Your functional limitations are the most critical evidence for your long term disability claim. Your insurance company is interested in how your disability affects your ability to work. The insurance claim examiner (and a judge if your claim goes to court) will look for you to provide detailed doctor’s notes on activity limitations. This information is crucial to getting your claim approved.
Assessing Your Residual Functional Capacity
The insurance claim examiner will rate your residual functional capacity (RFC) to determine what level of work you can do. To do this, claims examiners will review each category addressed on the RFC assessment form. They will look at the following information:
How Much Can You Lift and How Often?
For example, if you can lift 25 lbs frequently and 50 pounds occasionally, you will be assigned a medium RFC rating. You will be given a light RFC rating if you can only lift 10-25 lbs frequently.
How Long Are You Able to Sit or Stand?
For example, if you have a knee injury, you might not be able to stand for long periods. Or if you have suffered a lower back injury, sitting all day may be too painful.
How Well Can You Reach Out or Overhead?
Injuries or illnesses like degenerative disc disease and arthritis can make it hard to reach out or overhead.
How Well Can You Bend Down, Crouch, or Stoop?
Many manual labor jobs require bending, stooping, or crouching low. Your job choices will be limited if you cannot perform these functions.
How Well Can You Grasp Objects or Use Your Hands?
People who are suffering from disabilities like arthritis and muscular dystrophy will have a hard time grasping tools or typing all day because their fine motor skills are not as good as they were previously.
How Well Can You Hear or See?
Hearing and vision are critical to success in the workplace and life. If your disability has impaired your hearing, vision, or both, working will be very hard.
My Doctor Says I Am Disabled, So Why Was My Claim Denied?
There is a misconception that if your doctor takes you out of work, you must be disabled, and that should be enough for the insurance company to approve your claim. Unfortunately, the system does not work like that. Proving that you are disabled enough to receive long term disability benefits involves providing complete medical information, prognosis, and functional limitations. A note from the doctor will not be enough.
Read and Understand Your LTD Policy
We always advise you to read your long term disability policy to understand how your insurance company defines “disability” and what the benefit payment periods are. Disabilities defined by the insurance company can look a lot different than disabilities defined by the Social Security Administration. There are also more exclusions in a long term disability policy.
For example, if you drink alcohol regularly, that can be a cause for denial. Another example is mental illness; most policies only allow up to 24 months of long term disability payments for mental illnesses such as depression, anxiety, and bipolar disorder.
Read more about the traps that will derail your claim here.
Work With a Long Term Disability Lawyer
Your functional limitations outlined by your doctor are critical to the success of your claim. Ensure that your doctor completes and answers all the insurance company’s questions to avoid your claim being delayed or denied.
If you need help getting your claim approved, you can contact an experienced disability attorney who can help you gather the documents you need to prove your case and fight the insurance company for you.
The experienced disability attorneys at the Ortiz Law Firm can help you through every step, from appeals to a potential lawsuit. We only get paid if you win. You can seek help without worrying about upfront costs or unexpected bills. Our law experts will focus on your case so you can focus on your illness.
The Ortiz Law Firm has successfully represented people in disability cases across the United States. To see how we can help you win your long term disability case, call us at (888) 321-8131.
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