Postural Orthostatic Tachycardia Syndrome - Investigating the Disabling Properties of POTS, and Breaking Down POTS Disability Claims

Welcome to Season 4, Episode 8 of Winning Isn't Easy.  In this episode, we'll dive into the complicated topic of "Postural Orthostatic Tachycardia Syndrome". 

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses Postural Orthostatic Tachycardia Syndrome, also known acronymically as POTS. POTS, as a disorder, can be incredibly hard to diagnose and treat, and, yet, can also be potentially disabling. Disability carriers hate claims based on unpredictable medical conditions such as POTS: if you have been diagnosed with POTS, you might find receiving disability to be an uphill battle. But don't fret - in this jam-packed episode, host Nancy L. Cavey discusses an overview of the disorder, and how you might succeed in your claim for POTS disability.

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

1 - How Disability Carriers Contest the Diagnosis of POTS  

2 - What Disability Insurance Carriers Don’t Understand about the Excessive Heart Rate Increase in POTS

3 - What Disability Insurance Carriers Don’t Understand about Neuropathic POTS, Hyperadrenergic POTS, Hypovolemic POTS, and Secondary POTS

4 - The David v. Goliath Story of Ms. Outward, an Electrical Engineer with POTS,  and

5 - The Subjective Medical Evidence Defense

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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Transcript

Speaker A [00:00:11]:
 I'm Nancy Cavey, national ERISA and individual disability attorney. Welcome to winning isn't easy. Before we get started today, I have to give you a legal disclaimer. This podcast is not legal advice. So all we go let's talk today about postural tachycardia syndrome, known as POts, and your long term disability insurance claim and the challenges that you are going to face. Now. I don't want you to make the mistake that just because your doctor diagnosed you with pots, that you think that you are going to be getting FedEx the disability check from your disability carrier. Disability insurance companies are more than happy to collect your premium dollar, but like Scrooge, they don't want to pay a dime of disability benefits.
 
 Speaker A [00:00:57]:
 Potts, which impacts over 3 million Americans, is a disorder of the autonomic nervous system that regulates our heart rate, our blood pressure, sweating, and body temperatures. I am seeing pots cases not only in my practice generally, but I'm also seeing them in long haul COVID cases. And so I think this podcast is very timely. Now, there are many things that disability insurance carriers don't understand, and one of the things they don't understand is that it's basically a blood circulation disorder that's characterized by two things. First, there are symptoms of lightheadedness with or without fainting. There's difficulty thinking and concentrating, sort of like brain fog. There's fatigue. There's exercise intolerance, headaches, blurry vision, palpitations, tremors, nauseousness, and a heart rate increase from horizontal standing, or as tested on a tilt table of at least 30 beats per minute in adults measured during the first ten minutes of standing.
 
 Speaker A [00:02:02]:
 So today we're going to talk about what disability insurance carriers don't understand and why they don't make it easy for those with a pots claim to get the disability benefits they deserve. So I'm going to first talk about how disability carriers can test the diagnosis of pots. Secondly, I'm going to talk about what disability carriers don't understand about the excessive heart rate increase issues in pots cases. I'm also going to talk about what disability carriers don't understand about neuropathic pots, hypovemic pots, secondary pots, and hyperdrenic pots. Sorry about that. And I'm going to tell you the David versus Goliath story of Mrs. Outward, an electrical engineer with pots. And lastly, we're going to talk about the subjective medical evidence defense.
 
 Speaker A [00:02:50]:
 So before we dive in, let's take a break.
 
 Speaker B [00:02:55]:
 Have you been robbed of your peace of mind from 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 claim process. Request your free copy of the book@kvlaw.com. Today.
 
 Speaker A [00:03:15]:
 We'Ve got a lot of stuff to cover today, which I think you're going to find to be fascinating. So welcome back to winning isn't easy. I'm going to first talk about what disability carriers do or how disability carriers can test the diagnosis of pots. Now this is the first line of defense in a POTs disability insurance claim. Diagnosing pots is complicated, and this complicated process plays right into the hands of a disability insurance carrier. And that is there's no objective evidence for your pots diagnosis. Or we disagree that the tilt table test is really positive. Really.
 
 Speaker A [00:03:54]:
 So this diagnosis is complicated because symptoms will vary from person to person and they can also impact a wide range of organ systems. And it is also complicated because not all physicians get pots. So let's start with the diagnosis process. It obviously starts with a physical examination, blood work and the standing test or head up tilt table test. Now when you undergo a tilt table test, you're secured flat on a table that's raised to almost an upright position. Your heart rate, your blood pressure and your blood oxygen and exhaled carbon dioxide levels are measured. Now you might be diagnosed with pots if you meet these three elements. First, you have an abnormal heart rate response to being upright.
 
 Speaker A [00:04:46]:
 Secondly, your symptoms are worse when you're upright and you don't develop the orthostatic hypotension in the first three minutes. Now, I've also had cardiologists misread the heart rate response. So we want to make sure that your cardiologist gets the reading correct, or I promise you, the carriers are going to question the test results. Now, the carriers should also be looking for other tests. Objective testing for pots. Now, disability carriers will generally consider that pots tilt table test to be the gold standard. There are other tests that they should consider, but they always don't. And that's the Val salva maneuver, which tests the response of the autonomic nerves that control your heart.
 
 Speaker A [00:05:29]:
 There is the quantitative pseudomotor axon reflex test that measures your response of the autonomic nerves responsible for regulating sweating. There are also MRI and imaging test results to rule out tumors or other abnormalities. So there are times when I will actually suggest to my clients that they have these tests because it makes it harder for the disability carrier to deny the diagnosis. Now pots is generally only diagnosed when the orthostatic hypotension is present. I made a mistake there. POTS is only diagnosed when the orthostatic hypotension, which is a form of low blood pressure, is ruled out and when there is no acute dehydration or blood loss. So we've sort of covered the basics, if you will, of the diagnostic process. But there are also similar conditions that are at issue.
 
 Speaker A [00:06:26]:
 What do I mean by that? You would think that the carrier simply must determine if you're disabled and not require a specific diagnosis. Unfortunately, it isn't always that simple because there are many times when the policy requires an actual diagnosis and courts want to see the diagnosis. Now, part of the problem here is that there are many other medical conditions that have similar symptoms to pots. And pots can also complicate other health conditions. So, for example, it's not uncommon for a person who has me CFs to have fatigue, exercise, intolerance and the orthostatic intolerance. Those with sinus tachycardia also have a resting heart rate above 100 beats per minute. Fibromyalgia patients have gastroenterological issues such as irritable bowel syndrome, and they have excessive sweating. So again, when we're dealing with the diagnostic issues, I try to make sure that other conditions have been eliminated as part of the diagnostic process.
 
 Speaker A [00:07:27]:
 Now, as I said, pots can complicate other chronic medical conditions like asthma, inflammatory bowel disease, Lyme disease, autoimmune disease such as lupus or Sodrans. And these days it's also unknown complications of COVID-19. So in those cases, the carriers generally wants to see the diagnosis of the COVID-19 and the positive tilt test results and other testing to eliminate any other diagnoses. Now it's crucial that your physician document the objective basis of the diagnosis of the underlying medical condition and document the diagnosis of pots and eliminate other causes for your symptoms. Now that covers the waterfront, if you will, sort of into the issue of diagnosis. But your doctor should be addressing the impact of pots and each of your underlying medical conditions individually and in combination. And I don't want to gloss over the fact that your doctor should address the pots alone, because I want you to understand that if you have other medical conditions, I want the doctor to address those, and then I want the doctor to address the complications of the combination. In other words, I want the disability carrier to look at not only the underlying pots diagnosis, any other medical conditions that you might have, and then the complications of the combination.
 
 Speaker A [00:08:56]:
 And unfortunately, it may take more than one physician to address these issues, but I want to have the carrier consider your conditions individually and in combination. Now, the lack of documentation from your physician can play right into the carrier's hand. Documentation forms the basis of that diagnosis. And we want to make sure that you have all the testing that confirms the diagnosis of pots and all the documentation that eliminates other diagnosis. So we want to make sure that your doctor has an adequate fund of information from you and your symptoms so that they can make an informed diagnosis. And part of that, I think, is for you to start keeping a diary of your symptoms and how those symptoms impact your ability to function. Because I don't want the disability carrier to wrongfully deny your claim by challenging the diagnosis or your restrictions and limitations. Next, I'm going to talk about what disability carriers don't understand about the excessive heart rate increase in pOts cases.
 
 Speaker A [00:10:25]:
 Now, I find the disability carriers don't understand many of the things about postural orthostatic tachycardia syndrome. Notice pots. One of the primary things they don't get is why the heart rate increases excessively with pots while the structure of your heart is normal. They can't figure that out. They can't figure out why you have cardiac issues if your heart is normal. And this lack of understanding can result in delay, denial, or even termination of a legitimate claim. Now, pots affects 3 million Americans, and it's a disorder of the autonomic nervous system. That system regulates our heart rate, our blood pressure, sweating, and our body temperature.
 
 Speaker A [00:11:06]:
 Now, I want to take apart the terms postural orthostatic attacky cardiac syndrome because I think the carriers don't understand what each of those words mean. So let's talk about the first. Postural refers to the position of your body and the fact that you have symptoms as you become upright. Orthostatic refers to the act of standing up. Tachycardia refers to an increase in your heart rate, and the syndrome is a group of symptoms. So when I'm trying to present a pots case to the carrier, I really am hammering on all four of those words because I want the carrier to understand what that means in terms of your symptoms and your functionality. So let's talk about the tachycardia or the increased heart rate. For the most part, the structure of the heart with those who have pots is normal.
 
 Speaker A [00:12:04]:
 And again, they don't get the carrier doesn't get why you would have symptoms if your heart is normal. And the pots symptoms are caused by a number of factors. One is the lower amount of blood in circulation an excessive pooling of blood below the level of the heart when you're upright, and elevated levels of hormones released by the adrenal glands or neophrin, which is released by nerves. So the carriers don't understand that, and then they don't understand. When we stand, gravity pulls more blood into the lower half of your body. Our body activates certain nervous system responses to make sure there's enough blood reaching your brain. So, for example, your body will release hormones that will tighten blood vessels and cause a modest increase in your heart rate that allows for the blood flow to the heart and the brain as you stand. Now, once your brain gets enough blood and oxygen, the nervous response returns to normal.
 
 Speaker A [00:13:06]:
 But in cases of pots, the blood vessels don't respond properly to the signal to tighten. The longer you are upright, the more your blood pools in the lower part of your body. And as a result, you're not getting enough blood to your brain. And you feel lightheaded, fatigued, and you may even have brain fog. Now, the nervous system will continue to release chemicals in your body that will tighten the blood vessels and the heart rate will continue to increase. And that causes shakiness, skipped or forceful heartbeats, and can even cause chest pain. So the disability carrier doesn't understand or appreciate the impact of pulling and the symptoms that occur that can make you disabled. Now, there are some people with pots who have a drop in blood pressure while standing more than three minutes upright.
 
 Speaker A [00:13:56]:
 On the other hand, others can develop an increase in the blood pressure, which is known as hypertension, when they stand upright. And obviously, these symptoms can vary from person to person. As a result, when the disability carrier looks at the pots cases, they try to use a cookie cutter approach and apply a one size fits all. And pots just doesn't work that way. One of the tips that I give my clients is to use activity of daily living forms or more appropriately, a log that shows what your symptoms are on a daily basis, the range of your symptoms, what happens to you because of those symptoms, and how this impacts your ability to function. And so I think that is a way to document to your doctor the nature of your symptoms, the frequency of your symptoms, and how those symptoms impact your ability to function. That will help your doctor answer all the disability carriers questions about your diagnosis and your restrictions and limitations. And obviously, it should be shared as appropriate with the disability insurance carrier, because I don't want the carrier to put their head in the sand and ignore postural orthopedic tachycardia syndrome and the impact of your increased heart rate in your disability claim.
 
 Speaker A [00:15:20]:
 I don't want them to delay, deny or even terminate your claim because of a lack of understanding of what pots is. So I'm going to talk next about what carriers don't understand about neuropathic pots, hyperhedretic pots I'm sorry, I have a trouble saying that. Hypovolemic pots and secondary pots. So stay tuned.
 
 Speaker B [00:15:43]:
 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 do's regarding your disability application that will assist you in submitting a winning disability application. This is one you won'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@disabilityclaimsforprofessionals.com.
 
 Speaker A [00:16:19]:
 Welcome back to winning isn't easy what disability insurance carriers don't understand about neuropathic pots hyperedrenic pots, hypovolemic pots and secondary pots now the disability carrier's ignorance seems to know no balance when it comes to a pots claim. The causes of pots can vary from person to person, as well as the symptoms and the impact of those symptoms on your functionality. There are different characteristics of pots that can occur in different types of pots and they're not necessarily mutually exclusive. POTs can be classified into four different categories, and I'm going to talk about each of those and how they present in terms of symptoms. And again, this is something that the disability carriers don't understand and I'm trying to hammer in my pots disability insurance claims. So let's first talk about neuropathic pots. That's associated with damage to small fiber nerves, which regulate the constriction of blood vessels in the limbs and your abdomen. This in turn can cause symptoms and dysfunction in your limbs and in your gastrointestinal system.
 
 Speaker A [00:17:32]:
 There's hyperedrenic pots and that's associated with elevated levels of stress hormones in your body. This in turn can cause significant tremors, cold or sweaty extremities, migraine headaches and increased urination. The next type of pots is hypovolemic pots, and that's associated with an abnormally low level of blood, and this in turn can cause weakness and decreased tolerance for activities. Lastly, there is secondary pots. Now, secondary pots is associated with other conditions known as to cause automatic neuropathies. So we'll see pots in diabetes cases, Lyme's disease cases, autoimmune disorders such as lupus or Sodron's. And I am now also seeing this in my long haul COVID cases. What happens, of course, in a secondary pots case is you have the symptoms of the underlying disease or medical condition, but that is complicated by the symptoms of pots.
 
 Speaker A [00:18:41]:
 It's crucial that your physician make a clear, definitive diagnosis of pots, explain the type of pots you have, and document your symptoms. This, in my view, requires teamwork. The disability insurance carrier is sending you activity of daily living forms and also sending the disability. They're also sending your doctor, rather, attending physician statement forms, APS forms. Now, if you've ever closely looked at an APS form, you will see that they are not asking the right questions on purpose because the disability carrier doesn't really want the right information to make a decision about your case. So what I do, because I'm also a Social Security disability attorney, is I supplement that APS form with a residual functional capacity form that we use in Social Security pots cases. Why? Because the Social Security disability residual functional capacity form asks the right questions in a POTS case. So I staple them together and I asked the doctor to complete them both.
 
 Speaker A [00:19:45]:
 But we're not done yet. We've got to tie the diagnosis and the severity of your symptoms and your restrictions and limitations to your inability to perform either your own occupational duties or the material and substantial duties of any other occupation. And what I generally do is to have a vocational evaluator help us tie together this information. On the one hand, your doctor has confirmed the diagnosis of pots or the underlying medical conditions, confirmed what your restrictions and limitations are. And now we have the burden to prove that those restrictions and limitations preclude you from doing your own occupation or the material and substantial duties of your occupation. Now, I work closely with my clients in developing their occupational descriptions because I want the carrier to completely understand what your duties are and make sure that that occupational definition is consistent with the definition of what's in your disability policy. So, for example, if you have migraines, you might have to go into a cool, dark room to deal with the migraines. Or if you're having urinary issues, you may have to spend a lot of time in the bathroom, or you might have difficulty using your upper extremities because of the tremor issues.
 
 Speaker A [00:21:01]:
 So we want to make sure that we are developing the symptoms, the functionality of your pot syndrome, and tying it together from a vocational standpoint. Now, you need to remember that the disability carrier might agree with a diagnosis of Pots, but they are always going to question the severity of your symptoms and whether or not those symptoms are disabling, as that term is defined in your policy. So you've got the burden of proof, not the disability carrier. What I want to talk about next is tell you the story of Mrs. Outward. She was an electrical engineer with Pots, and it's a classic David versus Goliath story of Miss Outward, an electrical engineer with Potts postural orthostatic hypotension. Potts claims can be difficult to prove because disability carriers insist on objective evidence of both the diagnosis and the restrictions and limitations assigned by your physician. And disability carriers play games in these cases.
 
 Speaker A [00:22:35]:
 Let's talk about how these games are played out, and I'll give you an example. Mrs. Outward was an electrical engineer and she worked for a company by the name of Eaton. She was a strategic pricing manager, and she did work also as a sales marketing trainer manager, and she was a corporate marketing manager. Unfortunately, after suffering a miscarriage, her physical condition began to deteriorate. She was diagnosed with a number of medical conditions, including Epstein Barr virus and pots. Her disability plan and you need to get out yours, provided that she would be entitled to benefits for the first 24 months if she was totally and continuously unable to perform the essential duties of her regular occupation. And after that she would be entitled to benefits only if she was totally and continuously unable to engage in any occupation or perform any work for compensation or profit.
 
 Speaker A [00:23:34]:
 Now, of course, you need to look at your policy to understand the definitions of disability. But her plan had a trap, and that trap was used to deny her claim. The plan required that she provide objective findings to substantiate the period of time that her health care practitioner indicated she was disabled. All right, so what did objective findings mean? Well, you had to look in her policy much like you have to look in your policy. Objective findings were defined to mean findings that can be observed by your healthcare practitioner through objective means, not just from your description of your symptoms. The policy said that objective findings could include physical examination findings that document functional impairments or capacity, diagnostic studies or imaging studies, a diagnosis, x ray results, observations of abnormalities on examinations, and that they wanted objective evidence of medications or a treatment plan. So in this case, outwards physicians agreed with a diagnosis of pots. They noted that during periods of the ostostatic stress, she would pool a greater than normal degree of blood that would result in an increase in her heart rate and her myocardial contract ability.
 
 Speaker A [00:24:58]:
 As a result, she had extreme fatigue, exercise intolerance, and orthostatic intolerance. Many of the symptoms she complained of fatigue, pain, numbness, instability, cognitive issues, and exercise intolerance are not necessarily demonstratable through medical testing. But her doctors listed a number of verifiable medical findings supporting the diagnosis, including blood pressure readings, hemodynamic testing, and cuisart findings. Now, the plant administrator said yeah, and rejected those findings and requested a transferable skills analysis by their vocational evaluator. And of course they said to their vocational evaluator, don't consider the opinions of the treating physician. Rather, we want you to consider what transferable skills you think she has based on our liar for hire doctor's peer review analysis of her restrictions and limitations. Well, what were those? The liar for hire doctor Peer review said that she could do a light physical job for at least 4 hours a day and as long as 8 hours a day. And as a result of those inaccurate and wrong restrictions and limitations, the vocational evaluator did the transferable skills analysis and determined that she could be a call center service representative.
 
 Speaker A [00:26:25]:
 Well, she didn't even have that kind of experience. But nonetheless, the disability carrier denied her claim. On appeal, her treating physician explained why the medical reports and a functional capacity evaluation that the plant administrator was relying on were incomplete and incorrect. In other words, her treating physician had to take apart the disability carrier's physician's wrong conclusions. Her treating physician said, look, you didn't address the unscheduled break. She has to take every five to ten minutes during an eight hour day and she needs a rest period of every 30 to 60 minutes. That's unfortunately not uncommon. And the disability carrier said, too bad, so sad.
 
 Speaker A [00:27:06]:
 We are going to uphold this denial. Now Ms. Outward didn't give up. She filed a lawsuit. This ended up in the 6th Circuit in a case called Outward versus Eaton Corporation disability plan. And the 6th Circuit found that the denial of the claim was what's called arbitrary and capricious and remanded it back to the plan for a full and fair review. So what did the 6th Circuit say? They said, look, you didn't consider all the relevant medical evidence. You used three unqualified doctors to evaluate the claim and you didn't get an expert to address Ms.
 
 Speaker A [00:27:44]:
 Outwards issues. The court also took the plan to task for noting that while the plan required her to provide objective findings of disability, the plan purposely ignored the test results which were positive. The court said, look, relying on test results is appropriate, but you have to also consider the totality of the circumstances. You've got to look at the diagnosis, you've got to look at the symptoms, you've got to look at the prescriptions that she was given, you have to look at the treatment plan and you have to look at the results of that treatment plan. And the judge said, look, this whole denial was arbitrary and capricious because one, the treating physician listed all the test results, their observations, their treatment plans, and the prescriptions and treatment that supported the diagnosis of pots. Two, those facts should have been considered by the plant administrator along with the quantitative testing to evaluate the extent to which she was disabled. Now, because the opinions of her treating physicians were based on the test results, treatments and observations made over the course of many years, the court said, look, I think that your reliance on the opinions of doctors who merely reviewed the records or who only maybe saw her once was arbitrary and capricious. You've got to consider everything and you can't willy nilly reject things.
 
 Speaker A [00:29:15]:
 Number three, the plan cannot cherry pick medical evidence, which is exactly what they did. Number four, the court said, look, your denial is basically predicated on an independent, in quotes review of the medical records. And while those physicians who weren't qualified recognized that she exhibited the multiple symptoms normally seen in a pots case, that they couldn't also ignore the symptoms that are commonly recognized in pots. So she had extreme fatigue. Now, we know that that generally can't be verified by objective medical testing, nor could her complaints of dizziness and fatigue. But the court said, look, you just can't conclude that there are no restrictions and limitations just because there's no objective testing that will measure her fatigue, her dizziness, or her other symptoms which are recognized symptoms of fatigue. You just can't rely on objective findings to the exclusion of other applicable objective findings in determining the eligibility for benefits. In other words, you've got to look at the totality of the pot symptoms that she presented with.
 
 Speaker A [00:30:32]:
 Were they consistent with the diagnosis? Yes. Were they consistent with the kinds of symptoms that other people exhibit that cause restrictions and limitations? Yes. Are there tests to verify the extent or nature of these complaints? No, but you just can't ignore them because there's no objective testing. You have to consider them in the totality of the claim. And so, fifth, the court said the carrier's blind reliance on the results of certain medical testing basically skewed their analysis, not only their medical analysis, but ultimately their vocational analysis. And the court threw out their conclusion that she was not entitled to her disability benefits. And so I think that that is a phenomenal decision and one that illustrates the problems that you will see in Potts cases. Now I'm going to finish up this episode by talking about the subjective medical evidence defense, which also can be a case killer.
 
 Speaker A [00:31:37]:
 We'll come back in a minute. Welcome back to winning isn't easy the subjective medical defense used in Potts cases. Now, I have explained to you why you're in the fight to get the disability benefits that you paid for and you deserve as a result of your pots cases. But I think it's important before you stop working and apply for benefits or appeal a wrongful denial of your claim that you understand how carriers can also raise another defense. One of the most common defenses is what's called the subjective medical evidence defense. Get out your disability policy, because if you have a subjective medical condition clause in your policy, you're in for a rough ride. What is subjective evidence? Well, subjective evidence is just that. When you see your doctor, you complain of symptoms that are consistent with the diagnosis of pOts.
 
 Speaker A [00:32:50]:
 But you may not present with objective medical testing or objective findings on examination that document your subjective symptoms. So what are the subjective symptoms of pots? There are symptoms of lightheadedness, with or without fatigue, difficulty thinking and concentrating, sort of like brain fog, fatigue, exercise intolerance, headaches, blurry vision, palpitations, tremors, nauseousness. And of course, you have that heart rate increase when you go from horizontal to standing. It can be hard for your physician to find objective evidence that support your complaints. But I know that there are physicians who do believe in pots and who will support your claim. Unfortunately, group carriers and even private disability carriers like Unum or northwestern will disregard or even discount your subjective complaints in deciding to pay or terminate your benefits based on the subjective medical condition clause in your policy. Now, I try to combat this because I think it's crucial that your medical evidence and the statement that you give to me and to your friends about your symptoms can help cooperate and quantify your objective symptoms, not only in terms of the fact that you've got them, but the nature, the extent, duration and frequency of your symptoms. That's important because disability carriers often minimize the complaints of pots.
 
 Speaker A [00:34:21]:
 They try to use a one size fits all analysis. Even if there isn't a subjective medical condition limitation in the policy. Your level or the nature of your symptoms, discomfort and disability are personal to you. They can vary from day to day, week to week, and even month to month. And so I think that documenting, explaining and quantifying your unique symptoms are the key to getting your benefits. As I said, I think that one of the ways to go about that is to get statements from your family and friends. But I also think another way is to keep a pots diary that will document your symptoms, your functionality, the quality, quantity and nature of your symptoms and how they impact your ability to function. Now I think that that is documentation that can help your physician not only cooperate the diagnosis of pots, but your restrictions and limitations.
 
 Speaker A [00:35:17]:
 When we put that all together, though, the disability carrier may also look to a subjective medical condition clause in your policy that can limit your benefits. So get out your policy and look for that in the index or in the policy or policy definitions. The subjective medical condition limitation is another denial tool in the carrier's toolbox, and the policy may say that medical conditions are considered to be subjective in nature if they're characterized by pain, fatigue, headaches, exercise intolerance, or concentrating. So they'll say that those are subjective medical conditions where benefits are limited to just two years. Worse yet, the disability carrier's policy, the one that you have, may even list pots as a condition where benefits are limited to just two years. So either they're going to use a broad palette, if you will, of symptoms and say those symptoms are considered subjective and benefits are limited to two years, or they'll specifically use the word pots in the laundry list of conditions that they consider to be subjective, with benefits limited to two years. So the key to getting your benefits is going to be understanding the definition of disability, the definition of occupation, and whether or not there is any subjective medical condition clause in your disability policy. All of that can be a kick in the pants, and you owe it to yourself to consult with an experienced lawyer such as myself who can help you before you stop work or appeal a wrongful denial, as we can work our way through the way to get your benefits or the way to address a wrongful denial, we're done for today.
 
 Speaker A [00:37:03]:
 That's a ton of information, and as you know, I specialize in pots cases. So give me a call if you have a pots. If you've been diagnosed with pots and your doctor has told you to stop work or your claim has been denied, call me today at 727-894-3188 for a complimentary consultation. If you like this podcast, consider liking our page, leaving a review, or sharing it with your friends and family. Remember, our podcast comes out weekly, so stay tuned for next week's episode of Winning isn't easy. Thanks.