Frankel & Newfield, P.C.

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Disability Insurance Claims and Your Physician

What happens when the long term disability insurance company asks for more medical records and your primary treating physician says no?

During the decade plus that we have been practicing disability insurance lawyers, we occasionally run into this situation<. It often occurs when the claimant is a member of a large practice where they have been seen by many different physicians. It also occurs when, for whatever reason, sometimes valid, sometimes not, the claimant has a bad relationship with their physician (or even the physician’s staff).

Whatever the reason for this situation, it is one that can be managed, but does require some skilled negotiating.

Most important – this is not the time to change doctors. Insurance companies will notice and you will be accused of “diagnosis shopping” or “physician shopping.” It can be a red flag to an adjuster or a third party disability processing administrator and may be used to deny your claim, or at a minimum, to further scrutinize your claim.

Second, often the doctor’s refusal to fill out paperwork may be a result of them having far too many requests at a particular time for paperwork. It may not have anything to do with the relationship with the patient or the doctor’s feeling of whether or not the patient is disabled.

It may be helpful to contact the office manager to learn if the office has certain procedures that disability claimants are asked to follow when requesting medical records. And of course, to play nice with the physician’s staff to have them attend timely to your needs.

Even more helpful to gathering medical records and reports will be the assistance of an experienced professional who understands the pressures being felt by the doctor’s office to continually provide records and documents and the critical importance of these documents to the success of a disability claim. Navigating this process can be eased with the use of a skilled advocate, such as disability insurance lawyer.

Here’s the bigger problem: if you or a trusted family member or friend do finally succeed in getting a reluctant physician to provide medical records, what if the records supplied are not supportive of your claim?

This is the issue that we sometimes run into. Something as simple as a doctor’s note on the file that you are nervous about your new condition, or agitated about the injuries suffered as a result of an accident that was not your fault can be treated as proof that your real disability is a mental/nervous disability. The disability insurance adjuster may be seeking a reason to re-categorize your claim, and this is a common practice, as many policies have limited pay periods for claims resulting from or even contributed to by a mental or nervous disorder.

The doctor’s notes need to include information on specific tasks that your occupation requires, and specific functional limitations, and state clearly that you can no longer perform these tasks as a result of the injury or illness. If this is missing, another red flag can be raised for the disability insurance adjuster.  This is why having a long term disability insurance lawyer working with you throughout the process can help immensely.

Because of the importance of the medical records to the success of your claim, we often advise clients or those who are considering retaining our firm to provide us with their complete medical records before filing a claim. The earlier in the claims process we are brought in, the more effective we can be in a host of issues.

If you are facing a situation similar to those described above, with a physician who is not supporting your claim, or challenges in getting the doctors’ to attend to your needs or the insurance companies’ requests, call our office to learn how we can help. We can be reached at 877-LTD-CLAIM (877-583-2524).

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