Interstitial Cystitis

Welcome to Season 4, Episode 42 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Interstitial Cystitis."

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, explores Interstitial Cystitis.  Interstitial Cystitis is a long-term bladder disorder characterized by symptoms such as frequent urination, urgent bathroom needs, and pelvic discomfort. Around 1.3 million people in the United States are affected by this condition, with women making up more than one million of those cases. Host Nancy L. Cavey talks about how the severity and impact of Interstitial Cystitis can vary greatly from one person to another, as well as how the condition relates to disability claims. 

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

1 -  What Should I Be Telling My Doctor about My Interstitial Cystitis Symptoms That Will Help Me Win My ERISA Disability Claim?

2 - How You Can Use Social Security Regulations on Impairment to Overcome an ERISA Disability Carrier or Plan Denial of Interstitial Cystitis

3 - Is a Diagnosis of Interstitial Cystitis and Fibromyalgia Sufficient to Overcome an Aetna Disability Insurance Claim Denial?

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.

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, and now I've done that. But I assure 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. Now, today I want to talk about interstitial cystitis, which is a chronic bladder condition that it involves symptoms of frequent urination, urinary urgency, and pelvic pain.
 
 Nancy Cavey [00:00:59]:
 There's approximately 1.3 million Americans who suffer from interstitial cystitis, and more than 1 million of those individuals are women. The severity of IC can differ from person to person, and in severe cases there can be scarring of the bladder wall, pinpoint bleeding, or even ulcers. As a result, your bladder will lose the ability to hold urine, which means that you have to urinate frequently. I'm going to be walking you through an IC claim and how disability carriers react to these claims. And specifically, I'm going to talk about three things. Number one, what should I be telling my doctor about my interstitial cystitis symptoms that will help me win my claim? Two, how can I use Social Security regulations on impairment to overcome a disability carrier plan or denial of my claim? And then lastly, is the diagnosis of interstitial cystitis and fibromyalgia sufficient to overcome an Aetna disability insurance claim? So I'll give you a real world example of how this goes down. Let's take a break before we get started.
 
 Speaker B [00:02:12]:
 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 [00:02:36]:
 Welcome back to Winning isn't Easy. What should I be telling my doctor about my interstitial cyclitis symptoms that will help me get my ERISA disability benefits? I'm going to be frank. Winning an ERISA disability claim because of IC can be hard. You've got the burden to prove that you can't perform the material and substantial duties of your occupation, or any occupation, as those terms are defined by your policy or plan. It's really important that you understand what it is you need to prove. And that's one of the reasons why I strongly suggest you get a copy of your policy or your plan and read it cover to cover. Looking at the definition of disability, occupation and whether or not objective evidence is required. Now, you also need to understand that the carrier or plan is going to be reviewing your medical records.
 
 Nancy Cavey [00:03:31]:
 The disability carrier is going to have your doctor complete an attending physician statement form. And I find that these are generic forms that do not ask specific questions about the symptoms of IC and its disabling restrictions and limitations. I'm also a Social Security disability attorney. So many times I will be using an Interstitial Societies Social Security Residual Functional Capacity form as a supplement to the disability carrier or plans APS form. Now, before you give that to your doctor to fill out, I think that you should be giving your doctor a history at each visit of the following things so that they will have an adequate fund of information with which to fill out the APS form or the Residual Functional Capacity form. So you need to write these things down. How often you feel the need to urinate. How often you feel an urgent need to urinate.
 
 Nancy Cavey [00:04:33]:
 How often in fact you do urinate. How long you're in the bathroom at any one time what your urinary frequency is at night. How long you can sleep during the course of the night at one time without having to get up and urinate. The total amount of sleep you're able to get Whether you have to take a nap in the course of the day to compensate for your lack of sleep. Whether you have pain and if so, where is the pain? When do you have the pain? How long is the pain lasting? Whether or not your pain and fatigue interfere with your concentration or even ability to do simple tasks. Whether your pain, fatigue and urination interferes with your ability to complete a task. Whether your pain, fatigue and urination impairs your ability to climb, balance, stoop, crouch, lift, walk and even sit. Whether or not you have depression and anxiety because of your IC and how it impacts your ability to interact with people.
 
 Nancy Cavey [00:05:28]:
 Now, I think this information is helpful for your doctor not only to document in your records, but to help them to accurately and complete an IC form. It can also help you get the benefits you deserve because you are developing your medical records in a way that will paint a picture to your disability carrier plan as to what your symptoms are and how they would interfere with your ability to do the material and substantial duties of your occupation. Remember, it's your burden to prove that you can't perform the material and substantial duties of your own occupation or any occupation. Got it. Let's take a break. Welcome back to Winning Isn't Easy. How can you use Social Security disability insurance regulations on impairment to overcome an ERISA disability carrier or plan denial or termination of benefits for ic? Now, I will tell you that disability carriers or plans often require that the policyholder or plan beneficiary have an impairment. Unfortunately, many times that term is not defined in the policy or plan, and the carrier kind of creates their own definition of impairment.
 
 Nancy Cavey [00:07:13]:
 And they do that in interstitial IC claims. So as a practical matter, what they're looking for is an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. They're not going to take your word for it that you've got symptoms of ic, that you have an impairment. In fact, a diagnosis of IC doesn't necessarily translate into disability. It's just a diagnosis. So how do we at KV Law address the issue of impairment in an IC claim? Well, one of the things we do, even though this is not a Social Security claim, is we look at Social Security Regulation SSR 151 as a guidance. And if there is no definition of impairment in the policy and they're requiring an impairment, I argue that this Social Security regulation provides guidance on how to define an impairment, and they should be using this guideline. So let's talk about Social Security Ruling 15 1p and your interstitial societies claim this regulation specifically addresses what you have to prove in the context of a Social Security case to be entitled to your benefits.
 
 Nancy Cavey [00:08:31]:
 And again, I think that this is analogous to what needs to be proven in a ERISA disability IC claim. And what the regulation says is IC constitutes a medically determinable impairment when it produces appropriate symptoms and medical signs or laboratory findings and may result in disabling impairment. Now, there are some findings that are universally accepted, and Social Security has a laundry list of those signs that they are looking for. And so I'm going to read you section C of the regulation. Medical science can support a diagnosis of IC and can help establish a medically determinable impairment. These signs can include the following, which can be detected during a medical procedure that stretches the bladder with fluid cystoscopy under anesthesia with bladder distension. And so what they're looking for is fibrosis bladder wall stiffening, diffuse pinpoint bleeding caused by recurrent irritation on the bladder wall, and hunter's ulcers, which are patches of broken skin on the bladder wall. They're also looking for laboratory findings that can support the diagnosis of ic and they accept the following laboratory findings repeat sterile urine cultures while IC symptoms continue, positive potassium sensitivity test known as a Parsons test and an antiproliferative factor APF accumulation in the urine.
 
 Nancy Cavey [00:10:09]:
 They're also willing to look at other signs and findings. Social Security in this regulation acknowledges that because of ongoing research into the cause of ic, the medical criteria discussed above are only examples of signs and laboratory findings that establish a medically determinable impairment. In other words, they're not all inclusive. But I use this laundry list of testing and test results and other criteria to establish that my client has a medically determinable impairment. So how do we best document that impairment in an IC ERISA disability claim? Your medical records, as I've said, should document all the items found in Social Security Regulation 15.1p. I also in my Social Security and arrested disability cases, have the physicians complete a bladder problem medical opinion or IC Residual functional capacity form. Now these forms were developed by a Social Security lawyers to help Social Security applicants get their benefits. But I think that this can help in a ERISA disability claim because the disability carrier or plans attending physician reports don't ask the right questions.
 
 Nancy Cavey [00:11:22]:
 I think that using the ICRC form or the bladder form and Social Security Regulation 15.1p can be used in combination to help overcome a disability carrier or plans wrongful denial or termination of benefits on the basis that you don't quote, unquote have an impairment. Got it? Let's take a break.
 
 Speaker B [00:11:44]:
 Are you a professional with questions about your individual disability policy? You need the Disability Insurance Claim Survival Guide for Professional. 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@disabilityclaimsforprofessionals.com.
 
 Nancy Cavey [00:12:44]:
 Welcome back to Winning Isn't Easy. Is a diagnosis of interstitial societies sufficient to overcome a claims denial by Aetna? So I want you to remember that you, as the long term disability policyholder or plan beneficiary, have the burden to prove your entitlement to benefits. You should be getting a copy of that policy or plan, reading it cover to cover so you understand what's the definition of disability? What's the definition of occupation? Do I have to submit objective proof? And what is objective proof? One of the key things you need to understand right off the bat is that a diagnosis of interstitial cystitis is not going to be sufficient in and of itself. So let me tell you the story of a woman by the name of Boatwright. Boatwright v. Aetna. It's actually a Florida case from federal court. Mrs.
 
 Nancy Cavey [00:13:39]:
 Boatwright was diagnosed with interstitial cystitis with hunter's ulcers peripheral neuropathy, and she also had fibromyalgia. She applied for and was paid her own occupation long term disability benefits by Aetna. But of course, what happens is generally after two years, the definition of disability changes from an inability to do one's own occupation to an inability to do any occupation. And in essence, you have to prove that you can't even do a sedentary type job. Now, in this particular case, the definition changed to own occupation, which was defined as any reasonable occupation test. Aetna obviously denied her claim based on the lack of current medical information from her physician and the results of three Aetna medical peer review doctors who looked at her medical records and a vocational report was ultimately prepared that said she could do other work. And then they combined this with some surveillance. Now, you can understand that this case ends up in federal court.
 
 Nancy Cavey [00:14:48]:
 And Boatwright tried to overcome the lack of medical evidence by arguing that her diagnosis, that the lack of improvement over time and the fact that there are no cures for either ICU or fibromyalgia were sufficient to win the day. That didn't work. The federal judge disagreed, noting that diagnoses of conditions are insufficient to establish that you meet the definition of disability within the meaning of the terms of the policy or plan. Ultimately, the question before the plan administrator was whether or not the medical conditions precluded Boatwright from working in any reasonable occupation. And the denial was upheld. I think there's some really important lessons to be learned from this case that are applicable to not only IC cases, but all sorts of other cases involving ERISA disability carriers or plans. So what's lesson number one? Lesson one is that a diagnosis alone is not sufficient. Number two, that policyholder has the burden to provide medical information about their symptoms, how their symptoms impact their ability to work in any occupation or their own occupation.
 
 Nancy Cavey [00:16:08]:
 Number three, restrictions and limitations based on those IC symptoms. For example, the frequency of the symptoms or the nature of the symptoms would require that they be close to a bathroom or that they have unscheduled breaks of however long it takes for them to be in the restroom. Number four, I got my numbers here. Right. The objective basis of the restrictions and limitations that impact that person's ability to work in any reasonable occupation. So you've got a diagnosis, you've got restrictions, but what's the objective basis of the restrictions? Limitations. So you want to tie that back to studies that have been done, and there are some studies that will track voiding and those kinds of issues. In this kinds of case, I particularly think that a functional capacity evaluation is appropriate.
 
 Nancy Cavey [00:17:00]:
 Well, why is that? A functional capacity evaluation does measure how long you can sit, stand, walk, bend and lift. But most people who have IC will have symptoms while they're doing those types of activities. Bending, lifting, picking things up and potentially sitting. The FCE provider who is independent can document the frequency of any breaks that the person were in the restroom. And of course, what you want to do is to have your doctor endorse the evaluation test. If your doctor is not supportive of the claim, then you better well find a new doctor or with the assistance of your ERISA disability attorney, undergo your own independent medical examination by a physician who is not only sympathetic, but understands IC claims and the nature of the functional restrictions, limitations. And of course, I think to tie it all together, you have to have a vocational evaluation that will rebut the carrier's position that you can work in a reasonable occupation. Many times I find that these carrier ves have not taken into consideration the issues with sitting, the need to alternate sitting and standing, the need to use the restroom, the frequency with which a person uses the restroom, how that will interfere with a person's concentration or pace, how it would interfere with the ability to even attend work.
 
 Nancy Cavey [00:18:28]:
 So those are the kinds of things that I think should be developed in the course of winning an IC ERISA disability claim or filing a winning appeal. My appeals, for example, are 20 to 65 pages long, and that appeal is the trial of the case. You'll normally only have 180 days in which to file an appeal, and I just gave you a laundry list of things that need to be done, and you've got 180 days in which to do them. So it's really crucial that you understand the importance of what the policy says, your burden of proof, how the carrier arrived at this denial or termination, and work with an experienced ERISA IC disability attorney who can get you the disability benefits you deserve. Please don't let these kinds of mistakes doom your ERISA disability claim. If you have any questions about this, certainly feel free to give us a call because we do handle IC claims and we also handle them in the context of Social Security claims. And as I've said before, these are not necessarily easy cases to win. It takes a team, in my view, to win these cases, with lots of internal and external documentation to confirm that you are unable to perform your own or any occupation based on the terms of the policy.
 
 Nancy Cavey [00:19:50]:
 Got it. So if you've enjoyed this week's episode, please consider liking our page, leaving a review, sharing it with family or friends, and subscribe to this podcast. This way, you'll be notified when the next episode comes out. Please tune in for a another insightful episode of Winning Isn't Easy. Thanks.