When facing a long-term disability (LTD) denial, it is important to understand the concept of the “burden of proof.” Simply put, this means the responsibility is on you, the claimant, to prove that you are disabled under the terms of your insurance policy.
Here’s what you need to know. It’s not the insurance company that must prove you are not disabled; rather, it’s your job to convince them that you are.
What Does “Burden of Proof” Actually Mean?
In legal and insurance contexts, the burden of proof refers to the obligation to present evidence that supports your claim. In LTD appeals, this means medical records, doctor’s opinions, test results, and vocational assessments. The evidence should show that you cannot perform your job (or any job, depending on the policy definition) due to your medical condition.
Why the Burden of Proof Matters in Appeals
When your initial LTD claim is denied, the appeals process becomes your opportunity to reinforce your case. This isn’t just a second look at the same information. In most cases, the administrative appeal is your last chance to submit evidence before litigation. Especially when dealing with ERISA-governed plans. Failing to meet your burden of proof here could mean your claim never gets fully considered in court.
Real-World Example: Claim for Fibromyalgia
Take the example of Sarah, a marketing executive who developed debilitating fibromyalgia. Her insurer denied her initial claim due to what it called “insufficient objective evidence.” On appeal, she submitted updated treatment notes from her rheumatologist and functional capacity evaluations. She also submitted a statement from her employer about her declining performance due to pain and fatigue.
Because Sarah understood her burden of proof, she gathered the necessary documentation to support her claim.
Tips for Meeting Your Burden of Proof
- Understand Your Policy: Know how your policy defines disability. An “own occupation” definition of disability is different from “any occupation.”
- Collect Comprehensive Medical Evidence: This includes doctor’s notes, test results, hospital records, and treatment history. Objective findings (like MRIs or lab tests) carry more weight. However, detailed narratives and functional evaluations can support subjective symptoms.
- Get Supportive Doctor Opinions: Ask your physicians to complete specific disability forms. They can also provide narrative statements about how your condition limits your ability to work.
- Consider a Vocational Expert: Vocational assessments can show how your limitations affect your ability to perform various types of work. This is especially useful for “any occupation” standards.
- Be Consistent: Make sure all your documentation tells a coherent story. Inconsistencies between your claim forms, medical records, and personal statements can raise red flags.
Don’t Go It Alone
Appealing a denied LTD claim can feel overwhelming, especially when the burden of proof rests on your shoulders. A skilled disability attorney can help you gather the right evidence and present it in the strongest possible light.
If your claim has been denied and you’re preparing to appeal, contact the Ortiz Law Firm. We can help you understand what evidence you need and how to meet the burden of proof in your case. Call (888) 321-8131 to schedule a free case evaluation today.
