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 an administrative law 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 are capable of doing. To do this, claims examiners will go through 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. If you can only lift 10-25 lbs frequently, you will be given a light RFC rating.
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 of time. Or if you have suffered a lower back injury, it may be too painful to sit all day.
How Well Can You Reach Out or Overhead?
How Well Can You Bend Down, Crouch, or Stoop?
Many manual labor jobs require bending, stooping, or crouching low. If you cannot perform these functions, your job choices will be limited.
How Well Can You Grasp Objects or Use Your Hands?
People who are suffering from disability with 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 and See?
Hearing and vision are critical to success in the workplace as well as life. If your disability has impaired your hearing, vision, or both, it will be very hard to work.
There is a misconception that if your doctor takes you out of work, then 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 cause for denial. Another example is mental illness; most policies only allow for up to 24 months of long term disability payments for mental illness 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. Be sure that your doctor completes and answers all the questions that the insurance company has to avoid your claim being delayed or denied.
If you need help getting your claim approved, you can reach out to an experienced disability attorney that 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 of the process, 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.