Medical evidence is the foundation of any successful long-term disability claim. Whether you’re filing for benefits or appealing a denial, your medical records must tell a clear story about your condition, your treatment, and your ability (or inability) to work. In this post, we’ll walk through the types of medical evidence that matter most and how to avoid common pitfalls that can hurt your claim.
Why Medical Evidence Is So Important
LTD insurance providers don’t approve claims based on your symptoms alone. They need detailed documentation from your doctors that backs up what you’re experiencing. Without strong medical support, even the most serious health conditions can be dismissed.
What Counts as Medical Evidence?
Your medical evidence should paint a clear, consistent picture of your diagnosis, treatment, and how your condition limits your ability to work. Here’s what that usually includes:
- Medical Records: These are your doctor’s notes, test results, imaging scans, hospital summaries—anything that shows what you’re going through medically.
- Doctor’s Statements: A written letter or form from your treating physician that explains your diagnosis, symptoms, and how they affect your ability to work can be very persuasive. An RFC (Residual Functional Capacity) form is one common example.
- Reports from Specialists: If you’re seeing a specialist (like a cardiologist, neurologist, or psychiatrist), their input carries extra weight. Insurance companies often place more trust in a specialist’s opinion.
- Objective Testing: Results from MRIs, blood tests, and other diagnostics can help prove your limitations—especially when your condition isn’t visibly obvious.
- Treatment History: Showing that you’ve followed your treatment plan (medications, therapy, procedures) helps demonstrate that you’re doing your part to get better.
- Functional Capacity Evaluations (FCEs): This type of physical test measures your ability to perform work-related tasks. It’s especially useful in musculoskeletal or injury-related claims.
Watch Out for These Common Mistakes
Even if you’re seriously disabled, certain pitfalls can hurt your claim:
- Inconsistent Records: If different doctors say different things, insurers may question your credibility.
- Vague Notes: Phrases like “patient reports feeling tired” don’t explain how that tiredness affects your ability to work.
- Only Subjective Symptoms: Pain and fatigue are real, but try to back them up with objective findings when possible.
RELATED POST: Objective vs. Subjective Evidence in LTD Claims
If Your Claim Is Denied
A denial doesn’t mean the end of the road. Many LTD claims are denied at first, especially if medical documentation is incomplete or unclear. If this happens to you, you have the right to appeal—and often, submitting additional medical evidence is key.
Need Help with a Denied Claim?
The Ortiz Law Firm helps people nationwide appeal denied long-term disability claims. If you’re feeling overwhelmed, we’re here to review your case and guide you through the process. Contact us online or call (888) 321-8131 today for a free case evaluation.
