Disability insurance companies don’t always make it easy for policyholders who have multiple sclerosis (MS) to get the disability benefits they deserve.
MS is a progressive disease of the central nervous system that disrupts the flow of information within your brain and from the brain to your body. Each of the four types of MS have different symptoms. The symptoms and progression vary from person to person.
Regardless of which type of MS a policyholder has or the progression of the disease, disability carriers are notorious for denying and terminating many claims.
The Common Reasons Disability Carriers Deny MS Disability Claims
Common arguments disability carriers make are that:
- Coverage is excluded because of the pre-existing condition clause in your disability policy.
- Benefits are limited under the subjective limitation clause. Loss of balance, fatigue, pain, and difficulty concentrating may be the most disabling symptoms you have, but carriers routinely dispute the impact of those symptoms.
- You have had MS for years and have not been disabled before now. You will have to overcome the carrier’s argument that you have been working with these problems for years and nothing has changed. It is crucial that your medical records develop the progression of your symptoms.
- Your symptoms are intermittent.
- Your fatigue and pain are subjective complaints and you haven’t had any fatigue testing that supports your complaints.
- Your complaints of difficulty concentrating or other cognitive difficulties are not supported by your medical records, the Activity of Daily Living forms you completed, what your employer has told us or the surveillance we have.
- Your complaints of difficulty concentrating or other cognitive difficulties are subjective, and you haven’t had any neuropsychological testing to provide us an objective basis of your complaints.
- Treatment will allow you to continue to work so you couldn’t possibly be disabled.
As a result, many disability claims for MS are denied. Carriers have other reasons to deny claims. They’ll say:
(1) There is no objective basis of the diagnosis,
(2) There is no objective basis for the restrictions and limitations assigned by your physician because of your MS,
(3) There is no causal relationship between your MS and/or your restrictions and limitations, and your inability to do your own or any occupation.
Nancy Cavey overcomes a claims denial by working closely with you and your physician. She has seen first-hand her client’s suffering and the devastating effects of MS; she understands what you are going through.
Nancy Cavey offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.
What Are the Disabling Symptoms of MS?
MS symptoms can vary depending on the type of MS and the progression of the disease. The most common symptoms are:
- Loss of balance, dizziness, lack of coordination,
- Fatigue,
- Pain,
- Tremors,
- Muscle stiffness or spasm,
- Numbness or weakness,
- Difficulty concentrating or other cognitive problems, like forgetfulness,
- Depression, and
- Visual disorders.
It is important that your medical records document your symptoms and how those symptoms impact your ability to function.
This is particularly true because you have probably been working with difficulty but now find it hard to continue. The disability carrier will want to know what has changed and what caused you to file for disability.
MS is episodic. Your symptoms may slowly progress or flare-up. Your medical records should document the progression of your symptoms, the frequency of the flare-ups, and the symptoms you have during the flare-ups.
Keep an MS diary that notes how you feel, the nature of your symptoms and how the symptoms impacted your ability to function. Be sure to give your physician a copy of the diary with the entries between each visit. This diary can show the progression and impact of your symptoms.
How Do I Get The Disability Insurance Benefits I Deserve?
Regardless of the type of MS you have, the disease can interfere with your daily activities and with your ability to work. If you no longer can work or your doctor has told you to apply for disability benefits, you should take steps before you apply:
- Obtain a copy of your disability policy. See how it defines “disability,” “occupation” and “self-reported conditions.” You’ll need to understand what you have to prove and if there are limitations in your coverage.
Some policies consider MS without objective findings to be a subjective condition; benefits are limited to just two years. You need to know applicable policy limits before you apply for benefits.
- Obtain a copy of your medical records. Review them to see if there is an objective basis for your diagnosis, what your records say about your report of symptoms and your restrictions and limitations.
One of the most common reasons given for a claims denial is that there is “no objective evidence to support your subjective complaints of weakness or fatigue.’’ You want to make sure your physician addresses that issue in your medical records before you file a claim.
Your physician might have noted that you were feeling better, had less pain or cognitive problems or that you had more energy. These entries must be addressed before your application is filed or during the appeal process if your claim has been denied.
Carriers often make a leap of logic and say the policyholder either is exaggerating or faking their fatigue or cognitive problems. Nancy Cavey knows what proof is necessary to meet the policy definition of disability.
- Obtain a copy of your personnel file to see if your MS has affected your work performance.
- Obtain a copy of your job description. Create your own description of your physical duties with an explanation of how your symptoms impact your ability to do your occupation.
- Provide your doctor with the occupational description. Ask your doctor to prepare a report that explains the objective basis for your diagnosis, the objective basis of your restrictions and limitations, and the objective reasons you can’t perform some or all of the material and substantial duties of your occupation.
- Prepare a diary that explains your symptoms and any side effects of medication. Be sure to give examples of how your weakness, fatigue and other symptoms interfere with your ability to do things on a daily basis. Your pain may even give you problems with concentration.
- Hire Nancy Cavey to help you file your initial application. The application process is confusing and designed so you and your physician make mistakes that can result in a delay or even a denial of your benefits. She will work closely with your neurologist to make sure your records reflect the progression of the MS and your symptoms. She also makes sure your physician correctly completes all Attending Physician Statement forms.
Ms. Cavey knows how to prepare and file a winning shock and awe disability application that leaves the carrier little reason to question your claim.
- Hire Nancy Cavey to help you appeal a wrongful denial or termination of your disability benefits. Disability carriers are in the business of collecting premiums and not paying disability benefits. They’ll use any reason to deny your MS claim. The odds of getting your benefits on appeal are greater when you are represented by an experienced ERISA/private ID policy disability attorney.
Contact Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live
MS can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Nancy Cavey can review your policy and your medical records, and explain to you what your policy says and how to get your disability benefits. Call today for a free consultation at 727-894-3188.
