The process of filing a short or long term disability claim can be challenging, with many claims being denied due to a lack of sufficient evidence. Depending on your condition and symptoms, a cardiopulmonary exercise test (CPET) may be beneficial for supporting your short or long term disability claim. The CPET can provide your insurance company with objective evidence of your restrictions and limitations due to your medical condition.
This article will explore how the CPET can be a valuable tool in proving short or long term disability claims.
What is the purpose of the CPET?
The results of the CPET can substantiate your diagnosis and symptoms, offering your disability insurance company objective medical evidence of your condition. A CPET is a non-invasive diagnostic test that measures your cardiorespiratory fitness and physiological response to exercise. The primary purpose of the CPET is to gather objective data about your physical capabilities and limitations. The CPET provides objective data on your cardiovascular and pulmonary function during exercise, including oxygen consumption, cardiac output, and metabolic rate.
What conditions can the CPET diagnose or substantiate?
The CPET is a valuable diagnostic tool that can diagnose and evaluate various conditions that affect the cardiovascular and pulmonary systems, as well as other medical conditions that can affect exercise capacity. If you already have a diagnosis, the CPET can provide objective evidence of how your condition causes symptoms.
Conditions that the CPET can diagnose or substantiate include:
Chronic obstructive pulmonary disease (“COPD”): The CPET can help diagnose COPD by measuring your oxygen uptake and carbon dioxide output during exercise. COPD causes your lungs to have difficulty moving air in and out, leading to lower oxygen levels during exercise. CPET can also evaluate the severity of your COPD and help determine your overall functional capacity.
Asthma: During the CPET, your oxygen uptake, carbon dioxide output, and breathing patterns are measured, which can reveal underlying airway obstruction or bronchial hyperresponsiveness characteristic of asthma.
Pulmonary hypertension: The CPET measures oxygen consumption, cardiac output, and metabolic rate, which can be used to evaluate the severity of pulmonary hypertension. For example, patients with pulmonary hypertension may have a decreased oxygen uptake or a lower maximum exercise capacity due to the narrowing of the pulmonary arteries.
Cardiological conditions: The CPET can help diagnose cardiological conditions, such as heart failure, and evaluate your condition’s severity by measuring your body’s response to exercise, oxygen consumption, and cardiac output during exertion.
Postural Orthostatic Tachycardia Syndrome (“POTS”): The CPET can help diagnose POTS, a condition that affects the autonomic nervous system and causes symptoms such as lightheadedness, rapid heart rate, and fatigue. The CPET measures your heart rate, blood pressure, and oxygen consumption during exercise and evaluates your ability to tolerate orthostatic stress.
Chronic Fatigue Syndrome (“CFS”): The CPET can help diagnose CFS, a complex disorder characterized by profound fatigue, muscle pain, and cognitive dysfunction. The CPET measures your metabolic response to exercise and evaluates the presence of post-exertional malaise, a common symptom of CFS.
Long Covid: The CPET can be used to evaluate patients with Long Covid, a condition that affects people who have recovered from Covid-19 and continue to experience symptoms such as fatigue, shortness of breath, and exercise intolerance. The CPET measures the presence of post-exertional malaise and other symptoms associated with Long Covid.
Neuromuscular disorders: The CPET can help diagnose neuromuscular disorders, such as muscular dystrophy and multiple sclerosis, by assessing your muscle strength, endurance, and fatigue during exercise. The CPET measures oxygen uptake, cardiac output, and metabolic rate, which can be used to determine your functional capacity and determine how your neuromuscular disorder affects your ability to perform physical tasks.
Metabolic disorders: CPET can help diagnose metabolic disorders, such as diabetes and obesity, by measuring your exercise capacity and metabolic response to exercise.
What happens during the CPET?
Before the CPET, you will likely be asked to avoid caffeine and heavy exercise for 24 hours, as well as fast for 2-3 hours prior to the test. You should wear exercise-appropriate clothing for the CPET. When you arrive for the CPET, you will be fitted with a heart rate monitor. You will then be asked to sit quietly for several minutes while your resting heart rate, blood pressure, and oxygen saturation are measured.
Next, you will be asked to breathe into a mouthpiece to establish a baseline measurement of your respiratory function. Once you are ready to begin, you will start exercising on a stationary bicycle or treadmill, starting at a low intensity and gradually increasing in difficulty. Throughout the test, you will be asked to rate your perceived exertion level on a scale from 1-10.
A mask or mouthpiece will be worn to measure your oxygen uptake, carbon dioxide output, and breathing patterns during exercise. As you exercise, the resistance or incline on the bicycle or treadmill may be increased to continue challenging you. The test will continue until you reach a predetermined endpoint, such as reaching a certain level of exertion or experiencing symptoms like fatigue, shortness of breath, or chest pain.
After the test, you will be asked to sit quietly for several minutes while your heart rate, blood pressure, and oxygen saturation are measured to assess your recovery. Your results will then be analyzed by a medical professional to determine your exercise capacity, identify any limitations or abnormalities, and guide treatment decisions.
How does the CPET help my disability claim?
Many conditions substantiated by the CPET cause symptoms that are otherwise difficult to quantify, such as fatigue and muscle weakness. Your insurance company will likely be skeptical of self-reported symptoms and will require proof to approve your short or long term disability benefits. The CPET can be essential to support your claim.
Here’s how the CPET may support your claim:
Provides objective data: The CPET measures your physiological response to exercise, including oxygen consumption, cardiac output, and metabolic rate. This data is objective and provides concrete evidence of your limitations and abilities.
Evaluates functional capacity: The CPET evaluates your functional capacity and your ability to perform physical tasks necessary for your job. This information can help support your claim by showing how your medical condition affects your ability to work.
Quantifies impairment: The CPET can provide an accurate quantification of your impairment by measuring your exercise capacity and comparing it to normative data for your age and gender. This information can be used to evaluate your limitations and how they impact your work performance.
Provides a baseline: The CPET can provide a baseline for future testing and monitoring of your medical condition. This information can be used to track any progression of your condition over time.
How can The Maddox Firm prove my disability claim?
The Maddox Firm regularly handles disability insurance claims, appeals, and litigation for clients with complex diagnoses requiring CPET testing. We can help you determine whether the CPET is appropriate for your claim. Here are a few of the ways The Maddox Firm helps with disability claims:
The Maddox Firm will examine your short or long term disability insurance policy. If you are not familiar with the language used in disability insurance policies, it can be challenging to understand their terms. The Maddox Firm can help you determine the specific criteria that your disability claim must meet based on the terms of your policy. We can then develop a strategy for your disability claim and provide you with a clear idea of what to expect throughout the process. The Maddox Firm takes over all communication with your insurance company. As soon as you engage us to represent you, The Maddox Firm will promptly notify your insurance company that we will be managing your claim on your behalf. We will handle all written and phone communications with your insurance company. This approach ensures that you are protected from your insurance company’s misleading questions or unfair tactics.
The Maddox Firm will gather and review your medical records. We will request and obtain medical records from your treating providers on your behalf and examine your records to assess any red flags or missing gaps your insurance company may question.
The Maddox Firm will help obtain additional evidence for your disability claim. If you are in need of the CPET, we can recommend you to trusted providers to undergo that testing and coordinate with the evaluators to ensure the report is comprehensive and accurate. We will also assist in obtaining other evidence such as supplemental letters from your treating doctors or an official job description from your employer.
The Maddox Firm will file an appeal, litigation, or negotiate a settlement with your insurance company on your behalf. In the event that your short or long term disability claim is denied, The Maddox Firm can prepare and file an administrative appeal on your behalf. Generally speaking, if your claim is denied or terminated, you must follow the internal appeals process with your insurance company. Should your claim be denied again on appeal, you have the option to sue your insurance company for wrongful denial. The Maddox Firm routinely handles disability insurance appeals, litigation, and negotiations.
It is recommended you consult with an attorney before filing a short or long term disability claim on your own. If you have already received a denial or termination of benefits, you speak with an ERISA attorney before filing an appeal. The experienced team at The Maddox Firm will review 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.
Whether you are filing a claim for the first time, appealing a claim denial, or facing litigation against your insurance company, The Maddox Firm can help.
Contact us to help you file your claim, appeal, or litigation the right way.