As a nurse, you are the medical professional that works the closest with the patients. You rush in and out helping patients and doctors for 12 hours or more a day. Medical care facilities could not survive without you. So why does the insurance company make it so hard to file for long term disability when you are disabled?
In this article, we will explore:
- Why it’s so hard to file a long term disability claim as a nurse
- What you can do to help build a strong claim
Why It’s So Hard to File a Long Term Disability Claim as a Nurse
The nursing profession has evolved over the years. The most recent Dictionary of Occupational Titles was published in 1991, but insurance companies still use it today even though it’s based on clearly outdated information. The job responsibilities for a nurse have changed drastically since the 1990s and nurses now are specialized in different areas. To prove your claim of disability, you (and your attorney) will need to provide an updated job responsibility list to the insurance company.
According to the Bureau of Labor Statistics, nurses make a median salary of $70,000 with some specialized nurses making upward of $100,000 a year. The insurance company knows a long-term disability claim could cost them so they will try to find ways to deny your claim.
The majority of claims by nurses are related to back and neck injuries. Nurses are required to lift and move patients on a daily basis, and years of this will take a toll on your body. The dispute comes in proving that your chronic pain is job-related and not a pre-existing condition related to something that happened before you had coverage. An experienced attorney can help you navigate this issue.
What You Can Do To Help Build A Strong Claim
Read Your Policy
The first thing that you need to do before you start the process of filing a claim is to get a copy of your long-term disability (LTD) policy. How you get a copy of your policy will depend on the type of policy that you have: individual or group. If you have an individual policy, you will need to contact the long-term disability company directly and ask for a copy. If you have a group policy through your employer, you will need to contact the administrator of the policy, usually the human resources department. They are required to provide you with a copy within 30 days of receiving the request.
If possible, be sure to request a copy of your long-term disability policy in writing as documentation for you to have in case your employer or LTD company gives you the runaround.
Gather Evidence to Support the Claim
This is probably the most tedious process of filing an LTD claim. Gathering all the documents that will support your claim will take time.
This is a list of things you may gather to support a long-term disability claim. Keep in mind that this is not a complete list. There may be other evidence for you to provide in your individual claim, but this list is a good starting point:
- Copy of your LTD policy
- Copies of all letters from your insurance company and from you to the insurance company
- Why you can not perform your job duties (this will require medical documentation)
- A list of all medical providers that you have seen for this condition and a letter from each provider stating that your condition prevents you from working
- Letters that summarize all conversations (by phone or in-person) between you and the insurance company representatives, nurses, doctors, and your employer. Send copies to all parties involved in the communication via certified mail as proof it was received
- Keep everything chronological so that if your claim is denied, you have a complete record of how your claim was handled
- Proof of your monthly earnings
- Medical: Proof that you are under the care of a physician for your condition
- More Medical: All medical documents from your physician regarding your condition including but not limited to your official medical file, lab reports, X-ray and MRI reports, physician notes, list of surgeries including medical reports
A large monetary claim – like one for a sales Representative – will likely call for video surveillance. Surveillance is completely legal. During the surveillance period, a private investigator will stake out the claimant’s house, talk to nearby neighbors about the claimant’s daily activities, and then try to use that information against the claimant in the administrative decision (or in court); This is why it is crucial to not rush back into exercise routines or anything else that is very strenuous on the body during the claim period.
In our article about surveillance and long-term disability claims, we discuss the likelihood that social media accounts will be monitored. As a busy nurse, you probably do not have much spare time for social media. However, when you are at home with nothing to do but rest, you may be tempted to start an account on a social media platform such as Facebook, Linked In, Twitter, Instagram, or Snapchat. We suggest staying off social media entirely during the claim period. The insurance investigator will try to use posts to social media accounts to deny your claim.
Representation by an Experienced Long Term Disability Attorney
Nurses may face challenges when applying for long-term disability. The insurance company will try to save as much money as possible by finding reasons to deny your claim. Building a strong administrative claim will help you win your case.
Using an experienced disability attorney will help you protect yourself against the insurance company. The Ortiz Law Firm is based in Florida but represents claimants across the country. If your LTD claim has been wrongfully denied or terminated receive a free consultation by calling (888) 321-8131 with no obligation. 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.