How Do You Qualify Medically for Long Term Disability Insurance Benefits?

When applying for benefits you will need to gather many documents from your doctors, but what information do you need to provide to prove that you qualify medically for long term disability benefits?

You will need to provide your insurance company with medical records from only the doctors treating you for your disability. Providing medical records that are not related to your disability is irrelevant and could actually hurt your claim. The exact information that you need from your doctor will be based on the medical condition(s) that prevent you from working.

Is Your Illness/Injury Covered by Your Policy?

Before you file for long term disability, it’s important to ask for a copy of your long term disability policy. Your LTD policy will have details regarding what disabilities are covered and how long they will provide coverage. For example, most long term disability policies will only cover a mental illness disability for up to 24 months. The insurance company may also require you to provide a statement from your doctors that confirm you are not abusing drugs or alcohol. Disabilities like cirrhosis of the liver have been associated with alcohol abuse. Some LTD policies will deny the claim if they suspect substance abuse.

Here are some examples of common claims:

Examples of Common Claims

Back Injury Claims

When you file a claim for a back injury, you will likely be treated by an orthopedist, a physical therapist, your primary doctor, and possibly a pain management doctor.

You will need to provide the following information:

• Copies of CT scans, x-rays, and MRI results that show your back injury.
• Radiology reports that describe the findings from your image scans.
• Surgical records from attempts to repair your damaged back.
• Detailed records of your pain management plan and treatment plan. This will include all prescribed medications, dosages, side effects you have reported to your doctor, urinalysis results showing your compliance with your treatment plan.
• Physical therapy treatment plan and therapy notes. Notes should include your progress and setbacks during therapy.
• Statements from your doctor’s about your disability and your ability to work.
• Residual functional capacity forms (more on this below).

Residual Functional Capacity Report for Physical Disability

A residual functional capacity report for a physical disability will be unique to you and your case, but here are a few example questions:

• How much can you lift? How often can you lift it?
• How much can you carry? How often can you carry it?
• How far can you walk without resting?
• How long can you stand or sit at a time?
• Can you bend, stoop, kneel, or reach overhead?

Mental Illness Claims

When you apply for long term disability while suffering from mental illness such as bipolar disorder or generalized anxiety disorder, you will need to provide the following:

• Information regarding any in-patient treatment programs or psychiatric facilities you attended.
• A list of medication you are prescribed including dosages, what side effects you have experienced.
• Your psychiatric evaluation using the Diagnostic and Statistical Manual of Mental Disorders.
• A statement from your medical treatment facility about your interaction with others during your stay.
• A statement from your psychologist and psychiatrist as to why they think you should qualify for long term disability benefits.
• A mental residual functional capacity from your psychiatrist and psychologist.

Residual Functional Capacity Report for Mental Disability

A residual functional capacity report for a mental disability will be unique to you and your case, but here are a few example questions:

• Can you follow simple directions?
• Can you interact appropriately with co-workers?
• Can you interact with the general public appropriately?
• Will your condition become a disturbance in the workplace?
• Can you maintain proper dress and hygiene in the workplace?
• Are you reliable?

Claims for Multiple Disabilities

If you are suffering from multiple disabilities, you will need to provide documents that support them both. For example, if you are suffering from a back injury and depression, you will need to provide:

• A physical RFC that describes your physical limitations.
• A mental RFC that describes your mental limitations.
• Statements from both of your doctors who are treating you for your back injury, and your psychiatrist treating your depression that explain how this disability is affecting your ability to work.
• A list of your medications with details about dosage and side effects.

In Conclusion

When applying for long term disability benefits, your strongest evidence will be your doctors. Your claim will need strong medical evidence from all of your treating physicians including medical records, RFC reports from all of the doctors treating you, medication lists, reports of compliance, therapy notes, and statements from your doctors. It is a lot of information to gather alone. You can consult an attorney to help you win your claim.

The Ortiz Law Firm is an experienced disability insurance law firm that can help you through the appeals process and with lawsuits. The Ortiz Law Firm only gets paid if you win. You can seek help without worrying about upfront costs or unexpected bills. Our expert team will focus on your case so you can focus on your illness.

The Ortiz Law Firm has successfully represented people in disability cases across the United States. To see how we can help you win your long term disability case, call us at (888) 321- 8131.