Doc says I Can’t Work. But the Insurance Company Won’t Approve Me. What Should I Do?

What to do when your doctor says you can’t work but the insurance company won’t approve your disability.

Question: I have been diagnosed with a traumatic brain injury, and I cannot work. I have been receiving treatment, but the doctor says that I am still too sick to return to work. I have exhausted my short term disability benefits, but the insurance company has denied me for long term disability. What should I do?

Answer: Long term disability insurance companies want to get an unbiased opinion and concrete proof that you cannot work before they will approve your LTD claim. A note from the doctor may be okay with your employer but to receive long term disability benefits, you will need a shred of more evidence. The documentation that you will need to gather is referred to as your “administrative file.” Everything that is relevant to your case must be in your administrative file including all the documentation that you want to present as proof of disability. In addition to medical and lab reports, insurance companies want to know the following:

  • How much time does your doctor expect you to be out?
  • Does your doctor anticipate you being released back to duty?
  • Can you sit down and for how long?
  • Can you stand and for how long?
  • Can you bend or each overhead?

If your doctor provides the insurance company with enough evidence that you cannot do any of these tasks and doesn’t expect you to be able to work in the near future, you may have a case for long-term disability benefits. To prove your case, ask your doctor to complete a functional capacity report. This will help outline the tasks that the doctor believes you are not able to do safely without injuring yourself further.

It is important to know the most common reasons LTD claims are denied:

  • Incomplete medical information. One of the most common reasons claims is denied is due to missing or incomplete medical information. Forgetting to list a doctor’s office address or listing an incorrect address means the insurance could not verify your medical information. Forgetting to list all of your doctors and medications can also cause a denial.
  • Missed appointments. When you are sick and not working, it can become difficult to make doctor’s appointments; especially if you are required to make a co-pay each visit. However, the insurance company will say that you do not need medical attention if you are missing appointments. It’s very important to make all doctor’s appointments as scheduled.
  • Doctor’s Notes. It is very common for doctors only write down the clinical symptoms and not make notes regarding pain, depression, low energy level, etc. Be sure that your doctor writes these down in your file as proof that you are suffering from these symptoms as well.

Gather information

If you rely on the insurance company and doctor’s office to communicate, you could be waiting a long time. The best thing to do is to take the initiative to gather the documents that you need from your doctor, including the functional capacity report. Make yourself a copy, and then submit them to the insurance company yourself. Note: There may be a fee from your doctor’s office for completing forms.  It is important to know the harmful elements that can hurt your case too.

If you have already received a letter of denial, it would be a good idea to contact a LTD attorney that can help you navigate the process with the insurance company. An experienced LTD attorney can help you gather all the documents you need to create a complete administrative file. They can also help you stay on track with your timeline. Most cases have a deadline for appeals.

It’s important to note that your Long-Term Disability attorney does not get paid until you do so that you can proceed with your case without fear of upfront legal bills or costs.

Although based in Florida, the Ortiz Law Firm represents claimants across the United States.

If you’d like to speak to one of our Pensacola Long-Term Disability Insurance Attorneys about your denied claim, contact us at (50) 308-7833 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access Long-Term Disability Benefits and how to move forward with the process.

Related Articles:

What To Do When Your LTD Claim Has Been Denied

Reasons Why LTD Claims Are Denied