Month: October 2020

INTERSTITIAL CYSTITIS

Social Security (“SSA”) defines interstitial cystitis as a complex condition that causes pain or discomfort in the bladder and pelvic region that has lasted at least 6 weeks and cannot be explained by another cause, such as a urinary tract infection or kidney stones. Interstitial cystitis is most common in women. It is common for people to have symptoms such as urinary frequency and bladder pain for many years before even being diagnosed.

In Social Security Ruling 15-1p, SSA explains what evidence is needed to establish a medically determinable impairment of interstitial cystitis and how interstitial cystitis will be evaluated. The policy developed by SSA is based largely on guidelines developed by the American Urological Association and the National Institute of Diabetes and Digestive and Kidney Diseases.  SSA will be looking for sufficient objective evidence to support a finding that your interstitial cystitis, or your interstitial cystitis in combination with any other impairments, prevents you from performing substantial gainful activity. Substantial gainful activity is the ability to work full-time, generally 8 hours a day, five days a week.

How do I show Interstitial Cystitis is a medically determinable impairment?

SSA will only find interstitial cystitis is a medically determinable impairment if it has been diagnosed by a physician. However, they will not rely on a diagnosis alone. Your diagnosis must be consistent with the evidence in your case record. This means a diagnosis of interstitial cystitis also requires that supporting testing and ruling out other diseases that can cause your symptoms, such as kidney stones or a urinary tract infection. 

SSA recognizes that interstitial cystitis will vary from person to person. Sometimes the symptoms will vary in the same person. For example, some symptoms may worsen around the time of menstruation. Symptoms include, but are not limited to:

  1. Chronic bladder and pelvic pain that ranges from mild to extreme. Intensity may worsen as the bladder fills. People with interstitial cystitis may experience vaginal, testicular, penile, low back or thigh pain.
  2. Urinary urgency and/or frequency. This may interfere with sleep.
  3. Suprapubic tenderness on physical exam, sexual dysfunction, sleep dysfunction, and chronic fatigue.

Medical signs that support a diagnosis of interstitial cystitis include:

  1. Bladder-wall stiffening (fibrosis)
  2. Pinpoint bleeding on the bladder wall (diffuse glomerations)
  3. Hunner’s ulcers (patches of broken skin on bladder wall)

SSA will look at whether your medical provider has performed a physical exam and reviewed your medical history. They will evaluate whether your medical provider’s treatment notes are consistent with the diagnosis of interstitial cystitis and consistent with any work-related limitations.

What kind of documentation will SSA be looking for?

  1. Objective medical evidence will be most important. Specific testing that Social Security will look for in evaluating interstitial cystitis includes a) repeated testing showing there is no urinary tract infection despite interstitial cystitis symptoms; b) a positive potassium sensitivity test (Parson’s test); and c) testing showing antiproliferative factor (APF) in the urine. A cystoscopy is often done to visually examine the bladder.
  2. Your report of symptoms will also be evaluated. It is important that your report of symptoms is consistent with the objective medical evidence and supported by the other evidence in the record. Social Security is looking at how interstitial cystitis affects your ability to work. This might be chronic pelvic pain that affects your ability to focus or concentrate, urinary frequency and urgency requiring frequent bathroom breaks, or interrupted sleep leading to daytime drowsiness. Whatever your specific symptoms from interstitial cystitis, they need to be documented in the record both in your statements to Social Security and in the record submitted by your medical providers. Consider keeping a diary to document symptoms like the frequency of urination, pain, and response to treatment.
  3. Evidence from non-medical sources can be helpful. This may be evidence from friends, family members, former employers, or clergy. This kind of evidence cannot be used to establish a diagnosis of interstitial cystitis, but can help SSA determine the severity of your interstitial cystitis and how it impacts your ability to function. 

What can I do now?

  1. If interstitial cystitis is part of your disability claim, we need to have a clear diagnosis. Some people have symptoms of interstitial cystitis for years before they are diagnosed. It is important for you to have a clear diagnosis in the file accompanied by testing or other objective findings. It is not enough that your provider notes that your symptoms might be caused by interstitial cystitis. A diagnosis must be accompanied by testing supportive of an interstitial cystitis diagnosis and tests to exclude other conditions that could cause your interstitial cystitis symptoms. Start talking to your provider now to create a consistent, supportable record.
  2. In addition to having a supported diagnosis in the file, be sure you communicate with your provider and with us any co-occurring conditions you may have.  People with interstitial cystitis may also be diagnosed with disorders such a fibromyalgia, chronic headaches, chronic fatigue syndrome, Sjogren’s syndrome, systemic lupus, depression, and anxiety. 
  3. Stay compliant with medication and treatment. Generally, treatment for interstitial cystitis is directed at symptom control and may include diet changes, physical therapy, home exercise, stress reduction, and medication. If you are not willing to take medications or otherwise comply with your provider’s recommended treatment for your interstitial cystitis, please let us know why. A failure to follow through with recommended treatment can be seen as an indication that your interstitial cystitis is not as severe as you say. We want to make sure SSA understands your specific situation.
  4. If possible, undergo any testing recommended by your provider. Some of the specific testing important to a claim involving interstitial cystitis is discussed above. Treatment for interstitial cystitis may require you to see a specialist. Always let us know if you are unable to undergo any recommended testing due to issues such as finances or insurance issues.
  5. Interstitial cystitis is not always an easy disorder to understand. As mentioned above, it can be helpful to keep a diary tracking how often you are having symptoms, how long symptoms last, symptom severity, and any activities missed due to your interstitial cystitis.

Remember, interstitial cystitis is an impairment that is not always well understood. Not everyone will have the same symptoms or limitations. It is important for us to help SSA understand the specific way you are affected by interstitial cystitis.  

What Does Workers’ Compensation Cover?

Workers’ compensation can seem like the most elusive form of insurance. How does it work? What does it actually cover? And how does the claims process work? This article will go into each of these questions to help you better understand workers’ compensation.

What is Workers’ Compensation?

Workers’ compensation is a form of insurance that provides wage replacement and compensation for medical bills in the case that an employee is injured during the course of their employment. This form of insurance not only protects the worker, but it also protects the employer.

While this insurance assures workers that they will be properly cared for in the case of injury, they are also required to waive the right to sue their employer. What does this mean? Basically, when workers waive the right to sue their employer, they waive the possibility of being awarded a potentially larger sum than they could receive otherwise.

However, the employer in turn waives the employees burden of proving the employer was at fault.. For the employer, waiving the employee’s right to sue ensures that they will not have to deal with costly and painful lawsuits. Practically all states in the United States require employers to have some form of workers’ compensation.

What Does It Cover?

While every state has different laws governing to what extent workers’ compensation is required to cover employees, there are some general guidelines. Typically, workers’ compensation will cover medical expenses, lost wages, and funeral costs. 

When it comes to medical expenses, employers are usually required to reimburse you for any ER visits, check-ups, prescriptions, or surgeries that are directly resulting from the work-related accident. Once the employer accepts the claim they will generally pay for medical services directly.

In situations where the injury is more enduring, workers’ compensation will also give you more enduring reimbursement. For example, if a construction worker fell from a roof and broke his neck resulting in paralysis and the need for in-home care, workers’ compensation would likely cover the ongoing cost.

In addition to covering medical expenses, workers’ compensation also covers lost wages due to time away from work. The way this compensation works varies by situation. But generally, workers’ compensation ensures that you will receive a fair wage for necessary time off to recover.

Finally, in the rare and painful case of death, workers’ compensation will cover funeral costs and provide death benefits to dependents.. 

How Does a Claim Work?

There are two main steps to putting your claim through the system. First, you will want to report the incident to your employer as soon as you become aware of the injury. And second, you’ll need to file the claim.

 Reporting the incident may look a little different depending on the state that you live in but generally, there is a 30-day window after the accident occurs in which you can report the injury. After that window, you may not be eligible to receive compensation.  

To prove that your injury should be covered under workers compensation you must demonstrate that your injury was connected to work. In legal terms, this means that you have to show both that your injury arose out of your employment and that it occurred during your employment.

These requirements are more straightforward when it comes to on-the-job injuries such as cutting your hand using a tool at on your job..However, it gets a little trickier when it comes to illnesses that develop over time or injuries that occurred outside of an obvious workplace setting. In situations like these, you will want to look up the specific laws for your state that govern when an injury is covered by workers’ compensation and how that compensation works or consult an attorney.

After you’ve gone through the process of reporting your injury, your company will then give you paperwork to fill out to file the claim. After you’ve filled out this paperwork, it will typically be sent to the employer’s insurance company and/or to the state to be filed and processed.

If your employer does not dispute the claim that your injury was work-related, your claim will be processed, and you they will start paying your medical bills and compensating you for time off work. If your employer disputes your claim, you will have to file a claim with the labor commission, most likely with the help of an attorney..

When it comes to workers’ compensation, you want to know that your back is covered. This guide can give you a foundation to better understand how workers’ compensation works. But be sure to do your research regarding your state’s laws as well as the coverage offered by your employer to ensure that you understand what compensation you are entitled to in case of injury.