If your claim for long term disability benefits has been denied or terminated then you will have to submit an appeal if you hope to receive the benefits you deserve. These advanced strategies can be expensive and are not used in every case, but they can be highly effective in select cases.
First of all, you might order your own testing to be done. You might have your file reviewed by experts, whether they be medical experts or vocational experts, which are job experts. Let me give you some examples:
One of the things that the insurance company wants to know is what are your functional limitations as a result of your medical diagnosis? Let’s take fibromyalgia, for example. Fibromyalgia in and of itself is a medical diagnosis. What your medical records might not show and simply aren’t designed to show is what are your limitations as a result of fibro? So for example, how does it affect your ability to sit, stand, and walk, and bend and stoop and twist? Do you experience fatigue? How often do you experience fatigue? How long can you exert yourself before you need to rest? How long do you need to rest before you can resume activity? You can see how your medical records aren’t designed to identify those types of limitations.
Functional Capacity Evaluations
That’s where a functional capacity evaluation may come into play. We call these FCEs for short. So in some cases where there’s not sufficient objective medical testing that’s been done, you might actually go out and order your own functional capacity evaluation in order to try to obtain a report that identifies your limitations. An FCE can be anywhere from three to eight hours long. It can over the course of one day or two days, but it’s comprehensive testing that’s designed to test out what your limitations are. And then there will be a report that sets out again, how long they think, in their opinion, based on that testing that you can do things like stand and walk, difficulties in bending and stooping, how much weight you can pick up and carry across the room. Then that type of report can be used to identify whether you can do work activity. So you might order an FCE. Now, these tests can cost thousands of dollars and are not appropriate or necessary in every case, but it is one advanced strategy.
Another example would be for claims relating to cognitive problems, which are thinking problems, difficulty maintaining attention and concentration. Say you have a traumatic brain injury or something like that and we’re trying to identify what kind of limitations you have, then you might have a neurocognitive test that’s been performed by a physician. And again, that can be a comprehensive medical exam over the course of two, three, four hours where you meet with the physician and then based upon the testing that’s performed, they can issue a report that identifies the types of cognitive deficits that you have. That report can be extremely important in showing why you’d be limited in your ability to perform work activity.
Another type is neuropsychological testing. This is similar to neurocognitive testing, but neuropsychological testing is more along the lines of how one’s depression or anxiety or PTSD is extremely limiting and how that might impact one’s ability to do work activity.
Another advanced strategy is to order vocational testing, which is where you might have your file reviewed by a job expert. They will interview you, identify what your job was, get your job description from your employer, and they’ll try to determine whether that description is consistent with the way the job is performed in the national economy. They’ll interview you to determine what your duties and responsibilities were on the job. And then they’re gonna look at any kind of opinions that are set forth by your doctors, such as the FCE, or if your doctor filled out another report identifying your limitations. They will then give an opinion as to whether they think you could work in the type of job that you’ve done in the past, or maybe some other type of work, given the impairments that are identified in the literature. If you have that type of report, it can be extremely influential in showing the insurance company why it is that you should be entitled to benefits.
Specialized Literature and Studies
Finally, let’s say that there might be some type of specialized medical literature or studies that are out there. So we come across this in my clients who have more rare diseases and diseases that their own doctor never heard of until they addressed this patient. That doctor might not be as familiar with the types of limitations that one with that condition might have, so you might introduce some medical literature or studies that have been performed to show how people with your type of condition are impaired. So again, another relatively advanced strategy to use in trying to get the insurance company to change its mind.
So if you’d like to talk to someone about how we can assist in helping you develop this type of strategy in your case, then I encourage you to give us a call at (866) 853-4512. We have experience in handling thousands of long term disability cases, and we’d like to help you in your case as well.
If you’d like to explore more information before talking to somebody, there is a free book that I wrote called The Top 10 Mistakes That Will Destroy Your Long Term Disability Claim available for download.