Who Decides If I Am Disabled in a Long-Term Disability Claim?

Hi, I’m Nick Ortiz. I’m a board certified disability insurance attorney. Today, I’m here to answer the question, “Who decides if I’m disabled in a long term disability claim?” This is an interesting question, because most people assume that there’s someone like a doctor or an independent reviewer who’s going to decide their case, but that is not the case in almost every long term disability insurance case. There is an adjuster, an insurance adjuster, who works for the insurance company, who reviews the records and decides whether you qualify for benefits under the claim. What that means is the insurance adjuster is the one who decides whether they have to pay out on your case. A lot of us consider that to be a conflict of interest, because they may be biased against wanting their insurance company to pay out on your individual claim.

Moreover, if they’re an adjuster, they’re not a lawyer. In most instances, they’re not a doctor who’s gone through medical training to review all the medical evidence. Instead, they are an insurance adjuster, directly with the insurance company. Now, they will review all of your medical records, and they may have one of their doctors review your file and give an opinion as to what you can and cannot do. But, at the end of the day, the adjuster is the one who makes the final decision as to whether you qualify for benefits under the long term disability insurance policy. So, the long and short is, if you think there’s going to be someone who’s neutral, a neutral third party to decide the case, then unfortunately, that’s not the case. It will be someone directly associated with the insurance company, but at the end of the day, it is the claimant's burden of proof to show that he or she qualifies for benefits under the policy. That’s why it's so important for you to make sure that you have a lot of evidence to support your case in the way of medical evidence letters or opinions from your doctors and other evidence that goes to show that you are disabled and entitled to benefits.

If you’d like some assistance in gathering together this evidence to support your case, then I encourage you to give us a call at 850-308-7833 to discuss your case. If you'd like additional information about the long term disability process, then I encourage you to download a free copy of a book that I wrote called the Top Ten Mistakes That Will Destroy A Long-Term Disability Claim. You can download a free copy at www.freeLTDbook.com. Thanks for watching.