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When you’re fighting for long-term disability (LTD) benefits, one of the most important people on your team is your disability lawyer. But it’s not enough for them to know the law. They also need to understand your disabling conditions. That insight makes all the difference in your case.
Here are a few key reasons why your attorney’s medical understanding is critical.
1. Your Diagnosis Is Only Part of the Story
Insurance companies often reduce complex medical conditions to a single diagnosis code. But a diagnosis like “fibromyalgia,” “multiple sclerosis,” or “major depressive disorder” doesn’t tell the whole story. What truly matters in a disability claim is how your condition affects your ability to work.
A knowledgeable disability attorney will go beyond the label. They’ll take the time to understand your symptoms, functional limitations, and the day-to-day impact on your life. This deeper understanding helps them present a more complete and compelling case.
Here’s an example of how that can play out:
Example: Chronic Fatigue Syndrome (CFS)
Maria loved her job until she began experiencing persistent exhaustion, brain fog, and muscle aches. After several months of testing, she was diagnosed with Chronic Fatigue Syndrome (CFS). Despite this, her insurer denied her LTD claim, arguing that there was “insufficient objective evidence” to support it.
A disability attorney who understands CFS will know that it is diagnosed by exclusion and marked by symptoms that fluctuate. They can collaborate with your doctors and document functional limitations to build a strong case.
2. Medical Nuance Matters in Insurance Claims
A good LTD attorney doesn’t take a one-size-fits-all approach. Different conditions need different strategies. For instance, claims involving chronic pain, fatigue, or mental health disorders often hinge on subjective symptoms. Subjective means they can’t be easily measured with a lab test or scan.
A lawyer who understands this knows the kinds of challenges you might face and can prepare evidence to counter them. They can ensure that medical records and doctor statements address the specific criteria your insurance company uses to evaluate claims.
Here’s how that might look in a real case:
Example: Bipolar Disorder
James had a history of bipolar disorder. Episodes of depression and mania made it impossible to maintain a consistent work schedule or handle the demands of his role. His insurer argued that since he was not hospitalized and continued to receive outpatient care, he wasn’t truly disabled. His claim was denied.
A lawyer familiar with bipolar disorder knows how disabling it can be even without inpatient treatment. They can gather psychiatric evaluations and treatment records demonstrating the severity and unpredictability of symptoms. A personalized approach can help overturn the denial on appeal.
3. Communicating with Experts and Medical Providers
Your lawyer may need to coordinate with treating physicians and vocational experts. If they understand your condition, they’ll be better equipped to ask the right questions that will highlight the most important symptoms and limitations.
We prepare customized Residual Functional Capacity (RFC) forms for our clients’ conditions. These forms highlight how symptoms translate into real-world work restrictions—such as difficulty with concentration, reduced stamina, or inability to sit or stand for extended periods. This helps ensure that the medical documentation meets the criteria required for a successful appeal.
4. Anticipating Insurance Company Tactics
Insurers often rely on surveillance and so-called “independent” medical exams to deny claims. A lawyer who understands your condition will know how your symptoms fluctuate, when you might appear “fine,” and how to defend against these inaccurate or incomplete reports.
Get Support from a Lawyer Who Gets It
We’ve worked with clients facing a wide range of medical conditions. This includes musculoskeletal and neurological disorders, mental health conditions, autoimmune diseases, and more. This experience helps us build a claim that conveys the reality of your disability.
Whether you’re dealing with a complex diagnosis or an insurer that just won’t listen, we can help. If your insurance company has denied your long-term disability claim, contact us for a free case evaluation. We help clients nationwide, and you don’t pay unless we win.
