Many long-term disability claims are denied as a matter of course for people who are genuinely unable to work. Why? What are the most common reasons these insurance companies who are supposed to provide this necessary benefit deny these claims?
Here are just a few that we’ve seen:
1. Your medical treatment isn’t designed to prove disability, but to heal your condition
This is actually a good thing for you but a bad thing for your long-term disability case. You can see this throughout medical records. Your doctor is not documenting reasons why you can’t work, but symptoms you communicate, objective test results, subjective complaints, treatment options, etc. But most doctors are not thinking in terms of “how will this be interpreted by a disability insurance company?” But rather, “how can I get this person back to baseline and back to work?” Most doctors state things optimistically.
Most patients are also focused on the same thing; that is, “what can I do to get better and back to work?” Indeed, this is what you should be focusing on.
However, it is most important for you, no matter what condition you have, to communicate effectively with your doctor and tell him/her every symptom you are experiencing. It is also helpful if you note those symptoms in a journal of some sort so you can track what symptoms you were having and verbalize those when the time is right.
2. Insufficient medical documentation supporting disability
Almost every time a potential client comes to me and says, “I have all my medical records,” I know I still have a lot of work to do. For some reason, when a patient asks for his or her medical records, they never get a complete copy of everything. If you think you’ve gotten everything and you think you’ve submitted everything to the insurance company to consider your disability appeal, then the insurance company says, “insufficient medical documentation.”
The truth is, even if you submit all of the medical records, you probably haven’t done enough to establish your disability. The medical records were not written in such a way to prove disability. You should go one step further and have your doctor write out why you are unable to work with all of the supporting symptoms that are keeping you from performing the main duties of your job. This should supply the insurance company with enough information to approve your claim.
3. No Objective Medical Evidence
The insurance company doesn’t like to rely on your subjective symptoms. They would much prefer to look at a test performed by a medical doctor that says you are unable to do certain things. Unfortunately, there aren’t objective tests for everything. It is important to make sure you ask the insurance company for the objective test they need for you to prove your case. They cannot say, “no objective evidence” and deny your claim when no objective testing exists.
4. The Insurance Company Doctor Disagrees with Your Doctor
Insurance companies have doctors on speed dial who will generally say whatever they want them to say. These hired gun doctors will write reports without ever seeing you as a patient. They owe you no duties as a physician and they have no obligation to make sure you get a fair shake. Some insurance companies hire these doctors and will rely on their lone opinion to discount and discredit your treating doctors. The good news is that the 4th Circuit Court of Appeals has been very critical of this practice and in some cases will reverse the insurance company’s decision.
5. You Are Not Actively Getting Treatment
Many insurance companies will require that you continually prove your disability. To do that, you have to have up to date medical information to prove that you are still disabled. If you do not keep seeing your doctors and keep reporting your symptoms, there will be nothing other than your word that your symptoms still exist. I often say that if it is not in a medical record, it did not happen. This is how the insurance company views it even though you may see it differently.
These are just a few reasons why your disability claim may have been denied. If that has happened to you, give us a call to see if we can help.