Postural orthostatic tachycardia syndrome, better known as “POTS,” is a medical condition characterized by an excessive increase in heart rate upon standing up from a seated or supine position, accompanied by symptoms such as lightheadedness, fainting, and fatigue. It is often associated with decreased blood volume and autonomic nervous system dysfunction. In some cases POTS may be considered a disability, as it can significantly impact your ability to carry out daily activities and affect your quality of life. However, whether your POTS is considered a disability depends on the severity of your symptoms and how they affect your daily functioning and ability to work.
You may be eligible for short or long term disability benefits if you have POTS. To get your disability claim approved, your symptoms must be severe enough to meet the criteria required by your insurance company. In this article, we’ll discuss how POTS causes disability, how insurance companies evaluate POTS short and long term disability claims, and how The Maddox Firm can help prove your POTS short or long term disability claim.
How POTS Causes Disability
POTS causes a variety of physical and cognitive symptoms, including:
Lightheadedness or fainting upon standing
Rapid heartbeat (tachycardia)
Fatigue
Muscle weakness
Brain fog or confusion
Shaking and/or trembling
Nausea or abdominal pain
Shortness of breath
Chest pain or palpitations
Sweating or flushing
Dizziness or unsteadiness
Sleep disturbances
POTS commonly occurs as a co-morbidity with Ehlers-Danlos Syndrome (“EDS”) and Chronic Fatigue Syndrome (“CFS”). These conditions share certain underlying issues, such as dysregulation of the autonomic nervous system and connective tissue dysfunction. EDS, a connective tissue disorder, can cause orthostatic intolerance, which is a hallmark symptom of POTS. CFS is also associated with autonomic nervous system dysfunction, which can contribute to symptoms such as fatigue, brain fog, and cognitive impairment.
In terms of your short or long term disability claim for POTS, your insurance company will generally consider you disabled if your symptoms prevent you from working. POTS symptoms can impede your ability to perform your job in numerous ways. For example, lightheadedness or fainting upon standing can cause frequent interruptions in work and decrease productivity. Fatigue, weakness, and brain fog can result in decreased mental acuity and difficulty with focus and concentration, making it hard — if not impossible — to complete tasks effectively. Physical symptoms such as shaking, nausea, shortness of breath, and dizziness can impact your ability to perform the physical requirements of your job, such as standing, walking, or sitting for extended periods.
These POTS symptoms can have a significant impact on your ability to work effectively and lead to short or long term disability.
How Disability Insurance Companies Evaluate POTS Claims
POTS disability claims often present unique challenges to insurance company approval. POTS can be difficult to prove as a disability to insurance companies, as it is often an invisible illness, and its symptoms can vary greatly from person to person. Your insurance company require extensive documentation, such as medical records, diagnostic tests, and doctor’s reports, to support your claim for disability benefits. In some cases, your insurance company may even question the validity of POTS as a medical condition, which can make the process of obtaining disability benefits even more trying.
Additionally, POTS can be tricky to diagnose, and there is no one specific test that can confirm its presence. This creates difficulty in providing sufficient evidence of your condition to your insurance company.
Beyond medical documentation, your insurance company will require proof that your POTS prevents you from working. You will need to furnish sufficient vocational evidence that explains how your POTS symptoms specifically impede you from performing the material duties of your occupation.
The process of proving POTS as a disability to insurance companies can be particularly complex, and it is important to work closely with your healthcare providers and a disability attorney to ensure that your claim is properly documented and presented.
How The Maddox Firm Can Prove Your POTS Short or Long Term Disability Claim
A long term disability and ERISA attorney can assist you with your POTS short or long term disability claim. The experienced team at The Maddox Firm understands the unique challenges of getting a POTS disability claim approved. We know what steps are necessary to file your claim successfully.
Here are a few ways The Maddox Firm can help you prove your POTS disability claim:
We examine your insurance policy. Your disability insurance policy contains all of the eligibility requirements your insurance company demands you meet in order to get approved for disability benefits. The language in these policies can be confusing and hard to understand. The Maddox Firm will review your policy and explain to you what definition of disability you must meet to receive benefits. Your policy lays the groundwork to getting your POTS claim approved.
We review your medical and vocational evidence. As discussed above, POTS claims are especially challenging due to the nature of the condition. Because of this, objective medical evidence will be crucial to getting your claim approved. The Maddox Firm will request all existing medical records on your behalf. By examining your records, we can assess whether your medical documentation of your POTS disability is sufficient for your insurance company. We will also review your vocational evidence, including your resume and official job description, to see if the evidence explains all of your occupational responsibilities. We can then craft a personalized strategy to obtain any necessary additional evidence.
We help you obtain additional evidence to support your claim. The Maddox Firm understands what proof of your POTS disability your insurance company expects to approve your claim. For POTS claims, we often recommend our clients undergo additional medical testing.
A cardiopulmonary exercise test (“CPET”) can be used to help diagnose POTS and provide objective evidence of functional impairment caused by the condition. The test measures the body’s physiological response to exercise and can help determine if POTS is impacting your ability to perform physical activities, including work. A CPET can help identify symptoms such as shortness of breath, rapid heartbeat, and decreased oxygenation that occur during physical activity, which can be attributed to POTS. The results of the test can provide objective evidence of the impact of POTS on your functional capacity and be used to support a disability claim.
Other helpful testing for POTS includes a functional capacity evaluation (“FCE”). An FCE is a comprehensive assessment of your physical abilities and limitations. The evaluation typically includes tests of physical strength, endurance, range of motion, dexterity, and posture. An FCE can help provide objective evidence of the impact POTS has on your ability to perform work-related activities.
The results of a CPET and an FCE can provide objective evidence of your symptoms presence and severity, as well as your functional restrictions and limitations. These evaluation reports can be used to support your POTS disability claim. Not only will The Maddox Firm refer you for this testing, we will coordinate with the evaluators to review the reports for accuracy and completeness. We will make sure they reflect the full scope of your POTS disability and its impact on your ability to work.
In addition, The Maddox Firm will coordinate with your treating doctor to obtain a supplemental letter in support of your disability claim. The attending physician statement form insurance companies send are often limited and leave no room for your doctor to elaborate on your POTS symptoms. Your doctor’s office visit notes may also not relay the full scope of your symptoms and their impact on your ability to work. Your doctor can provide a letter outlining your patient history, the onset of your POTS, their observations of your condition, and their medical opinion on your ability to work. This letter can then be submitted to your insurance company as further proof of your POTS disability.
We take over communications with your insurance company. The Maddox Firm will take over all communications with your insurance company on your behalf. We will ensure that all forms and paperwork are completed accurately and in a timely manner, and make sure that your insurance company meets all of their required deadlines. Should your insurance company request an interview, your attorney will prepare you beforehand and attend the meeting to safeguard you from any overstepping or inappropriate questions.
We will file your appeal, litigation, or negotiate your settlement. If your POTS short or long term disability claim is denied, The Maddox Firm can prepare and file an administrative appeal on your behalf. Typically if a claim is denied or terminated, you must go through the internal appeal process with your insurance company. If your claim is denied on appeal, you can sue your insurance company for the wrongful denial. Your insurance company may also at some point offer a lump sum settlement to buy out your disability claim. The Maddox Firm routinely handles disability insurance appeals, litigation, and negotiations.
We always recommend speaking with a trusted attorney before filing or appealing a POTS short or long term disability insurance claim. Whether you are looking for assistance in navigating the claims process, appealing a POTS claim denial, or litigating a final adverse decision, The Maddox Firm can help.
The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.