It can be difficult to secure POTS disability insurance benefits when you are unable to work. That is especially so when your inability to work is caused by Postural Orthostatic Tachycardia Syndrome (“POTS”). This autonomic nervous system condition causes an array of symptoms when an individual changes positions from lying down to standing up. Those symptoms can include dizziness, fatigue, decreased cognition, and increased heart rate (a.k.a. tachycardia).
POTS presents unique challenges to both group and individual disability insurance claims. Its variable and intermittent symptoms make it hard to prove you can’t reliably perform your job duties. POTS can be especially disabling for professionals in cognitively and/or physically demanding jobs. In this article, we explain how to navigate the disability claim process for POTS, what medical and vocational evidence is most effective, and how a disability insurance lawyer can help ensure your claim is properly evaluated.
Table of Contents
- Why Insurers Often Deny POTS Disability Claims
- Evidence Needed to Prove a Disabling POTS Claim
- ERISA and Invisible Illness Claims: What POTS Patients Need to Know
- Professional Considerations for Executives and Skilled Workers
- Protect Your Rights With Experienced Legal Counsel
- Frequently Asked Questions About POTS Disability Insurance Benefits
Why Insurers Often Deny POTS Disability Claims
There are several reasons disability insurers deny POTS claims. As referenced above, insurers can mischaracterize the fluctuating nature of POTS symptoms as non-disabling. Other common reasons for claim denials include:
- An alleged lack of ‘objective evidence’
- Insistence on medical examinations or video surveillance to undermine a claimant’s credibility
- Use of a pre-existing condition for a misdiagnosed or long-standing symptoms to exclude the condition from coverage.
Evidence Needed to Prove a Disabling POTS Claim
There are several pieces of evidence that can help you prove your inability to work due to POTS. First, there are several autonomic testing measures you can undergo to objectively establish the presence of POTS symptoms.
What Medical Evidence Helps Prove POTS Disability Benefits — Including Tilt Table Testing
The most common of those measures is the “tilt-table test” . This test shows how the body reacts to multiple changes in position while you are lying on a table. POTS can be established by a positive test result demonstrating blood pressure drops and heart range changes that cause dizziness or fainting.
Another type of objective test not specific to POTS that can help establish disability is a functional capacity evaluation (“FCE”). This physical testing can illustrate a lack of physical endurance, as well as orthostatic intolerance. In similar fashion, a neuropsychological test can objectively establish any cognitive deficits you experience due to POTS.
Detailed treating doctor narratives are also important. These should connect the dots between positive test results, symptoms, and occupational limitations.
From a vocational standpoint, you should submit your job description so your insurer can accurately identify the specific demands required of your job. A vocational assessment from an independent expert can also help establish your occupational demands within the context of your functional limitations.
How to Win a POTS Disability Claim: Appeal Strategies That Work
If your insurer intends to deny your disability claim, you need to understand why and how to combat their decision. If your insurer requires an exam with their chosen doctor, review the report carefully and correct any falsehoods or errors.
Sometimes insurers will surveil a claimant to see if they engage in any activities inconsistent with their disability. Likewise, they may review your social media accounts for such activity. Often, insurers will amplify the significance of menial activities to assert a claimant is not disabled. If this is true in your case, you must reframe their findings as consistent with your disability and inconsistent with an ability to work on a full-time basis.
Ultimately, you must provide your insurer with a combination of medical records and occupational vocational findings that unequivocally demonstrate your inability to work due to POTS. These records can also be supported by peer-reviewed literature and clinical guidelines regarding POTS.
ERISA and Invisible Illness Claims: What POTS Patients Need to Know
Most disability claims are governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). If yours fall under this umbrella, there are several important legal considerations you must be aware of. Most importantly, you must ensure that you comply with your disability policy’s administrative deadlines for filing an appeal. Most disability plans allow for 180 days to submit an appeal of a denied claim; and insurers can refuse to even consider your claim if you do not meet your deadline.
It is also important to understand the level of judicial review that will apply to your claim if you later need to file suit against the insurer. If your claim faces ‘arbitrary and capricious’ review, a court can only reverse the denial if it finds no reasonable support for the insurer’s decision. Many disability policies contain discretionary clauses to save this standard of review for the insurer. Thankfully, many states, including Illinois and Washington, have banned discretionary clauses in disability insurance policies. On the other hand, the de novo standard of review gives claimants more of a fighting chance – it permits the judge to weigh all relevant evidence and make an independent decision whether the claimant is entitled to benefits.
You must submit all supporting evidence before the insurer issues a final decision. Courts rarely allow new evidence later. This is because it is rare for judges to admit additional evidence after filing suit under ERISA. Therefore, submitting everything you can during the administrative process helps you preserve the record for potential litigation in the future.
DeBofsky Law successfully litigated a POTS disability case involving a wrongful denial under a pre-existing condition exclusion. In Krueger v. Reliance Standard, the court ruled that the insurer had improperly denied long-term disability benefits to a professional with POTS, finding both the denial process and the medical review inadequate. This ruling reaffirmed that insurers must consider both subjective and objective evidence when evaluating complex conditions like POTS.
Read the Full Krueger v. Reliance Standard Case here.
Professional Considerations for Executives and Skilled Workers
One’s ability to work through POTS symptoms can be especially difficult for professionals, such as doctors, lawyers, executive level leaders, and other occupations with significant cognitive demands. That can still be so even if the occupation requires mostly sitting. When applying for disability benefits, you must make sure that your insurer has accurately classified your high-level occupation and considered all relevant work duties, including cognitive ones. Ensuring that the insurer does so increases your odds of establishing disability due to your POTS symptoms.
Protect Your Rights With Experienced Legal Counsel
It is incredibly important to get early legal representation to intervene and prevent any potential mistakes in submitting your appeal of a denied disability claim. The attorneys at DeBofsky Law has plenty of experience handling complex disability claims involving dysautonomia and other rare and invisible conditions, including POTS; and we will put you in the best position possible to ensure that your disability claim due to POTS is approved.
Frequently Asked Questions About POTS Disability Insurance Benefits
Can you get long-term disability benefits for POTS?
Yes, if your symptoms—such as dizziness, fatigue, or cognitive issues—prevent you from performing your job duties consistently, you may qualify for long-term disability benefits. Success depends on medical evidence and clearly showing how POTS limits your occupational functioning.
What medical tests support a POTS disability claim?
The tilt table test is the most recognized diagnostic tool for POTS. Additional evidence may include functional capacity evaluations (FCEs) and neuropsychological testing to document physical and cognitive limitations that support your claim.
Why do insurers deny disability claims for POTS?
Insurers often deny claims due to the invisible and fluctuating nature of POTS symptoms. They may argue there is a lack of objective evidence, rely on surveillance footage, or use biased medical reviews to discredit your condition.
How can I win a POTS disability claim appeal?
To win an appeal, submit strong medical documentation, treating physician statements, and vocational evidence that clearly links your POTS symptoms to your job limitations. Legal representation can also help challenge flawed insurer tactics or procedural errors.
