on a Typical Day?” on a Disability Carrier or Plan’s Activity of Daily Living Form

4 - When I Apply for My ERISA Disability Benefits, Why Do They Ask Me What I Do around the House?

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

Nancy Cavey [00:00:15]:
 Hey, I'm Nancy Cavey, 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've got to tell you that. So now I've done that. I want to assure you that nothing will ever 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 let's get going.
 
 Nancy Cavey [00:00:49]:
 Applying for ERISA disability or individual disability insurance benefits involves filling out lots of forms, including the infamous Activity of Daily Living Form. Your responses to that form can make or break your claim. It pays for you to take the time to complete the form accurately and truthfully. Your ERISA disability carrier or plan will ask you to complete this form many, many times during the course of your claim. So you should take it seriously every time you're asked to complete it. Yes, it's a pain, but don't blow it off. The ADL form is going to ask a lot of questions and these will include questions about your medical condition, how your illness, injuries or conditions limit your ability to work, what you do during the typical day, your specific daily activities, and your ability to perform activities such as sitting, standing, walking and lifting. Now, you must be truthful in completing this form.
 
 Nancy Cavey [00:01:49]:
 Don't exaggerate. Simply tell the truth. Now, I'm a lawyer and I know that may be simplistic, but it is really hard to do in practice and I know that. In fact, I think there are traps built into ADL forms that carriers will seize on to deny the claim. And as a result, I'm going to walk you through how to answer some of the ADL common questions and the traps that you need to look out for. So specifically, I'm going to talk about four things today. That question how should I answer the question? What keeps you from working? How should I answer the question? How bad is your pain? Tips for how to answer the question what do you do during a typical day? And when I apply for a risk of disability benefits, why do they ask me what I do around my house? Got it. Well, let's take a break before we get started.
 
 Nancy Cavey [00:03:02]:
 Welcome back to Winning isn't Easy. Ready to get started? How should I answer the question? What keeps you from working? Well, obviously the answer is truthfully. You remember you've seen these TV shows where they swear in the witness and have them take an oath that says that they promised to tell the truth, the whole truth and nothing but the truth. Well, it's a bit like that, but in reality, telling the quote unquote truth about what keeps you from working can be easier said than done. So let's talk about this. You may be tempted to answer this question by talking about your diagnosis. The claims examiner and the liar for hire insurance doctors are going to review your medical records and they are going to also look at these ADL forms and your answers. The doctors understand the diagnosis and this is not really what the question is asking you.
 
 Nancy Cavey [00:04:02]:
 The question really is about your symptoms that you have and how those symptoms impact your ability to do the material and substantial duties of your occupation. Now, I think the word prevent or words prevent you from working is disingenuous because the issue is whether or not you can do the material and substantial duties of your own occupation or any occupation as those terms are defined in the policy or plan. I think you need to understand that definition so that you can be thinking about what your occupational duties are as defined, and then what symptoms you have that would prevent you from doing those occupational duties. You need to get a copy of your policy or plan and look at what that definition of own occupation is. Now, some policies will say it's not your occupation as performed for your employer, or it's not your occupation as performed in the local economy, or it's not even in your occupation as it's performed in the national economy. Like you might know, it might say your occupation is defined as it is described in the Dictionary of Occupational Titles. Now, the Dictionary of Occupational Titles hasn't been updated since 1990, but you want to, if that's the standard, get out the Dictionary of Occupational Titles description for your job duties so you can see what they are. I also think you should get your employer's description of your occupational duties.
 
 Nancy Cavey [00:05:37]:
 Take out a piece of paper and on the left hand side write down what are the occupational duties as described by the Dictionary of Occupational Titles, if that's applicable, what your employer says your duties are and then what your actual duties are. And after each duty I think you should be drawing a line and talking about your symptoms. Now this question is really about what are the symptoms that you have? What is the severity of your symptoms and how potentially would those symptoms interfere with your ability to do the material and substantial duties of your occupation? So why is all of this important? Well, one of the things that their liar for hire doctors are also going to be looking at is the symptoms that you describe. And they want to look at those symptoms as you're describing them on your activity of the other living form and then look at the symptoms as they've been described by your doctor and the medical records. Are those two descriptions consistent? And are those symptoms consistent with the diagnosis? And are those symptoms consistent with the level of severity that you keep that would keep you from doing your own occupation? Many times I will see that the liar for hire peer review doctor agrees that the symptoms exist and are related to the diagnosis, but they'll say they don't rise to this level of severity. That would prevent you from doing the material and substantial duties of your occupation or any occupation. And of course they're looking at to at the history of your symptoms and then looking at the diagnostic studies and the physical exam findings and saying are these consistent? Also, is the nature of your symptoms consistent with the nature of the treatment? In other words, there's a certain level of improvement that might be expected with different types of treatment and they want to see whether or not your symptoms are consistent with the nature of the treatment. And are those symptoms consistent with your reported response to the treatment? In other words, if you say you're not getting any benefit, but you're out there walking your dog and bending over, that can be problematic because of the inconsistency.
 
 Nancy Cavey [00:07:53]:
 And of course, are those symptoms in your medical records consistent with the symptoms that you're reporting on your activity of daily living forms? And the big kicker is, are those symptoms that you're telling your doctor you had and in those activity of daily living forms consistent with your social media accounts? Now, you've heard me many times say if you have a social media account, shut it down. Don't have any posts by family members or friends. You know, the innocuous picture of you at a birthday party or at a graduation or at a wedding, all will be used against you. So please don't have your family or friends or even you do any posting to social media. So what is it about symptoms and functionality? Well, as I've said, ultimately the carrier of the plan has to determine whether you're capable of doing the material and substantial duties of your occupation, notwithstanding all of the medical problems that you have. And again, this goes to the definition of disability and occupation in your policy or plan. Now, your doctor's going to be asked to complete attending physician statement forms that comment on your functional abilities. And in part, doctors do rely on what it is you have to say.
 
 Nancy Cavey [00:09:15]:
 Now, by the way, as an aside, the APS forms, in my opinion, don't ask the Right, questions. But that's a different narrative, if you will. Now, at some point in time, the disability carrier may say to the doctor, look, you are basing your opinion about the client's restrictions and limitations and ability to do their material and substantial duties based on what your patient, our policyholder or plan beneficiary says. And by the way, doctor, we've got some social media accounts that say they're doing things that are again, consistent with the restrictions and limitations or what you told, or what the patient told you. So, doctor, would you change your mind about the ability to work or the restrictions and limitations? You can also be assured that the insurance company or the plan is going to have your medical records reviewed by their liar for hire staff nurses or doctors. And at some point they are going to question your restrictions and limitations because after all, they don't want to pay benefits for a second longer than they have to. And that's particularly true when the definition of disability changes from an inability to do your own occupation and any occupation. Why is that true when you're at the any occupation stage? Basically, they have to prove in quotes that you can do at least a sedentary type job, which is basically sitting down all day.
 
 Nancy Cavey [00:10:50]:
 So they're looking at these medical records not only at the own occupation stage, but the anti occupation stage to see if there are some way that they can attack restrictions and limitations. And it is inconsistency between what you say on those ADL forms, what you tell the doctor, and what you may even be telling the adjuster in that not so friendly phone call that you think is just an innocuous phone call. So what I try to do is to have my clients take the document that I described, symptoms and functionality worksheet, and take that to the doctor after I've reviewed it and approved it, and ask that that be made part of the chart. But we also want to compare that with what's on the ADL forms. So do you have difficulty sitting? Do you have to alternate sitting and standing every 45 minutes to an hour? Do you have to get on the floor? Are you in a recliner? Do you have trouble walking, walking the dog? Do you have trouble stooping, bending, lifting? So think about that in terms of practicalities. You might have difficulty standing in front of the kitchen sink doing dishes, or you might have difficulty just sitting in a chair at the dining room table. You want to be telling your story to the disability carrier and to the doctor in terms of symptoms and functionality. Now, of course, you live it every day.
 
 Nancy Cavey [00:12:15]:
 So you should be able to provide some details about the problems that you're having so that ultimately the carrier, your doctor, maybe their doctor, maybe ultimately a judge, can understand your symptoms and your functionality. You can see that honesty and consistency is the key to getting and keeping your ERISA disability insurance benefits. Got it. Let's take a break.
 
 Speaker B [00:12:41]:
 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.
 
 Nancy Cavey [00:13:25]:
 Welcome back to Winning isn't Easy. How should I answer the question on the Activity of daily living form? How bad is your pain? Well, again, the answer is truthfully. And again, that might be easier said than done. You might be tempted to once again answer that question based on your diagnosis because you think that will carry the day. That's not what will carry the day. They know what the diagnosis is. Generally what they want to know is what are the symptoms that you have, the severity of those symptoms, and how those symptoms impact your ability to function not only at home, but in the workplace. Now let's talk about your symptoms, your pain, your functionality.
 
 Nancy Cavey [00:14:11]:
 Ultimately, the carrier or plan has to determine whether you're capable of doing your own occupational duties, as that term is defined, or any occupation duties as that plan or as that term rather is defined. Now, when you see the doctor, the doctor is going to ask you, how are you doing? And I don't want to see in your medical record something that says, well, I'm doing fine, I had a good day, I'm okay. None of those words mean anything, but every one of those words can be taken out of context by the carrier and they will. You don't want to exaggerate your pain, but you want to explain it in a way that's understood. Sometimes doctors or even carriers will have you use a scale of 1 to 10, one being the least 10 you'd be in the emergency room. I personally hate these scales. I am very stoic. I have a very, very, very high pain level.
 
 Nancy Cavey [00:15:14]:
 So what you may consider painful wouldn't bother me at all. And so people apply their own subjective analysis, if you will, to these pain scale ratings. But if you're going to be using a pain scale rating, you don't want to tell the carrier or the doctor that your pain level is 10 out of 10. Every day, day in and day out, they're going to wonder why on earth you weren't in the emergency room or hospitalized. That type of comment, 10 out of 10 is an exaggeration. Everybody experiences pain differently. But you don't need to exaggerate your level of pain for your doctor or the carrier or the plan to believe you. And if you feel that way about your doctor, that's a key.
 
 Nancy Cavey [00:15:58]:
 You need to find a new doctor. You want to be truthful about the symptoms, your pain, and how it impacts your ability to do things. Now, I know that pain levels can vary depending on whether you're taking medication, how effective the medication is, what you're doing, you have good days, you have bad days. So I don't really like these open ended questions. If you're having that type of situation going on, we want to give example. You know, on a good day my pain level might be X and that allows me to do 1, 2, 3, 4, but then I pay for it and then I have to lie down. Ice whatever it is you need to do to recover or to have those symptoms or pain levels subside. It might be that you actually have a bad day.
 
 Nancy Cavey [00:16:52]:
 So you're having a good day and you go out and you do something, but you pay the price the next day. So you want to make sure that in my view, that you're giving examples of ranges. This is your average pain on a good day, on a bad day, and how that might alternate depending on activity. That activity needs to be consistent with what you've told your doctor and with what you've reported on your activity of daily living forms and God forbid what you've got on your social media accounts. So again, it might be that you have difficulty sitting, you might have problems with your upper extremities, you might have to take a nap, you might have good days or bad days, you might have difficulty concentrating, you may be limiting your driving, whatever it is. In my view, that's okay to explain, not in excruciating detail, but in a range fashion, so that if for some reason they put surveillance on you, what you're doing is within the range of what you said you could do. Please don't use the word never. I never do this, I never do that.
 
 Nancy Cavey [00:18:00]:
 I promise you they will have a surveillance picture of you doing exactly what you said you never did. Or there'll be that social media account that shows you doing what you never said you could do. Okay, so ideally you're going to be talking about the location of your pain, the frequency of your pain, what symptoms you have associated with the pain. So you might have numbness and tingling, the interaction of those other symptoms together, and again, give examples of what impact the symptoms have on your functionality. You've heard the term kiss. Basically, that is sort of an abbreviation for keep it simple, stupid. So keep it simple. Write it out, put it aside, wait a day or two and come back and read it.
 
 Nancy Cavey [00:18:55]:
 Does it sound like an exaggeration? Is it accurate? Are there things that need to be changed? And better yet, if you're represented by an attorney such as myself, your attorney should want to review those ADL forms with you before they are submitted and certainly compare what you have put on that ADL form with what's in your medical records. Got it. Let's take a break. Welcome back to Winning Isn't Easy. Tips for how to Answer that Question what do you do during a typical day on a disability carrier plan's activity of daily living forms? Now, I know that you might be tempted to say that you really don't do anything and that you really don't have a typical day and leave it at that. But that's not going to work. You most likely have organized your day around what you need to do on a personal basis to take care of your personal needs and what needs to be done around the house. So get out a piece of paper and write down what you do from the time you get up to the time you go to bed.
 
 Nancy Cavey [00:20:31]:
 What is it that you do to take care of your personal needs? What problems do you have getting in and out of bed, bathing, dressing, cooking, eating, preparing meals, if you will, and cleaning up that mess. So you want to think about all the things you do on a daily basis and consider, can you do those on a sustained basis? Do you have to take breaks? Do you have to take naps after you do this basic activity? Or do you have to get off your feet and elevate your legs or ice? Have you made any modifications to your bathroom, shower, or kitchen? You want to be able to tell the disability carrier or plan what it is you do, the modifications that you've made and the problems that you have. Now. Think about what needs to be done around your house. Do you do the laundry? Do you sweep? Do you swifter? Do you vacuum? Do you dust? Do you go shopping? How long can you do any one of those activities at one time? For example, do you need assistance taking the laundry to the washing machine, putting it in and then taking it out and then putting it in the dryer and then folding the laundry or putting the laundry away? For some of my clients, that has to be broken up in the course of the day. And people have to help. So you need to be thinking about those sorts of things. For example, do you have a Roomba to vacuum around? Do you have family or friends that come in? Do you, if you do it, break it up.
 
 Nancy Cavey [00:22:03]:
 Are you. What are you doing? Is it just a little area of a counter? In other words, it's not the king's castle. You're probably breaking it up, you know, based on things that need to be done or rooms that need to be done. Now, I'm sure that you are potentially going grocery shopping. Some of you use Instacart or other delivery services, which is fine, but some of you are probably going to the grocery store. And if you've got kids, just because you're unable to work doesn't mean that you are not trying to be the best parent you can. You might be taking them to school or picking them up, but you also might have somebody who carpools or who is available to pick up your child. If you are having a bad day, you probably aren't engaging in the kids activities.
 
 Nancy Cavey [00:22:52]:
 You might be attending, you know, a school activity, but you probably pay the price. So you want to be thinking about those things. And of course driving is an issue. Are you attending your doctor's appointments by zoom? Are you going to doctor's visits? How long does it take to get there? Do you have to make stops? How many stops do you have to make? Do you have somebody who will take you on days that you're having difficulty? You just need to think about that on the way home. Are you running into the grocery store? Are you doing a full Thanksgiving style shopping trip? Or are you just running in to get some milk, either holding onto the cart or riding on an electric cart? And how do you feel after you do all these activities? Think again about what you do and the price that you pay. That's particularly true even in the most mundane things. One of the things that carriers might want to know is do you watch TV or do you get on the computer? And you may be tempted to say yes and yes and yes. But having the TV on in the background for noise is different than watching, you know, a movie on Netflix.
 
 Nancy Cavey [00:24:07]:
 At least in Netflix you know, you can potentially stop it and start and come back. So you need to be thinking about that. Do you have problems concentrating on what's going on in the course of, of a show? So you can see just with these basic kinds of questions that I just run through, you aren't doing nothing. So don't say I don't do anything. Okay. On the other hand, we don't want to write War and Peace. We don't want to write a book. The ERISA disability carrier or plan is looking for a good description of what it is you do in terms of your daily activities, but not a minute by minute description of what it is you're going to do.
 
 Nancy Cavey [00:24:46]:
 Why? Well, too much detail can be a problem because the carrier is going to review your medical records and those social media accounts, if you have them, to see whether what you're telling your doctor is consistent with what's on the form or what's on that social media account. So it's consistency and they may be inclined based on what you say or to put surveillance on you because they're looking for inconsistencies between what you reported and what you're actually doing. So write enough that somebody would understand what your life looks like on a daily basis and the fact that you have good days and bad days. Explain what you do on a good day. Explain what you do on a bad day. Explain the price you pay for having a good day. So I want you to be honest and not exaggerate. But once you've completed the form and sections of the form, put it aside for a day or two.
 
 Nancy Cavey [00:25:43]:
 Have somebody else read it. Does it tell an accurate and complete story what it's like for you on a daily or a weekly basis? Better yet, if you're represented, you want your attorney to review it and compare it to what's in your medical records before it's submitted. We don't want you to plant a denial bomb in your answers. You don't want something you've said to blow up in your face and be grounds for a claim denial or termination. Got it? Let's take a break.
 
 Speaker B [00:26:12]:
 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 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're giving away free copies of the Disability Insurance Claim Survival Guide for Professionals. Order yours today@disability claimsforprofessionals.com.
 
 Nancy Cavey [00:27:11]:
 Welcome back to Winning Isn't Easy. When I apply for my ERISA disability benefits, why does the disability carrier plan ask me on these activity of daily living forms what I do around the house? Now, when you apply for disability benefits, you're going to be asked to complete these ADL forms that ask Lots of questions, including questions about what you do in the course of a day and around your house. I often think, what on earth does this have to do with anything? Because you're claiming that you can't do your own occupation or any occupation. Well, when you think about it, there really are two reasons why the disability carrier asking that question. The first goes to your credibility and consistency in what you're telling your doctor about your functional capabilities. So, for example, you may say, look, I have a back problem, and that really prevents me from being a computer programmer. Yet you tell your doctor that one of your neighbors called you up and said, hey, you know, I know you do computer programming. Can you set up a website for me? That's inconsistent with telling the doctor that you can't be a computer programmer and you can only sit for a short period of time and then helping out your neighbor.
 
 Nancy Cavey [00:28:28]:
 The second reason is that what you do around the house can give the ERISA disability carrier plan a clue how you organize your life in view of your disability. So it might be if you have back problems, you sit in a recliner and you get up every 15 to 20 minutes and you change positions. And it might be that you can't sit in a car for more than 30 minutes, or you might not be able to stand in front of that kitchen sink for more than 15 minutes, or have difficulty, you know, standing at the dryer and folding up the laundry. It might be that you have to take breaks because of all these activities, or that you have good days and bad days when you do these things around the house. So you want to think about this. Take out that piece of paper, write down what you do, write down your symptoms, write down what problems you have functionally and the price you pay for doing those kinds of activities. So what will that ERISA disability carrier plan do with my answers? The disability carrier is going to get your medical records. They're going to have you fill out these ADL forms.
 
 Nancy Cavey [00:29:36]:
 They're going to, of course, check your social media account. And what they are doing is looking for consistency between what you report you can do and what you're actually doing. And then they're going to kind of compare that with what the actual occupational duties that you have, the physical occupational duties, or even the cognitive occupational duties. What they're trying to do is say, look, what they can or cannot do around the house is an example of what, in fact, their actual level of physical or cognitive functioning might be. And that is going to help them decide whether or not you're entitled to your benefits. Now, many times I see carriers cherry picking these forms, cherry picking the medical records, and decide that what you're telling them is not consistent with what you're claiming you can and cannot do or what your doctor has said you can and cannot do. What you put on those ADL forms can be used as a reason to assign surveillance because if they think you're doing more than what you say you do in these forms, what you're telling the adjuster on a call or your doctor, they are going to say, ha ha, I got you. They're going to go to your doctor and say, look, in rendering your opinion, doctor, about your client's, your patient's restrictions and limitations, you have relied on what they've told you, right? The doctor will say.
 
 Nancy Cavey [00:31:06]:
 And then they're going to say, well I want you to assume that they've said in their forms or they've told us this or we've got surveillance or there's social media that says blah blah blah blah blah. Doctor, will you change your opinion? Many times the doctors will say, well my patient has lied to me, I'm going to change my opinion. And many times what the carrier or the carrier's doctor is telling your doctor isn't truthful or isn't accurate or is incomplete. And they don't. The doctor doesn't call you up and say, would you come in and let's talk about this before I change my opinion. Ultimately, all this can lead to a claim denial or termination. You can see that accurately completing these forms with some degree of detail can make all the difference. And better yet, having an experienced ERISA disability attorney help you with these forms and making sure that you're answering them accurately, completely and consistently can be the key to getting and keeping your disability benefits.
 
 Nancy Cavey [00:32:07]:
 Got it? I hope you have enjoyed this week's episode of Winning Isn't Easy. If you've enjoyed this episode, please like our page, leave a review, share it with your family or friends, and better yet, subscribe to this podcast. This way you'll get notification of when our next episode comes out. Please tune into our next episode of Winning Isn't Easy. Thanks.