Why Your Doctor, the Treating Physician, Is Important in an LTD Claim

Most people understand that medical evidence in a long term disability claim is essential. But sometimes the importance of treating physicians are overlooked. So what role does your doctor play and how can you make sure they complete all the documentation that you need to file your claim?

This article explains how important your doctor is to get your claim approved, what happens when your doctor and the independent medical examiner disagree, and what to do if your claim is denied.

Why Doctor’s Are So Important to LTD Claims

When filing for long term disability claims, it is important to have your treating physicians write statements that explain your disability. These statements will include how you were diagnosed, how the doctor is treating you, what medications you are taking, and what limitations you have, including every day and work. Having statements from all of the doctor’s that are treating you will dramatically improve your chances of being approved.

Often, these statements can make or break your case, so be sure your physician includes everything about your disability:

  • How was it diagnosed? What evidence is there to support that diagnosis(like lab results)?
  • What is the prognosis? What is the treatment plan, and have you stuck to your treatment plan?
  • What medications or assistive devices are you prescribed? Have you been successful with them?
  • Are you receiving therapy such as physical, occupational, or speech?
  • Has the therapy been successful, or have there been setbacks?
  • What kind of quality of life will you have with this diagnosis?

Before Requesting A Statement, Talk To Your Doctor

Before requesting a statement from your doctor(s), talk to them about your intent to file for disability. If they are not in agreement with you, their statement may not necessarily help your case, but you can ask them to prepare a residual functional capacity (RFC) report for you. If they do agree that you do need to apply for benefits, then they can begin the process of preparing your statement.

What If My Doctor and the Independent Medical Examiner Do Not Agree?

In addition to your doctor statements, the insurance company will most likely ask you to submit to an independent medical examination (IME). Ask is probably not the right word – they will tell you to submit to an IME. The insurance company does have the right to request this of you and can deny your claim if you do not agree to it.

There is a chance that your doctor and the IME will not agree. It’s not uncommon. Your doctor works for you, and the doctor conducting the IME is paid by the insurance company. The insurance company would like for the IME to prove that you can work so they can deny your claim. If your case goes to an administrative law judge, they will also look at the evidence supplied by your doctor who has a long history with you, unlike the IME examiner who has only spent one day with you.

If Your Claim Is Denied

If you submit your evidence and your claim is denied, your doctor can still help you during your appeal process by providing you with additional evidence to support your claim. Your letter from the insurance company will outline exactly why your claim has been denied. You can use your letter to guide you when gathering more supporting documents.

If you are having trouble understanding what they want, consider consulting a disability attorney. An experienced disability attorney has reviewed hundreds of letters like yours and can help read between the lines to make sure you are not missing anything before your last appeal is up. Research has shown that your chances of getting your claim approved with an attorney are much higher than without one.

In conclusion,

Statements from your doctors are extremely important to get your claim approved. If your claim is denied, your doctor can help you gather additional evidence to support your claim. If you are having trouble fighting the insurance company, an experienced disability attorney can help you, and research has proved that more cases are approved with an experienced disability attorney.

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 contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine  how to move forward with the process.


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