Burns and Long-Term Disability

Welcome to Season 6, Episode 21 of Winning Isn't Easy. In this episode, we'll dive into Burns and Long-Term Disability.

Burn injuries are often viewed as acute medical events, but their effects can extend far beyond the initial incident. Depending on the depth and severity of the injury, burns can lead to lasting complications such as chronic pain, infection, scarring, contractures, and permanent functional limitations that affect a person's ability to work and perform everyday activities. In this episode, attorney Nancy Cavey examines how burn injuries are classified, how they are treated, and the long-term physical consequences they can produce. She discusses the medical progression of burn injuries, the challenges associated with recovery and rehabilitation, and the factors disability carriers consider when evaluating whether a burn-related condition has become a disabling impairment. Together, these issues illustrate how a burn injury can evolve from a temporary medical condition into a Long-Term Disability claim, and why understanding the medical and functional impact of burns is critical when pursuing disability benefits.

In this episode, we'll cover the following topics:

One - What Burns Are (Definition, Types, Causes)

Two - Symptoms, Complications, and Treatment

Three - Burns and Long-Term Disability Evaluation

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/


Resources Mentioned in This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mind

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Transcript

Nancy Cavey [00:00:00 - 00:01:02]

Foreign. Injury can last far longer than the moment it happens. What began as a sudden exposure to heat, chemicals, electricity or radiation can evolve into months of medical treatment and in some cases, a lifetime of physical limitation. But how do we separate a healing injury from a disabling one for the purposes of an ERISA disability claim? Hey, I'm Nancy Cavie, national ERISA and individual disability attorney. Welcome to Winning isn't Easy. Before we get started, I have to give you a legal disclaimer. This podcast isn't legal advice. The Florida Bar association says I have to say this, and now that I've said it, nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the the games that disability carriers or plans play, and what you need to know to get the disability benefits you deserve.

Nancy Cavey [00:01:02 - 00:01:59]

So off we go now. Burns are often thought of in the terms of immediacy, the pain, the visible damage, the urgent need for care. But clinically, they exist on a much broader spectrum. And that's important in the context of an ERISA disability claim. From first degree burns that affect only the outer layer of the skin to third degree burns that destroy multiple layers of tissue, nerves and function. The the severity of a burn shapes not only the treatment in the moment, but the outcomes long after the initial injury. Even when the skin begins to heal, there can be complications such as infections, scarring and contractures that can continue to alter a person's physical abilities in profound ways. And in this episode, I'm going to walk us through what burns actually are, how they're classified, what happens in the body when these injuries occur, and then how going to explore the medical realities of the symptoms, complications and treatment.

Nancy Cavey [00:01:59 - 00:02:50]

From minor burns managed at home to severe injuries requiring hospitalization and long term rehabilitation in the context of an ERISA disability claim. And then finally, I'm going to turn to the question at the center of the disability evaluation. When does a burn become a long term impairment that impacts a person's ability to perform their own or any occupation? And how do disability carriers or plans and actually assess the impact on a person's ability to perform their own occupation or any occupation? So we're going to dive in. First, I'm going to talk about what the different types of burns are, the definition, the types, the causes. Secondly, I'm going to talk about symptoms, complications and treatments. And third, I'm going to specifically address burns and long term disability carrier or plans evaluations of a disability claim. But before we get started, let's let's take a quick Break.

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Nancy Cavey [00:03:26 - 00:04:25]

Welcome back to Winning Isn't Easy. Let's talk about what burns are, their definition, the types and causes, and how that can be crucial in a ERISA disability claim. Now, burns are, at their core, tissue damage that will result from heat, overexposure to the sun, radiation, chemical or electrical contact. Now that definition is simple enough on paper, but it's the reality that we need to talk about. Because burns exist in a wide spectrum. Some are minor, some heal quickly, others are severe, life threatening, and can permanently alter how a person functions in their daily life. This variability matters because the same word burn can describe anything from a small patch of redness skin to a, a full thickness tissue destruction involving multiple layers of skin, underlying fat and even nerve endings. And this range is part of, I think, what makes burns medically complex and later on in the context of a disability claim, legally complex.

Nancy Cavey [00:04:25 - 00:05:40]

Disability carriers or plans have a tendency to use a one size fits all approach to cases. And I think that's a huge problem in burn cases. So let's rewind this a little bit. Burns will occur when the body is exposed or overexposed to damaging energy sources, heat, sunlight, radiation sources, chemicals, electricity. This injury happens when this energy overwhelms the body's ability to protect and repair tissue, depending on how long the exposure has lasted, the nature of the exposure, the intensity of the exposure, and what part of the body affected the outcome can look very different from one case to another. It's really crucial, I think, in ERISA disability claim, that the nature of the exposure, the length of the exposure, what part of the body is impacted, is really addressed from the very beginning by your treating specialist, who of course should be burn specialists. Now treatment and other symptoms are generally closely tied to those same variables, the location, scale and severity of the burn. More severe burns can require things like hospitalization, surgical intervention, grafts, infection management, months of after care and rehabilitation.

Nancy Cavey [00:05:41 - 00:06:26]

It's also crucial to understand that symptoms don't always appear immediately. And even in the most serious cases, signs and symptoms can take days to develop. That can impact the diagnosis and early treatment. Again, what's important here is again the, the nature of the burn, the location, the, the duration, what you were burned by or exposed to. And then we want to make sure that the history is documenting the development of the symptoms and we want to discuss early treatment. Now, this is important because clinically, burns are defined into three main classifications based on the depth of the tissue damage. First degree burns affect only the outer layer of the skin known as the epidermis. These are minor burns present with redness and pain.

Nancy Cavey [00:06:26 - 00:07:31]

They're uncomfortable, but they usually heal without long term damage and they're often treated by care at home. Those are not the kinds of burns that are going to result in a disability claim. Now let's talk about second degree burns that extends deeper and they affect both the epidermis and the second layer of the skin known as the dermis. These burns are more serious and they can cause swelling, red and white splotchy skin, blistering, severe pain, and in many cases, scarring. Because the dermis contains blood vessels, nerve endings and connective tissue, damage at this level tends to be significant and more complex and more painful. Again, we want to be talking about what the nature of the burn is, what blood vessels may have been damaged or destroyed, nerve ending damage, connective tissue damage, and we want to discuss the complexity of not only the nature of the damage, but the pain associated with it. We also have third degree burns, and that's the most severe classification. They're going to affect the epidermis, dermis and underlying fat.

Nancy Cavey [00:07:31 - 00:08:58]

The appearance can vary from black, brown or white skin, a leathery texture, destruction of nerve endings and the damage can cause numbness rather than pain in the affected area. It's important that we're distinguishing between the nature of the destruction to the nerve endings and the presentation of symptoms. Obviously, these types of burns require urgent medical intervention and generally will result in permanent functional impairment. That thing that needs to be addressed in the course of a case involving burns is the not only the location of the burns, the depth and the width, if you will, of the burn, but the location of the burn, particularly as it relates to hands, feet, face, groin, buttocks and joints. The importance here is that there might be systemic complications because you might have charred or discolored patches caused by chemicals or electricity that, for example, can result in difficulty breathing or other systemic complications. So we just don't want to limit our discussion in your medical records to the obvious nature of the second or third degree burn. We want to talk about the systemic complications. And that's again important because many times the systemic complications can be just as disabling as the underlying burn.

Nancy Cavey [00:08:58 - 00:10:09]

So, for example, a fire injury might involve both thermal damage and smoke inhalation, a Chemical burn can contain damage to tissue. And so we want to not only discuss the nature of the underlying burn injury, its location, and the symptoms related to the particular burn, but we want to talk about the other systemic involvements. The smoke inhalation, the impact that it has on your ability to breathe, the chemical burn that can cause damage that can impact an internal organ. We want to remember that your case is more than just the the burn. It is also the systemic complications. Got it. Let's take a break. Welcome back to Winning isn't Easy.

Nancy Cavey [00:10:09 - 00:11:11]

Symptoms, complications, and treatments of burn Injuries. Now, as I've discussed, the symptoms of burns depend on the severity of the of the burn and the area impacted. The issue ultimately becomes, in my view, the complications. Complications are more likely in severe, deep or widespread burns, and one of the most serious risks is infection because the damaged skin is going to lose its protective barrier function, makes it easier for bacteria to enter the body, that in severe cases, can lead to bloodstream infections known as sepsis. Another complication might be fluid loss. Note that the skin plays a critical role in maintaining fluid balance, and significant burns can lead to low blood volume, known as hypovolemia. This in turn can impact blood pressure and organ function. Thermoregulation can be impacted, so you can have severe burns that lead to dangerously low temperatures, known as hypothermia, especially when there are large areas of skin that are damaged and unable to retain heat.

Nancy Cavey [00:11:11 - 00:12:00]

As I mentioned before, there can be respiratory complications that occur if a person inhales hot air or smoke during a fire. This damage can make the difficulty breathing and maybe even require ventilatory support. It's another complication that I think disability carriers don't necessarily get, and that's the scarring. Now, there's different kinds of scarring. One type is known as keloids, which involve an overgrowth of scar tissue that extends beyond the original injury site. But in my view, the most important complications or devastating complications is contractures. That's where the scar tissue tightens and shortens the skin, the muscles and tendons. As a result, that will restrict the movement, particularly when the burn occurs over a joint, and it can impair mobility and function.

Nancy Cavey [00:12:00 - 00:13:25]

Your medical records really need to document fully the impact of the complications and particularly, as I've said, pulmonary issues and scarring. Now, in terms of pulmonary complications, the disability carrier plan is going to want to see things like pulmonary function tests, pulmonary respiratory treatment, and in terms of problems with scarring and joint involvement, they're going to want to see aggressive physical therapy Perhaps surgery, injection therapy, anything that would loosen, if you will, the scarring that is restricting motion. Recovery from a burn can take weeks, months or longer. And it's really important that that healing process also be documented, particularly if we have systemic problems, infections, respiratory problems, contractures. And we want to make sure that your medical records are documenting the nature of the recovery, but the complications from the recovery. Ultimately it's the symptom history, the physical exam findings, the diagnostic studies, blood test, X rays, skin examinations, physical therapy notes, all of those can document the progression of the healing and the response to treatment. It is crucial to that you're documenting the evolution of symptoms because they are going to change over time from obviously very acute to chronic symptoms. And I find that disability carriers or plans don't make that distinction.

Nancy Cavey [00:13:25 - 00:14:10]

Obviously you have the immediate debilitating symptoms, but it is often the long term chronic progression of the symptoms and the increasing difficulty with functioning that really needs to be documented. This is where carriers line for hire. Doctors will cherry pick the medical records and conclude that there might be improvement. And then that improvement is to the point where you can return to your own occupation. They're going to ignore problems with pain, fluid retention, pulmonary issues, problems with range of motion. Your records really need to document that if you're going to be successful in not only getting your disability benefits, but maintaining those benefits over time. Got it. Let's take a break.

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Nancy Cavey [00:15:01 - 00:16:21]

Welcome back to Winning Isn't Easy Burns and Long Term Disability Evaluations. Now, in the course of this podcast, I've given you my thoughts about what should be in your medical records, what should be documented, and why disability carriers look at these claims through a single lens. In my experience, I think the transition from an acute injury to chronic impairment and is where disability carriers start screwing up these claims, if you will. Now, the chronic impairment is often driven by complications such as scarring, contractures, nerve damage, and systemic effects from infection or prolonged healing. And I think from a disability evaluation perspective, burn prevent unique challenges. Many disability policies require objective medical evidence of the diagnosis and objective evidence of the restrictions and limitations so that means that you have to document not only the existence and severity of the burns and its impact, but the functional impact. That means that your medical records have to include diagnostic confirmation, exam findings, documented treatment history, and your diagnosis and treatment really have to come from a qualified specialist, a dermatologist, but more likely a burn specialist. However, if you've got pulmonary complications, they're going to want you to be seen by a pulmonologist.

Nancy Cavey [00:16:22 - 00:17:22]

I find that specialists are more likely to provide detailed assessments of the depth, extent and difficulties with functional limitations. Now, remember, the disability carrier plan is going to review the medical history for consistency. They're going to look for alignment between the reported symptoms findings and diagnostic studies and inconsistencies can raise questions about the severity and duration. Now, the functional limitations of are really crucial. Your medical records need to document things like mobility, endurance, pain levels, and the ability to do your occupational task or any occupation. I like to work backwards in these cases. I want to obviously understand what the definition of occupation is in that policy. And then we want to understand what in fact those occupational duties are that are essential duties, material and substantial, and then work backwards and develop the medical evidence and potentially the vocational evidence that establishes why you can't do the material and substantial duties of your occupation.

Nancy Cavey [00:17:22 - 00:18:22]

So, for example, you might have contractures that limit the range of motion, particularly if joints are involved. The scarring can restrict movement or cause chronic pain. Nerve damage can lead to persistent numbness or hypersensitivity. That also needs to be well developed because ultimately the disability determination is going to take all of the medical conditions together and consider them not in isolation. That means that burns are going to be evaluated in combination with any other physical or psychological conditions that impact the ability to perform your own occupation. Now, I haven't discussed the psychological aspects of burn injuries up until this point, and I've done that on purpose. I think it's really important that we're documenting, as I've said, both the physical reasons why you can't perform the material and substantial duties of your own occupation. I haven't talked about psychiatric issues because I want us to have laid that foundation.

Nancy Cavey [00:18:22 - 00:19:11]

Now that we have that foundation, however, we need to address the psychiatric issues. Burn patients legitimately have psychiatric problems. We with depression, anxiety, post traumatic stress disorder, and those complications can derail an ERISA disability claim. How so? Well, many disability policies or plans have what's called a mental nervous policy limitation. And they come in two flavors. There is the one which I call the Monty Python mental nervous policy limitation. And there's the other that I call the generic one, the generic one is the better one, quite frankly. And, and in that generic definition, they will say if your disability is the result of an underlying psychiatric condition, benefits are limited to just two years.

Nancy Cavey [00:19:11 - 00:21:04]

So the issue here is, are you disabled as a result of the burns or the psychiatric issues? Obviously, we want to make sure that your medical records are documenting that it's the burns and the physical consequence that is the cause of the disability and that your psychiatric problems are there, but not necessarily the cause of the underlying disability. Not so in the Monty Python definition. In the Monty Python definition, the definition is if your disability is caused or contributed to, regardless of how small, by any psychiatric problems, benefits are limited to just two years. So you need to understand what is in your disability policy. Do you have the easy to please if you will psychiatric limitation or do you have that Monty Python restriction that will limit your benefits to just two years? And if that's the case, if we've got that contribution, you need to make sure that your psychiatric treatment, your psychological treatment, is addressing the fact that there is no contribution, not even a wafer thin contribution, that your physical symptoms are so overwhelming that that is the cause of your disability. That obviously is going to take, I think, assistance with an experienced ERISA disability attorney to look at those medical records, to look at the nature of your condition and to see whether legitimately that in fact is the case. Because if it is, there has to be specific documentation, I think, in your medical records that will avoid the application of the Monty Python mental nervous limitation. So you can see that burn injuries sit at the intersection of not only acute trauma and long term functional consequences, their impact can obviously shape legal and vocational issues in the context of a disability claim.

Nancy Cavey [00:21:04 - 00:22:16]

But at that intersection of a burn injury is also the physical functional problems, restrictions and limitations, and potentially the psychiatric restrictions and limitations. And it's at that intersection where a ERISA disability claim can just fail. It's really, really important that you're consulting with an experienced ERISA disability attorney who can read that disability policy or plan, understand the definition and application of a mental nervous policy limitation, and shepherd you and your doctor through the process of proper and accurate, honest documentation of the impact not only of your physical problems, but your psychiatric problems. That wraps up today's episode of Winning Isn't Easy. Thank you for tuning in. If you found this episode helpful, take a moment to like our page, leave a review, share it with your family and friends, and subscribe to our podcast. Please join us next week for another insightful discussion and episode of winning isn't easy. Thanks for listening, Sam.