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”. Medical evidence can be from many different doctors and can take time to gather. By 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 insurer’s definition of the term “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.
Objective Evidence to Support a Long Term Disability Claim
At the end of the day, 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. Most insurance policies require proof of objective evidence before the insurance company will pay out benefits on an LTD insurance claim. This is the evidence that insurance companies cannot deny exists.
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 who has handled disability claims for over a decade. He understands how to find and utilize medical and other documentary evidence that will hold up in court.
Why Objective Evidence is Needed
What is objective medical evidence? Objective medical evidence includes medical signs and laboratory findings. Signs are anatomical, physiological, or psychological abnormalities which can be observed by a medical provider.
Signs are separate from the claimant’s statements (which are often referred to as “subjective complaints” or symptoms). Signs may be shown by medically acceptable clinical diagnostic techniques. 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 which can be shown by the use of 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.
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, mention all of the patient’s complaints, evidence the results of the examination, note what treatment was provided, state the patient’s response to treatment, and detail future plans and 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.
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 is willing to provide a statement in support of 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.
Long term disability 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;
- Push and/or pull;
- 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 the insurance company is seeking. 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 that is typically used to provide this type of detailed statement is called a residual functional capacity (RFC) form. The insurance company probably has its own generic RFC that it uses in all claims, but its form is typically too generic and is used to deny claimants benefits. To obtain an RFC form that may actually assist you in winning your claim, use our free RFC form.
Legal Representation in LTD 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. Mr. 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 objective evidence is unavailable to prove up a claim, we will work to develop a proper administrative record with all available information substantiating the claimant’s disability.
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, contact us at (888) 321-8131 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.