How Long COVID and Other Social Security Disability Residual Functional Capacity Forms Can Help You Win Your ERISA Disability Insurance Claim

Welcome to Season 5, Episode 5 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "How Long COVID and Other Social Security Disability Residual Functional Capacity Forms Can Help You Win Your ERISA Disability Insurance Claim."

Join attorney Nancy L. Cavey, a leading expert in disability claims, for an insightful discussion on how Long COVID residual functional capacity forms can help you win your disability insurance claim. Strong medical evidence is essential for a successful disability claim - especially for conditions like Long COVID. A key part of this process is working with a trusted doctor who can accurately assess and document your functional status. In this episode of Winning Isn’t Easy, Nancy will also explore the various forms that can help you gather the medical evidence needed to strengthen your claim.

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

1 - The Role Your Physician Plays in Your Long COVID Claim

2 - The Role Your Physician Plays in Determining Your Post-COVID Functional Status

3 - Why You Should Use a Long COVID Social Security Disability Residual Functional Capacity Form in Your Short-Term Disability and Long-Term Disability Claim

4 - Why You Want to Supplement a Long COVID Social Security Disability Residual Functional Capacity Form with Other Applicable Forms

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.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/


Resources Mentioned in This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mind

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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

Transcript

Nancy Cavey [00:00:15]:
 Hey, I'm Nancy Cavey, national ERISA and IDI disability attorney. Welcome to Winning Isn't Easy. Before we get started, I've got to give you a legal disclaimer. The Florida Bar association says I have to tell you that this podcast is not legal advice. So I've said that nothing is ever going to 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, getting your shorter long term disability benefits for Covid and long Covid isn't always easy, particularly since there are a number of reasons that disability carriers or plans will commonly use to deny or terminate benefits. I've discussed that in our recent podcast episode An Update on Long Covid Long Term Disability Claims.
 
 Nancy Cavey [00:01:07]:
 In that episode I promised that I would discuss long Covid and Social Security Disability residual functional forms and how they can help you win your ERISA disability claim. That's what we're going to discuss today. Now. Now the disability Carrier plan is going to require that your physician complete forms called Attending Physician Statement Forms to address your functional, physical, cognitive and psychiatric restrictions. You have gotten those forms. And you wonder why they're asking the dumb questions that they ask on this generic form. Because they aren't asking the right questions about your long Covid, your other system based impairments, whether or not you've had a preexisting condition that's been aggravated or accelerated by the long Covid, or whether you've got some new medical conditions that are linked to Covid. They just don't ask the right questions.
 
 Nancy Cavey [00:01:58]:
 Well, the short answer is that they don't want to ask the right questions because they don't want to know the right answers and they want to use your physician's responses to their non generic questions as a reason to deny or terminate benefits. Generic questions are just vague questions that aren't tailored to your particular situation. And I know that sounds strange, but that's the game they play. So the APS form is a game and the sooner you know that, the sooner you can protect yourself as you apply for your benefits, stay on claim or fight a wrongful termination. So I'm going to talk about four things in this episode. One is the role of your physician in the long haul or Covid type situation. 2. The role your physician plays in determining your post Covid functional status.
 
 Nancy Cavey [00:02:52]:
 Number three why you should use the Long Covid Social Security Disability residual functional capacity forms in your short or long term disability Claim. And lastly, why you want to supplement that Long Covid Social Security Disability residual functional capacity form and use that to enhance the APS form. Okay, now before we get started, I'd like you to go to KVLaw's Covid long term disability page. You can download there the Long Covid Social Security Disability residual functional capacity form. And as we talk, you can follow along and get a sense of why I think this is a very important form to use. Okay, we'll take a break while you go get that form.
 
 Speaker B [00:03:36]:
 Have you been 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 [00:04:01]:
 Welcome back to Winning Isn't Easy. Let's talk about the role your physician plays in your long haul or Covid claim. I'll be frank. Your medical records can make or break your long Covid claim and as a result, it really is important that your physician be a great historian and that you be a great historian documenting the onset of your symptoms, the progression of your symptoms, the treatment you're getting, and the response to the treatment and your functionality. Number two, your doctor should be documenting the objective testing and exam findings that confirm the diagnosis of long Covid. But just as important, if not more important, they should be documenting the objective testing and findings that address either an aggravation of your preexisting condition, your post long Covid hauler, symptoms by body system, and any new medical conditions that you have developed as a sequela of COVID Really, really crucial now why your physician is going to be asked to comment on your functional, physical, cognitive and psychological restrictions. That sounds easy, but it's not. Because the starting point in my view is the definition in your policy or plan of occupation, own occupation, any occupation, material and substantial duties of the occupation so that you understand and your doctor understands what it is you have to prove.
 
 Nancy Cavey [00:05:24]:
 You didn't insure your job. You insured your occupation as that is defined by your policy or plan. So you need to get that policy or plan out and ask, okay, what's the definition of disability? What's the definition of your occupation? What's the definition of any occupation? Are there any definitions of subjective medical conditions? Are there any situations in which that policy lists Covid or symptoms as subjective medical conditions that limit benefits to just two years? Is there a definition issue with mental nervous conditions and if so, are the Benefits limited to just two years. If your disability is caused or contributed to by mental issues that we see in Covid like depression or anxiety or post traumatic stress disorder. All of this is important that you understand before you stop work and apply for benefits or certainly when you're dealing with a claim denial or termination. And your physician needs to understand that because their opinion is going to matter in your disability claim. Got it. So in the next segment, I'm going to talk about that actual role of your physician in determining your post Covid functional status.
 
 Nancy Cavey [00:06:37]:
 Got it? Foreign welcome back to Winning isn't Easy. So what's the role your physician plays in determining your post Covid functional status? Well, your physician is going to be asked to address your functional status and hopefully you've undergone appropriate testing to address these issues. You understand that your doctor understands the definition of disability and proof that's required. I want you and your physician to think about this three ways. The first question in my mind is did you have a preexisting condition that was aggravated or accelerated? If so, we want to address that, if you will, on a separate piece of paper. Here's my preexisting condition here. Were my symptoms, my treatment, my functionality? And this is how it's changed after Covid. Increased symptoms, increased treatment, new symptoms.
 
 Nancy Cavey [00:07:45]:
 This is how it impacts my functionality. Secondly, we want to talk about the actual long Covid systemic complications you might have. Cardiological issues, pulmonological issues, gastroenterological issues, neurological issues, cognitive issues, or other complications. You can have one or lots of them. You should be writing down by systemic complication what your symptoms are, how it impacts your ability to function. But you also need to make sure that your doctor has conducted testing and referred you to specialty doctors that can address not only the diagnosis but the system based complications. Now the other thing that you want to address is any new medical conditions that have occurred post Covid. I'm seeing a lot of POTS cases.
 
 Nancy Cavey [00:08:37]:
 I'm seeing acceleration of Ehlers Danlos syndrome type symptoms or even the beginning of those symptoms. I am seeing activation of Epstein Barr. I'm seeing mast cell syndrome type issues. I'm seeing trigeminal neuralgia issues. I'm seeing all sorts of new conditions as a result of COVID And again, you want want to make sure that your physician has documented your symptoms and your functionality, but that there is an objective basis for addressing the diagnosis of those conditions and your functionality. Now your doctor again is going to be asked to address the restrictions and limitations. And I think if you're giving your physician information in this manner that I just discussed. It will help the doctor address the restrictions and limitations and particularly as they're applicable to the definition of your own or any occupation.
 
 Nancy Cavey [00:09:34]:
 I've talked repetitively about how we want to use Social Security Disability Residual Functional Capacity Forms as a supplement to the attending Physician statement forms and I'll talk about that in a minute. But understand that the disability Carrier plan is going to hire their own liar for hire doctor to cherry pick your medical records and to minimize or even disregard your your symptoms and your functionality. We want to make it more difficult for them to legitimately attack those opinions of your physicians, particularly those regarding your restrictions and limitations. Got it? Now in our next episode, I'm going to be talking about why we should be using that Long Covid Social Security Residual Functional Capacity form in your claim. During the break, please, if you haven't done this Already, go to KVLaw's Long Term Disability Covid page and download that form. Got it? Let's take a break.
 
 Speaker B [00:10:35]:
 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 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 at disability claims for professionals.com.
 
 Nancy Cavey [00:11:14]:
 Welcome back to Winning Isn't Easy why you should use a Long Covid Social Security Disability Residual Functional Capacity form in your Short and Long Term disability claim. Now look, in addition to being a nationwide ERISA Short and Long Term disability attorney, I'm also a Social Security Disability attorney. In fact, I was one of the first attorneys in Florida to try a long Covid case in front of a Social Security judge. And I did that before Social Security came out with policy and position statements and instructions to physicians about what should be in medical records. I won that case by addressing the long Covid symptoms and symptoms of other functional impairments based on the body systems involved, and the judge agreed with my approach. One of the things I'm strongly going to suggest that you do after you finish listening to this episode is to go onto the Social Security website and download the Social Security Administration's policy and position statements and instructions to physicians as to what should be in a patient's medical records and share that with your physician. That will help them document your medical records in a way that will help you win. Not Only your Social Security disability claim, but your ERISA short and long term disability benefits.
 
 Nancy Cavey [00:12:27]:
 Now we attorneys, Social Security attorneys, have developed a long Covid residual functional capacity form. Social Security won't tell your doctor about it and not all doctors are aware of this form. Now note we modify this form to meet our clients particular needs and medical records. So this generic form may not be the end all or be all in your particular case. But in my mind it's a key part of the evidence that has to be developed. In addition to this Covid residual functional capacity form, we review our clients medical records. And if our client has new medical conditions like pots, we will have the client go get their physicians, the specialty physicians to complete a POTS residual functional capacity form. If you've got cardiological complications, we download the cardiological residual functional capacity form and we want that filled out.
 
 Nancy Cavey [00:13:23]:
 So we want as many of these applicable residual functional capacity forms filled out to maximize not only your chances of getting your Social Security benefits, but your short and long term disability benefits. Because remember, we've talked about how the APS forms don't ask the right questions on purpose. So if you're ready, let's get out and go over the COVID residual functional capacity form. Now I'm not going to go over all of it, but I am going to talk about parts of it specifically. Now one of the questions they ask is for the doctor to answer the following questions regarding your impairments. And they want to know how long the physician has treated you and the frequency of the contact. That's important because the Social Security administration wants to understand the nature and length of the relationship that the doctor has with you which will impact their ability to render meaningful opinions. They want to know what's the diagnosis and the prognosis.
 
 Nancy Cavey [00:14:22]:
 They also want a list of symptoms and there's a checklist and that is taken from Johns Hopkins, Mayo Clinic and CDC information. This part of the questionnaire asks the doctor to check the symptoms that have been pronounced after the infection and have persisted more than six months. From my perspective, I think things that are important are symptoms that are chronic and symptoms that relapse and remit. The question of whether there's testing pertaining to the symptoms and treatment pertaining to the symptoms. So it's all kind of got to be tied together, if you will. So among the questions that are asked are does the patient have issues with pulmonary issues, breathing, coughing, do they have a fever? Do they have cardiovascular issues, palpitations, do they have orthostatic intolerance? POTs, weight loss, edema, do they have diabetes or abnormal glucose serum? Do they have post exertional malaise both physically and cognitively? Do they have exercise intolerance? Are they easily fatigued? Do they have problems with insomnia, blood clots? They want to understand whether from a gastroenterological standpoint, you've got rashes, do you have problems with using the bathroom in terms of diarrhea, urination, do you have shortness of breath? Do you have poor short and long term memory? Are you easily confused? Are you easily overwhelmed? Do you have brain fog? Do you have headaches? Now if you indicate that you have headaches, I'm always gonna wanna set off. By the way, a migraine, residual functional capacity form, changes in taste or smell, it's not gonna get us too far, quite frankly. But pain is important and where that pain is is important.
 
 Nancy Cavey [00:16:19]:
 If you've developed, for example chronic fatigue syndrome or you have other issues of that nature, we also want the chronic fatigue syndrome RFC completed. I have cases where people who have pre existing fibromyalgia have their fibromyalgia made worse because of COVID So I'm going to say let's also use the fibromyalgia residual functional capacity form. If you are having problems with tingling and numbness, particularly of your hands or your lower extremities, I'm going to want to use a residual functional capacity form that will address those symptoms because they can impact your ability to engage in bilateral manual decoration dexterity. Do you have sleep problems? Well, if that's true, we want to use the sleep disorder residual functional capacity form. How about tinnitus? Or tinnitus, depending on how you want to pronounce it. We have a residual functional capacity form for that. I'm going to save depression and anxiety for a little later in this presentation, but the doctor is going to ask questions about that. Now question number five is if your patient has pain, characterize the nature, location, frequency, participating factors and the severity of your pain.
 
 Nancy Cavey [00:17:43]:
 Now that's important because again, that can impact your ability to function. But if you've done the analysis the way I've suggested, you know, aggravation of pre existing, the post Covid issues and any new medical conditions. And you've done this kind of outline for your doctor, this will help your doctor characterize your pain, your frequency, your location, precipitating factors. Again, everybody wants to know what's the objective findings and they also want to understand the treatment and the impact of treatment. Every disability insurance policy or plan requires that you get reasonable and appropriate treatment. So you want your doctor to address that. Now, if you've gone through multiple medication trials, you also want to be able to be documenting that for your physicians. You tried this, you, it didn't work.
 
 Nancy Cavey [00:18:35]:
 They switched you to that or you had these side effects. Let's get into the question of whether your impairments can be expected to last and how long they're expected to last. I think that's importantly from Social Security standpoint. But the frequency and nature and duration of these symptoms are important, I think because of functionality issues. If you have a condition that's going to wax or wane or is going to interfere with your ability to function so that you can't attend work, that's important. Let's talk about psychiatric questions. We have to be really careful here. Why many disability policies have mental nervous policy limitations.
 
 Nancy Cavey [00:19:17]:
 And there is what I call the regular flavored one and the Monty Python flavored one, the regular one, if you will, the vanilla one, is, is a disability that is caused by mental nervous conditions is limited to just two years. But then there's the Monty Python one, which is the one that scares me the most. And that is a disability that is caused or contributed to ever so thin that Monty Python wafer, thin mint that can result in a limitation of benefits to just two years. So in my view, I understand why you have depression and anxiety personality disorders or post traumatic stress disorder, but I really don't want the doctor to say that your disability is contributed to by those conditions because benefits can be limited to just two years. Now, one of the most important questions in my view is intention and concentration that can be caused from physical issues or cognitive issues. What's important, of course, is how the issues interfere with your ability to do a simple task and an eight hour workday. Would it interfere? Rarely, occasionally, frequently, Constantly. The greater that response, the more likely it is you're not going to be able to maintain the pace and concentration required to meet the production requirements of an occupation.
 
 Nancy Cavey [00:20:46]:
 I will be quite frank with you. When we get to the any occupation stage of a case for long term disability and certainly for Social Security, the issue is whether you can engage in even sedentary work. A job sitting down all day, using your arms or your upper extremities. The bilateral manual dexterity issue with enough concentration and pace to complete tasks in a timely manner and to do so without breaks that are greater than the normal breaks and absenteeism. I know I just rattled off sort of a laundry list there, but ultimately the game is to prove that you can't even engage in a sedentary job. That's why question number 15 is really important. It's the functional limitations. Now, some doctors will say, I can't answer these questions, I don't know, because they either really don't want to get involved or they don't want to commit.
 
 Nancy Cavey [00:21:40]:
 And if that's the case, then it really is incumbent upon you to either find another doctor or to get a functional capacity evaluation to measure the kinds of things that are outlined. How far can you walk? How long can you sit? Do you have to change positions? Can you have to alternate sitting, standing, or other positions? Do you have to take unscheduled breaks? Do you have to lie down at unpredictable intervals, like to take a nap because you're fatigued? How long do you have to take a nap? Do you need any assistive devices? Do your legs need to be elevated? And if we're talking about a sedentary job, you know, how long do those legs have to be elevated? Do you use a cane? How much can you lift? Or how long can you look down side to side? That's particularly important and I think in postural orthostatic type issues. And again, that is really crucial, particularly as it relates to sedentary work, because you're turning side to side, looking up and down. Bilateral manual dexterity is really crucial, I think. Every occupation, I think, requires a degree of bilateral manual dexterity. And so if you can start eliminating that because of problems with your hands, problems with stiffness or pain that impact your ability to use your hands, that's really great. I like the good days, bad days questions. You may have a good day, and on a good day, you do something that needs to be done and you pay.
 
 Nancy Cavey [00:23:25]:
 You pay for days. It might be physically with pain. It might be increased symptoms of a cardiological nature. It might be increased problems with cognition. Again, having broken those kinds of things out for your doctor, it should be relatively easy for the doctor to fill out. And I tell my clients, use this laundry list as you are writing out your symptoms and functionality as a mental checklist. Do you in fact have this problem? Yes or no? What is it? How often do you have it? How does it impact your ability to function? That sounds like a heck of a lot of work, and it is. And you most likely are going to need the assistance of a family member or friend.
 
 Nancy Cavey [00:24:08]:
 But I assure you it is worth taking the time to do this. I make my clients do this, and in particular, I make my Social Security disability clients do this because this information will make all the difference in getting benefits both for Social Security and for short and long term disability benefits. Got it. That was a mouthful, wasn't it? So let's take a quick break. All right, welcome back to Winning Isn't Easy. Why you want to supplement this long Covid Social Security disability residual functional capacity form with other residual functional capacity forms and staple them all to that attending physician statement form. As I've said, that attending physician statement form is generic. It doesn't ask the right questions.
 
 Nancy Cavey [00:25:12]:
 It certainly doesn't ask the right questions. In view of the complexity of a long Covid hauler case, as I explained, I tried one of the first long Covid Social Security cases in the United States. And before the hearing, the judge asked me how he should go about deciding the case. I told him we should approach the long Covid issues separately. Each body system involved individually, then a combination of all the medical conditions. And if there was something new, if there had been an aggravation of a preexisting condition, we wanted to address that. And if there were new medical conditions that developed post Covid, we were going to also address those. So I submitted an RFC form for every system that was involved with my particular client's issues.
 
 Nancy Cavey [00:26:04]:
 Pain, orthopedic spine issues, cardiological issues, POTS issues. And we had her doctors complete these forms to attest to the individual restrictions and limitations. Now, again, if we have a situation where we have a pre existing condition, we want to document the progression of the disease, the symptoms and the functionality with that appropriate form. If we have complications from COVID be they pulmonary, cardiological, urological, neurological, cognitive, we want the appropriate residual functional capacity for them. And if you've got a new disease like POTS or the activation, I'm sorry, Ehlers Danlos, chronic fatigue syndrome, trigeminal neuralgia, tinnitus, whatever is new, that's becoming a known new complication of long Covid, we want that particular form. Why? We want to address each medical condition individually. But disability carriers are also required to consider the combination of all these conditions and obviously the impact and side effects of medication and treatment. So I want to give it to them individually and then I want to argue collectively.
 
 Nancy Cavey [00:27:36]:
 And when you combine all of this in a big pot, they can't perform their own occupation or any occupation. You can see that long Covid hauler cases are complex, not only medically but legally. They require extensive proof, both medically and ultimately vocationally. It's really key, in my view, that a team approach be taken to these cases. An understanding of the policy, an understanding of the medical conditions and your disabling symptoms and functionality, what testing needs to be performed to confirm the diagnosis and the restrictions and limitations, tying it together with these residual functional capacity forms and then tying it all together with the appropriate proof, be it statements from you, your family, diaries, logs, videos that will then form the basis of a vocational opinion as to why it is you can't do your own or any occupation. This is not, in my view, something that you do for the faint of heart. Just because you may have slept in a Holiday Inn does not make you an expert in handling long hauler Covid cases. If you have any questions, you are more than welcome to call our office and schedule a free 30 minute consultation.
 
 Nancy Cavey [00:29:02]:
 And if your claim has been denied or terminated, please call us because you're only going to have 180 days in which to file an appeal, that is the trial of your case. You can't hold your evidence for your day in court because there is no day in court in an ERISA case. Your appeal is the trial of the case. Complex, factually, medically, legally, that demands the assistance, in my view, an experienced ERISA and Social Security disability attorney. I hope you've enjoyed this week's episode of Winning Isn't Easy. Please like our page, leave a review, share it with your family or friends or your support group. Please subscribe to this podcast. I hope that you find this information helpful and something that will guide you in getting you both your Social Security and ERISA disability benefits.
 
 Nancy Cavey [00:29:48]:
 And by the way, we welcome questions from our listeners at the start of each episode. Description. Where you're listening, there's a link that you can text us comments or questions. I assure you that we will be addressing these in future episodes. Got it. Please tune in next week for another insightful episode of Winning.