Long term disability cases are heavily decided by the medical evidence that is provided as part of fulfilling your “proof of claim” or “proof of loss”. Medical evidence can be from many different doctors and can take time to gather. By providing the insurance company with sufficient and timely medical records, you are decreasing the potential for a denial.
Proving Your Disability
The longest and most tedious process is gathering your data to prove your disability. After you read through your policy, you should be able to determine if you may qualify for LTD based on your insurer’s definition of of the term “disability”. You will need to provide the claim adjuster with proof of your disability. This will include the opinion and notes from your treating physician(s), all lab and test results, x-rays, MRI scans, notes from doctors that have treated you, detailed surgical reports. This information will need to be gathered from all doctors that are treating you for your disability not just your primary physician.
Gathering Objective Evidence to Support a Long Term Disability Claim
At the end of the day, it is the claimant’s burden to prove that a physical or mental condition has so negatively affected the claimant that the claimant can no longer continue in his or her career. Most insurance policies require proof of objective evidence before the insurance company will pay out benefits on an LTD insurance claim. This is the evidence that insurance companies cannot deny exists.
Why Objective Evidence is Needed
What is objective medical evidence? Objective medical evidence includes medical signs and laboratory findings. Signs are anatomical, physiological, or psychological abnormalities which can be observed by a medical provider. Signs are separate from the claimant’s statements (which are often referred to as “subjective complaints” or symptoms). Signs may be shown by medically acceptable clinical diagnostic techniques. Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception. They must also be shown by observable facts that can be medically described and evaluated. Laboratory findings are anatomical, physiological, or psychological phenomena which can be shown by the use of medically acceptable laboratory diagnostic techniques. Some of these diagnostic techniques include chemical tests, electrophysiological studies (electrocardiogram, electroencephalogram, etc.), X-rays, MRIs, CT-Scans, blood tests and psychological tests.
Psychological and neuropsychological testing are objective tools that may be used to defeat the insurance company’s position that the claimant is malingering or exaggerating his or her disabling condition.
All of the foregoing evidence is especially important in proving disabilities that are ordinarily diagnosed based on the claimant’s subjective complaints, such as Fibromyalgia, chronic pain syndromes, chronic fatigue syndromes and chronic back pain conditions.
A functional capacity evaluation may also provide objective clinical evidence to prove whether the claimant is physically capable of performing the usual and customary duties of a given occupation.
When Objective Evidence is Not Available
When conclusive objective evidence is unavailable, a long term disability may still be validated through the use of subjective evidence. Subjective evidence primarily includes the patient’s self-reports, and the observations of friends and family. If objective evidence is unavailable to prove up a claim, we will work to develop a proper administrative record with all available information substantiating the claimant’s disability.
Make Sure Your Documents Are Easy to Read
The best medical records are typed, mention all of the patient’s complaints, evidence the results of examination, note what treatment was provided, state the patient’s response to treatment, and detail future plans and a prognosis. Unfortunately, many records don’t contain enough information to determine disability.
It’s essential to include the complete and correct information on all your forms. Any missing or incorrect information can lead to a denial of benefits. Be sure to have your physician note symptoms that are not always measured with lab tests such as pain. Physicians are known for not documenting a patient’s pain level in their notes so be sure that they are documenting all your symptoms. It is important to make all your scheduled appointments and do not skip treatments or taking your medications while waiting on an LTD decision. If you miss appointments or do not take your medications, it will be a sign that you do not need treatment as you say you do; this could lead to a denial of benefits.
Legal Representation in LTD Claims
Here at the Ortiz Law Firm we assist long term disability claimants by compiling and effectively presenting objective evidence to support the LTD claim. Mr. Ortiz is an experienced disability law attorney and has handled disability insurance claims for over a decade. He understands how to find and utilize medical and other documentary evidence that will hold up in court.
If your LTD claim has been wrongfully denied or terminated and you’d like to speak to an experienced Pensacola Long-Term Disability Insurance Attorney about your denied claim, contact us at (888) 321-8131 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.