Long-term disability claims are heavily decided by the medical evidence that is provided as part of fulfilling your “proof of claim” or “proof of loss.” Ultimately, it is the claimant’s burden to prove that a physical or mental condition has so negatively affected the claimant that the claimant can no longer continue in his or her career. Medical evidence can be from many different doctors and can take time to gather. Providing the insurance company with sufficient and timely medical records decreases the potential for a denial.
Proving Your Disability
After you read through your policy, you should be able to determine if you may qualify for LTD based on your insurer’s definition of the term “disability.” Then, the longest and most tedious part of the long-term disability claim process is gathering medical evidence to prove your 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 who have treated you, and detailed surgical reports. This information must be gathered from all doctors treating you for your disability, not just your primary physician.
Objective Evidence To Support a Long-Term Disability Claim
Most insurance policies require proof of objective evidence before the insurance company pays out benefits on an LTD claim. What is objective medical evidence? This is the evidence that insurance companies cannot deny exists. Objective medical evidence includes medical signs and laboratory findings. Signs are anatomical, physiological, or psychological abnormalities that a medical provider can observe.
Signs are separate from the claimant’s statements (often called “subjective complaints” or symptoms). Medically acceptable clinical diagnostic techniques may show signs. Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception. They must also be shown by observable facts that can be medically described and evaluated.
Laboratory findings are anatomical, physiological, or psychological phenomena that can be shown using medically acceptable laboratory diagnostic techniques. Some of these diagnostic techniques include chemical tests, electrophysiological studies (electrocardiogram, electroencephalogram, etc.), X-rays, MRIs, CT scans, blood tests, and psychological tests.
A functional capacity evaluation may also provide objective clinical evidence to prove whether the claimant is physically capable of performing the usual and customary duties of a given occupation. Psychological and neuropsychological testing are objective tools that may be used to defeat the insurance company’s position that the claimant is malingering or exaggerating his or her disabling condition.
Why Objective Evidence Is Needed
Objective evidence is crucial for long-term disability claims because it provides concrete proof of the claimant’s condition and limitations. Without solid evidence, it’s just one person’s word against another. Having medical records, test results, and assessments from healthcare professionals can strengthen the case and make it more convincing.
Objective evidence clearly shows the claimant’s situation, leaving little room for doubt or interpretation. This can ultimately lead to a smoother and more successful claims process, ensuring that individuals receive the support they genuinely need during challenging times.
All of the foregoing evidence is especially important in proving disabilities that are ordinarily diagnosed based on the claimant’s subjective complaints, such as fibromyalgia, chronic pain disorders, chronic fatigue syndrome, and back pain conditions.
Make Sure Your Documents Are Easy To Read
The best medical records are typed, mentioning all of the patient’s complaints and examination results, noting what treatment was provided, stating the patient’s response to treatment, and detailing future treatment plans and prognosis. Unfortunately, many records don’t contain enough information to determine disability.
Including complete and correct information on all your forms is essential. 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 not skip treatments or stop taking your medications while waiting on an LTD decision. If you miss appointments or do not take your medications, it may indicate to the insurer that you do not need treatment as you say you do; this could lead to a denial of benefits.
What If Objective Evidence Is Not Available?
When conclusive objective evidence is unavailable, a long-term disability may still be validated through the use of subjective evidence. Subjective evidence primarily includes the patient’s self-reports and the observations of friends and family.
If your doctor will provide a statement supporting your long-term disability claim, you should obtain a written medical source statement. Be aware, however, that overly conclusory statements that essentially say, “My patient is 100% disabled and unable to work” are nearly useless. The claims examiners who review disability claims are not interested in short, conclusory statements from personal physicians.
Instead, the doctor should explain why the claimant is unable to work. How can a treating physician do this? In a “to whom it may concern” letter or by filling out a residual functional capacity form. The LTD insurance company is looking for a doctor’s evaluation of how well the disability claimant can:
- Lift and carry weight;
- Sit;
- Stand;
- Walk;
- Push and/or pull;
- Bend;
- Balance;
- Crouch;
- Stoop;
- Kneel;
- Grip and manipulate objects; and
- Reach overhead and in other directions.
A doctor should also provide information regarding a patient’s range of motion in all major joints.
Unfortunately, many doctors are unwilling to provide this type of detailed statement, even though this is exactly what is needed to support their patient’s claim. Despite resistance from medical providers, claimants who are seriously interested in winning their disability claims should strive to obtain this type of statement from their doctor.
A form typically used to provide this type of detailed statement is a residual functional capacity (RFC) form. The insurance company probably uses a generic RFC in all claims, but its form is typically too generic and is used to deny benefits. To obtain an RFC form that may actually assist you in winning your claim, use our free RFC form.
Legal Representation In Long-Term Disability Claims
Here at the Ortiz Law Firm, we assist long-term disability claimants by compiling and effectively presenting objective evidence to support the LTD claim. Nick Ortiz is an experienced disability law attorney and has handled disability insurance claims for over a decade. He understands how to find and utilize medical and other documentary evidence that will hold up in court.
If your LTD claim has been wrongfully denied or terminated and you’d like to speak to an experienced Pensacola long-term disability insurance attorney about your denied claim, call us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim and recover the benefits you deserve. If objective evidence is unavailable to prove a claim, we will work to develop a proper administrative record with all available information substantiating the claimant’s disability.
