How the Long Term Disability Insurance Company Uses Medical Evidence to Decide Whether You Can Work

Long term disability cases are heavily decided by the medical evidence that is provided. Medical evidence can be from many different doctors and can take time to gather. Providing the insurance company with sufficient and timely medical records, you are decreasing the potential for a denial.

Proving Your Disability

The longest and most tedious process is gathering your data to prove your disability. After you read through your policy, you should be able to determine if you may qualify for LTD based on your insurers’ definition of disability. You will need to provide the claim adjuster with proof of your disability. This will include the opinion and notes from your treating physician(s), all lab and test results, x-rays, MRI scans, notes from doctors that have treated you, detailed surgical reports. This information will need to be gathered from all doctors that are treating you for your disability not just your primary physician.

Make Sure Your Documents Are Easy to Read

The best medical records are typed, mention all of the patient’s complaints, evidence the results of examination, note what treatment was provided, state the patient’s response to treatment, and detail future plans and a prognosis. Unfortunately, many records don’t contain enough information to determine disability.

It’s essential to include the complete and correct information on all your forms. Any missing or incorrect information can lead to a denial of benefits. Be sure to have your physician note symptoms that are not always measured with lab tests such as pain. Physicians are known for not documenting a patient’s pain level in their notes so be sure that they are documenting all your symptoms. It is important to make all your scheduled appointments and do not skip treatments or taking your medications while waiting on an LTD decision. If you miss appointments or do not take your medications, it will be a sign that you do not need treatment as you say you do; this could lead to a denial of benefits.

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

  • Incomplete medical information. One of the most common reasons claims are 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.
  • Inaccurate 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.

Related Article: My doctor says I can’t work, isn’t that enough? Hint: We explain here why a doctor’s note is not enough.

Have you been denied?

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 (850) 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.

What’s the Process Like with Our Firm?

The first thing to do is to contact us by phone or email. You will speak to a licensed attorney with substantial experience with long-term disability claims and appeals. There is no charge for this call. You will not be obligated to hire us. During the call, you can ask any questions you have regarding long-term disability, and we will answer them. Click Here for additional information about the LTD Process with the Ortiz Law Firm.