Your Credibility and Applying for Disability: How the Insurance Company Assesses Your Complaints

Obviously, not all medical disorders are diagnosed with “objective” test results, which can make establishing a claim for long term disability with such conditions challenging. Take fibromyalgia, for example.

You cannot take an x-ray of fibromyalgia and prove it with objective medical testing. Yes, the “pressure point test” is a traditional method of testing for fibromyalgia, but this test is primarily subjective (not objective) in nature as it relies on the subjective complaints of the patient (i.e., it relies on the patient saying it hurts when the doctor presses a pressure point). As someone with fibromyalgia may not be able to produce traditional objective medical evidence of his or her condition, a claimant applying for disability for fibromyalgia may have a more difficult time proving that his or her condition is totally disabling.

The Difficulty of Proving Subjective Complaints

Another symptom that is difficult to prove with “objective” medical testing is impaired cognitive functioning. Most insurance companies will not accept a claimant’s self-reported memory loss or inability to concentrate. That is why it is essential for the claimant to speak with his or her treating physicians about such symptoms and – if possible – undergo neurological testing, psychological testing, or a mental status examination. These types of tests can help provide the insurance company with evidence describing the severity of the claimant’s cognitive impairments.

The Difficulty of Proving Mental Illness

When you apply for long term disability while suffering from mental illness such as bipolar disorder or generalized anxiety disorder, you will need to provide the following:

• Information regarding any in-patient treatment programs or psychiatric facilities you attended.
• A list of medication you are prescribed including dosages, what side effects you have experienced.
• Your psychiatric evaluation using the Diagnostic and Statistical Manual of Mental Disorders.
• A statement from your medical treatment facility about your interaction with others during your stay.
• A statement from your psychologist and psychiatrist as to why they think you should qualify for long term disability benefits.
• A mental residual functional capacity form completed by your psychiatrist and psychologist.

The Difficulty of Proving Migraine Headache Disorders

A migraine headache disorder is another medical condition that may not appear on objective testing. However, this condition can be recorded in a symptom log. When a claimant experiences a migraine, it is not always feasible to see the doctor immediately or necessary to seek treatment in an emergency room. That’s why the claimant should keep a migraine headache log to document the frequency, severity, and duration of his or her migraine headaches. A migraine headache claimant should also provide this completed symptoms log to his or her treating physician and ask that the symptoms log be added to his or her medical records. This will allow the treating physician to view the claimant’s symptoms and understand the severity of his or her condition.

Missing Medical Records

Long term disability insurance claims are often denied due to “insufficient medical evidence”. Many claimants are under the mistaken assumption that it is the insurance company’s duty and obligation to obtain all of your medical records. However, this is simply not the case. Most insurance companies will request medical records. However, it is the claimant’s “burden of proof”, which means the claimant should make sure the insurance company has all relevant medical records. For this reason, you should ask your disability carrier for a list of all of the records it has requested and a list of records it has actually received. If some medical records are missing, you should make sure that your insurer requests the appropriate records or even obtain those records yourself. Some persistence may be required.

Legal Representation in Long Term Disability Insurance Claims

Although based in Florida, the Ortiz Law Firm represents claimants across the United States. If your LTD claim has been wrongfully denied, delayed or terminated and you’d like to speak to an experienced Long Term Disability Insurance Attorney contact us at (866) 853-4512 to schedule a consultation. 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.