Cavernous Malformation And Long-Term Disability Claims

Cavernous malformation (also called CM, cavernoma, or cavernous angioma) is a condition characterized by clusters of abnormal, dilated blood vessels in the brain or spinal cord. These malformations can vary in size and location and can cause a range of symptoms that can significantly affect a person’s ability to work. The following is a comprehensive overview of cavernous malformations, the challenges associated with proving disability, and how an attorney can assist with long-term disability (LTD) claims.

What Is a Cavernous Malformation?

Cavernous malformations are vascular abnormalities consisting of enlarged blood vessels that form a lesion. Most CMs have no clear cause, but familial CMs are passed down through families through certain genes. These lesions can leak or bleed, causing stroke-like neurological symptoms. While some people remain asymptomatic, others experience debilitating symptoms, including:

• Seizures: A common complication that can prevent individuals from maintaining safe employment.
• Headaches: Often severe and chronic.
• Neurological Deficits: These may include weakness, numbness, difficulty with coordination, or vision and speech problems.
• Cognitive Impairments: Such as memory problems, difficulty concentrating, or confusion.

The location of the malformation (e.g., brainstem, spinal cord) plays a critical role in the severity and type of symptoms experienced. CMs in the brain and spinal cord are most likely to cause symptoms.

Cavernous Malformations and Long-Term Disability Claims

Cavernous malformations can make it difficult or impossible for affected individuals to work, especially if symptoms are severe or unpredictable. To qualify for long-term disability benefits, claimants must prove that their condition and symptoms meet the definition of disability in their LTD policy. This often involves demonstrating how the condition limits the ability to perform work-related tasks, such as:

1. Physical Limitations: Weakness, impaired coordination, or mobility problems that limit physical job functions.
2. Cognitive and Emotional Impairments: Memory loss, poor concentration, and mood disorders that affect concentration and decision-making.
3. Unpredictability of Symptoms: Frequent or sudden seizures and episodes of neurological dysfunction that make it unsafe to maintain steady employment.

Medical Evidence to Support a Disability Claim

Medical evidence is essential to prove that a cavernous malformation prevents substantial gainful activity. Key documentation includes:

• Neurological Evaluations: Detailed assessments of motor skills, coordination, and cognitive function.
• MRI or CT Scans: Imaging that identifies the size, location, and severity of the malformation.
• Treatment Records: Documentation of surgeries (if any), medications, and ongoing therapy.
• Specialist Reports: Input from neurologists or neurosurgeons outlining limitations and prognosis.
• Seizure Logs: Records of seizure frequency and severity, if applicable.
• Residual Functional Capacity (RFC) Form: Completed by a physician to highlight the claimant’s functional limitations.

Challenges in Cavernous Malformation Disability Claims

Insurance companies often deny long-term disability (LTD) claims for cavernous malformations, citing insufficient medical evidence or claiming that the claimant can still perform work. Common challenges include:

• Proving the Severity of Symptoms: Cavernous malformations often cause intermittent symptoms such as seizures or headaches. These episodic problems can be difficult to document comprehensively enough to prove that they prevent work.
• Connecting Cognitive Impairments to Disability: For those who experience memory loss, difficulty concentrating, or other cognitive impairments, it can be difficult to prove that these problems are severe enough to interfere with work-related tasks—especially for jobs that require concentration or decision-making.
• Addressing Misclassification of Conditions: Insurance companies may misclassify physical or neurological symptoms to mental health conditions. This can lead to claims being denied or benefits being limited under mental health exclusions.
• Policy Definitions: Some LTD policies require proof that the condition prevents not only current employment, but also any employment for which the claimant is qualified. This places an additional burden of proof on the claimant.

Lessons Learned from Watson v. Reliance Standard Life Insurance Company

The case of Watson v. Reliance Standard Life Insurance Company highlights the difficulty of securing LTD benefits for conditions with subjective or fluctuating symptoms, such as those associated with cavernous malformations. Cheryl Watson’s LTD claim was initially denied because Reliance Standard classified her disabling symptoms—including chronic fatigue, pain, and cognitive impairments—as resulting from a mental health diagnosis (somatoform disorder). This classification subjected her to a 24-month limitation under the policy’s mental health provisions.

This case highlights several important considerations for LTD claimants:

• The Importance of Comprehensive Medical Evidence: Watson’s case demonstrates the critical role of detailed medical documentation. For cavernous malformation claims, key evidence includes MRI scans, neurologist reports, treatment histories, and functional capacity evaluations.
• Challenging False Characterizations: Watson’s insurer attributed her physical symptoms to a psychological condition. Claimants with cavernous malformation may face similar attempts to downplay the severity of their condition. Documenting how the symptoms affect the ability to work is critical.
• Understanding Policy Limitations: Watson’s benefits were initially limited by a policy provision for mental health disorders. Claimants should carefully review their policy’s terms and be prepared to counter attempts to classify physical impairments as psychological in nature.
• The Value of Persistence in Appeals: Watson’s eventual success in federal district court demonstrates the importance of persistence. For cavernous malformation claimants, an initial denial is not the end of the road—a strong appeal with additional evidence can lead to a favorable outcome.

How a Long-Term Disability Lawyer Can Help

Nick Ortiz and the Ortiz Law Firm have extensive experience navigating the complexities of LTD appeals, including those for cavernous malformations. Here’s how working with a disability lawyer can help:

• Developing Strong Medical Evidence: Ensuring comprehensive documentation of symptoms, treatments, and limitations.
• Interpreting Policy Language: Identifying the specific criteria for disability in your insurance policy and building a case around those terms.
• Coordinating Expert Testimony: Including hiring neurologists or occupational experts to support your claim.
• Managing Deadlines: Ensuring timely submission of all required documentation.

The Ortiz Law Firm Provides Legal Assistance for Complex Long-Term Disability Claims

Cavernous malformations can make it difficult or impossible to work, but proving disability requires expertise in interpreting medical evidence and insurance policy language. At the Ortiz Law Firm, we specialize in helping people with complex conditions secure the benefits they deserve.

If you’re struggling with LTD claim denials or need assistance proving your disability, we can help. By building strong medical evidence, countering insurer tactics, and navigating the appeals process, we ensure that your case is as strong as possible.

Whether you’re facing an initial denial or have exhausted your administrative appeals, contact us for a free case evaluation. With the right legal and medical support, you can get the benefits you’re entitled to. Contact us online or call us today at (888) 321-8131.