Five Things Your Attorney Wishes Your Doctor Knew About Disability Insurance Claims
Friday, November 15th, 2013
1 – A diagnosis alone is not enough to make you disabled in the eyes of the insurance company. They are looking for information in your medical records that clearly states NOT ONLY that you are not able to perform the material duties and tasks of your occupation (or potentially any occupation), but HOW and WHY you are not able to perform work functions.
2 – Your medical records should also reflect the specific tasks or abilities that your occupation requires. Does your job require sitting for extended periods of time and being able to process large and complex amounts of information in a very short period of time? Or does the position require you to travel from city to city to make deals and close sales? Your records need to reflect your need, for example, to lug a 30 pound suitcase through a crowded airport, use public transport to travel from appointment to appointment, and stay focused during intense sales presentations.
3 – A simple phrase that seems innocuous to you or your doctor is often enough for their disability insurance company to terminate a claim. Phrases like “seems overly anxious” or “is stressing” will raise a red flag to a claims adjuster to potentially deem your claim the result of a mental or nervous disorder, which may carry a limited pay period.
4 – Test reports matter a lot, particularly for the so-called “subjective conditions” like Chronic Fatigue Syndrome and Fibromyalgia. We have a lot of experience working with primary treating physicians and most of them need to be educated in the appropriate language that will work best for patients with these particular conditions – to neuter any effort by the insurance company to claim a lack of evidence to substantiate the impairment. Even though some conditions do not have “testing” to prove the existence of a condition, evidence is still necessary to demonstrate the functional deficits which support impairment.
5 – The paperwork that your treating physician has to fill out and submit to the disability insurance company is extremely important to your claim. They may see this as a burdensome task and delegate it to a clerical staffer, who is not likely to understand the disability claim process or its importance. How to protect yourself? Have an experienced disability attorney review medical records before they are submitted to the insurance company, and interface with the doctors’ office to ensure things get accomplished properly.