Vascular Malformations of the Brain

Welcome to Season 5, Episode 27 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Vascular Malformations of the Brain."

Vascular malformations of the brain may be rare - but when they strike, the effects can be devastating. These defects in the brain’s blood vessels can trigger seizures, strokes, cognitive decline, and even life-threatening hemorrhages. For patients, it’s not just a medical battle - it’s also a fight to protect their livelihood. And with ERISA-governed disability insurance, the odds often feel stacked against you. In this episode of Winning Isn’t Easy, disability law expert Nancy L. Cavey unpacks one of the toughest areas of neurological disability claims: vascular malformations and Long-Term Disability benefits. You’ll learn what these conditions are, how their unpredictable symptoms make steady employment difficult, and the common tactics insurers use to deny claims. Nancy shares proven strategies to strengthen your case - like building a detailed medical record, documenting symptom fluctuations, and avoiding traps such as “subjective condition” or mental health limitations. Whether you’re newly diagnosed, appealing a denial, or just trying to understand your coverage, this episode will give you the tools to protect your rights and fight for the benefits you deserve. Because when your brain - and your future - are at stake, winning isn’t easy, but it is possible with the right strategy.

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

One - What Are Vascular Malformations of the Brain?

Two - Navigating ERISA Disability Claims for Vascular Malformations

Three - Strategies to Build a Strong Claim and Avoid 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.


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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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 [00:00:00]:
 Foreign 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 have to say this, and now that I've said it, nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games the carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Today I'm going to be talking about a rare but serious set of neurological conditions. Vascular malformations of the brain.
 
 Nancy Cavey [00:00:49]:
 This is a high stakes condition with symptoms that can dramatically alter a person's life and ability to work. But. But when it comes to disability insurance and particularly ERISA plans, the deck can feel stacked against you. So let's get going. I'm going to talk about number one, what are vascular malformations of the brain? 2. Navigating ERISA disability claims for vascular malformations and three strategies to build a strong claim and avoid denial. Now, this information can help you regardless of whether you have a vascular malformation or or any other type of medical condition that is the basis of an ERISA disability claim. So stay tuned.
 
 Nancy Cavey [00:01:28]:
 But before we do that and come back, we'll take a quick break.
 
 Speaker B [00:01:32]:
 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 [00:02:04]:
 Welcome back to Winning Isn't Easy. So what is a vascular malformation of the brain? A vascular malformation of the brain or vmb, it just isn't a typical neurological diagnosis. It's a defect in the brain's blood vessels that are often present from birth and they can quite quietly evolve for years before showing symptoms. There are six main types of brain vascular malformations. There are AVMs, which are a tangled mess of arteries and veins that bypass the normal circulate capillary system and they can rupture, causing strokes or brain damage. There are cavernous malformations, cms that are a cluster of enlarged blood filled spaces that leak or bleed. There are venous or venous angiomas, VA's, which are abnormal but usually are a benign collection of veins. Number four is a capillary telogentesis.
 
 Nancy Cavey [00:03:02]:
 I hope I said that right. There are enlarged capillaries that can sometimes bleed. And there is the vein of gallon malformation. That's a rare condition normally seen in newborns. And it involves a large malformed formed vein that's deep in the brain. And then there is the mixed malformation. When a patient has two or more different types of malformations, obviously each of these can disrupt the brain function in a unique way. Some remain dormant, others will suddenly erupt, if you will, into a serious neurological event.
 
 Nancy Cavey [00:03:35]:
 So what are the symptoms that you should be looking for and what I look for in a vascular malformation disability claim? Well, number one, headaches. They're often severe and resistant to medication. Two, seizures, which can be unpredictable and hard to control. And there can be cognitive issues such as memory loss, brain fog or poor concentration. There's also stroke like symptoms, so you'll have slurred speech, weakness and even paralysis. There's also hemorrhaging, which is internal bleeding in the brain that can be fatal or permanently disabling. Now, can you imagine trying to hold down a job, especially a high pressure or safety sensitive one, while navigating unpredictable seizures, post stroke fatigue or even memory lapses. Even sitting at a desk all day can become an uphill battle if your brain is under siege.
 
 Nancy Cavey [00:04:29]:
 Now, VBMs just don't affect your brain. They affect your whole life. So what happens when you reach the point where working isn't safe anymore or even sustainable? That's where risk of disability benefits come in. And I'm going to talk about that in our next segment. But I need you to understand that when a disability insurance carrier is looking at one of these claims, they're going to be looking for the diagnostic studies that prove a vascular malformation. They're going to be looking at the different types of vascular malformation you might have. And of course, they're going to be looking for a good report of your symptoms and how those symptoms impact your ability to function. So let's take a break and then we'll come back and talk about ERISA disability benefits.
 
 Nancy Cavey [00:05:21]:
 Welcome back to Winning Isn't Easy Navigating ERISA disability claims for vascular malformations. Now, if you have disability insurance coverage through your employer or you have it through a plan, it's most likely going to be governed by a federal law called the Employer Retirement Income Security act, erisa. Now, there is an exception, and that is if you work for a government agency, state agency, municipality, or you work for a church, potentially your disability policy or plan is governed by state law. It doesn't really matter. I Think whether your policy or plan is governed by ERISA state law, or you actually have purchased your own individual disability policy, which is also governed by state law. This is a complex area of law and it's not something that we necessarily learn in law school. By the way, there are very few classes that you can take to learn about ERISA or disability insurance litigation. But there's also the medical side of this.
 
 Nancy Cavey [00:06:30]:
 When it comes to vascular malformations, I find that a lot of lawyers, and certainly disability insurance carriers or plans don't understand the uniqueness of a vascular malformation type claim. So let's talk about why or what disability carriers or plans don't understand. First, they don't understand that symptoms can fluctuate. You may have worked years with a malformation and all of a sudden you're claiming that you're disabled and unable to work. Now they're going to assume that you can keep on going unless you've had a stroke or some major event that's clearly disabling. But many claims in my experience will involve a gradual decline, not a sudden trauma. So I want to talk about specifically about the four ways that a disability carrier plan will deny a claim. So you're thinking backwards.
 
 Nancy Cavey [00:07:15]:
 In other words, from the very beginning, you are thinking about why this claim might be denied or benefits might be terminated. So number one, you've worked before, why not now? They want to know what's changed. Your records need to answer that question very clearly. So your doctor should be documenting how often your symptoms occur, how they've gotten worse, specific tasks that have become more difficult to do or that you can't do at all. And you need to obviously make sure that you are giving and your doctor is recording physical limitations. You might have trouble walking, climbing stairs using your hands, and you might have cognitive deficits like brain fog or attention problems. This is the kind of case where I recommend keeping a symptoms log and sometimes even photos or videos can show the real impact of things like seizures or post stroke motor issues. So think about that as a creative way to document your medical records and to prove up your claim.
 
 Nancy Cavey [00:08:12]:
 Number two, there's the okay, there's no objective proof of your limitations defense. They're going to come through your medical records and your file. You know, things that you said in your activities of daily living forms and even calls that you might have with the adjuster for inconsistencies. And if your symptoms don't line up with your medical records or daily activities or even, gosh forbid, your social media accounts, that will give them an excuse to deny your claim. Now, a functional capacity evaluation can help. It's a formal test that measures your ability to sit, stand, walk, lift, and do the basic activities of living in and work. You want to make sure that you're getting the FCE from a friendly FCE provider, and you want your doctor to review the results and endorse them, because I find that it gives your case more weight. Number three, your condition is subjective, so we're only going to pay for two years.
 
 Nancy Cavey [00:09:03]:
 Now, many ERISA policies or plans have subjective medical condition limitations that will capture benefits for two years for things like pain, fatigue, sleep problems. And if your symptoms fall in those category, you want to make sure that your medical team backs up these complaints with objective testing, such as imaging, EEGs, neurological assessments, because we want to establish that there is an objective basis for these subjective complaints. Number four, depression and anxiety is really the real issue. The reason you can't work. You can imagine that it's common for vascular malformation patients to experience depression and anxiety. But if your policy has a mental nervous policy limitation, the insurer will try to classify the entire package, the entire disability, as psychological in nature so that they can limit the benefits to just two years. Now, to avoid this, your doctor has to emphasize that your primary limitations are physical and neurological. Physical symptoms may exist, but they're not the core of your inability to work.
 
 Nancy Cavey [00:10:10]:
 Now, one of the things that you do need to understand is that this mental nervous policy limitation comes in two flavors. There's that your mental or psychological issues are the cause of your disability, or what I call the Monty Python version, which is they are contributing ever so slightly. So what needs to be done here is that your doctor can certainly acknowledge that you have the psychological symptoms, but they have to clearly opine that those symptoms are, in fact, not contributing to your disability. A final critical point is if your claim is denied, you're only going to have 180 days under an ERISA claim to file an appeal. And the appeal is the trial of your case, and no new evidence can be added. That's unlike a situation where you might have a disability policy or plan driven, for example, the city of St. Petersburg, or through the Diocese of Pinellas county or St. Petersburg.
 
 Nancy Cavey [00:11:09]:
 Those are not generally covered by erisa. And if there is a denial, you have the right to sue under state law, much like you would have the right to sue if you had purchased an individual disability insurance policy. So the remedy matters. And there are strict time frames that have to be enforced or will be enforced in the context of an ERISA disability claim. In our particular situation, we want to make sure obviously that the appeal is filed timely and that that appeal is absolutely solid in terms of the legal reasons why they're wrong, the medical reasons why they're wrong, the vocational reasons why they're wrong. So it takes time to put together a winning appeal and, and it's really important that the appeal be done properly, but also timely because if you blow that 180 day deadline, you can lose your right to not only appeal, but subsequently to file a lawsuit in federal court. And again, filing a lawsuit is completely different because in federal court, in an ERISA claim, we are only asking for limited damages, the payment of your benefits and fees and costs. There are other things like extra contractual damages, bad faith, consequential damages that you can't get in an ERISA case, but that you can get in a state law case.
 
 Nancy Cavey [00:12:35]:
 So you can hear in my explanation that what law governs your claim is really important to understand because the carriers will use that to their advantage in creating these reasons to deny or terminate your benefits. Got it. Let's take a break.
 
 Speaker B [00:12:52]:
 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 giving away free copies of the Disability Insurance Claim Survival Guide for Professionals. Order yours today@disabilityclaimsforprofessionals.com.
 
 Nancy Cavey [00:13:39]:
 Welcome back to Winning Isn't Easy. Let's talk about strategies to build a strong claim and avoiding a claim denial. What can you do to protect your rights and give your disability claim the best chances of success? I think there are five proactive steps that you should take regardless of whether you have a vascular malformation claim or any other type of disability claim. Number one, build that medical record early and often. Go wait for a crisis. Get documentation of every symptom that you have and how it impacts your ability to work, and make sure that your doctor is making that an integral part of your records. The more detail, the better. Obviously, keep a copy of any document that you're giving your doctor that will provide an explanation of your symptoms and functionality.
 
 Nancy Cavey [00:14:34]:
 Number two, tell your doctor about how your condition affects your job. Now, you have to understand you've not insured your job, you've insured an occupation. So you need to understand how the policy or Plan defines that term. But once you understand that and potentially get a copy of your employer's job description, you want to be able to clearly explain to your doctor, preferably not only orally but in writing, what problems you're having. So it might be, you know, I forget conversations that I've had in the morning, I get dizzy walking across the office after I have a seizure. I need several days to recover and this is how I feel. And here's the sequela that I have of the seizure. So detail really matters.
 
 Nancy Cavey [00:15:22]:
 Symptoms and functionality. Number three, keep a weekly symptom log number. Now I know that can be really depressing, but I think it also shows the consistency of the symptoms that you are having and the impact that they have on your function. So you might want to write down what happens each day. You might have headaches, cognitive slips, fatigue. As a result, you may miss appointments, you may make errors at work, you might have emotional issues like irritability, or you might have anxiety about having a seizure. This isn't necessarily therapeutic, I think, I think it'd be kind of depressing to write this all down. But it is documentation that's essential to a claim because without this documentation, disability carriers and plans have that tendency to say, well, you know, you worked before, nothing's really changed or nothing has really progressed.
 
 Nancy Cavey [00:16:17]:
 It's just status quo and you worked before. Again, it's documentation. Number four, don't underestimate surveillance or social media. Disability carriers are going to look at all of your social media accounts and even more. What do I mean by more? They may hire someone to follow you. That's called surveillance. What they do is if they find that your post or activity contradict your claim, they will use that against you. They will probably keep give you a call to discuss how you're doing and ask open ended questions about your activities that can lead people to exaggerate.
 
 Nancy Cavey [00:16:56]:
 They'll then compare what you've told your doctor to what you just said to them. And then they'll compare it to what you put on your activities of daily living form. And then they'll compare it to social media posts. They're looking for inconsistencies so they can go back to the doctor and say, look, in rendering your opinions about this person's restrictions and limitations, you you relied on their representations to you about what they could or couldn't do. And by the way doctor, guess what we found. Do you think you would have changed? You want to change your mind about your restrictions and limitations and that happens. So I want you to Be honest and I want you please think twice before doing anything online, either yourself, your spouse, friends or other family members. You need to be out of the public social media Eye number five Know your policy.
 
 Nancy Cavey [00:17:47]:
 Now I talked about that a little bit earlier by saying you need to understand what your occupation is, but you also need to understand what is disability. You also need to understand are there mental health or subjective policy limitations that will limit your benefits to just two years. Those are crucial terms in your policy or plan that that will help you understand what it is you need to prove and help you identify traps that can be found in the policy. One of the traps might be that they say you aren't getting appropriate medical treatment for your medical condition with the frequency that's required or the intensity that's required. That's in another section of your policy under medical care. So that's why I think it's really important that you read the policy or plan and if you have any questions, consult with an experienced ERISA disability or IDI disability attorney. Vascular malformations of the brain are serious. They're often invisible, and insurance companies are not necessarily looking for the damage that you live with live with every day.
 
 Nancy Cavey [00:18:51]:
 You deserve to be heard, you deserve to be believed, and you deserve to get the benefits that you have paid for. In other words, you have spent money to buy a disability insurance policy if, in the event something like this happened, you wanted to give your family financial peace of mind and you wanted to give yourself emotional peace of mind. So please don't let a disability carrier deny or terminate your benefits wrongfully. You've got rights. Remember that. Thank you for tuning in to this week's episode of Winning Isn't Easy. If you found this episode helpful, please take a moment to like our page, leave a review, and share it with your family and friends. And of course, please subscribe to this podcast.
 
 Nancy Cavey [00:19:32]:
 You may have noted that at the beginning of each episode description there's a link where you can send us questions or comments. And I tell you I love to answer questions. So please ask me some questions. And please join us next week for another insightful episode of Winning Isn't Easy. Thanks for listening.