Frankel & Newfield represents many California residents in disability insurance matters. Clients from California make up a large portion of the disability practice, possibly because of the sheer size and high population of the state. No matter how different the disabilities of the California clients may be, they share many of the same problems as claimants in other states.
Known as the Golden State, California is the third largest state in the nation and also has the largest population of any state – more than 37 million inhabitants. California’s cities have their unique characteristics: Los Angeles is a fast-paced hub of the entertainment industry; San Diego offers perfect weather, lovely beaches and a famous zoo; San Jose is at the heart of technology; San Francisco is famous as a financial and cultural city, and Fresno, an inland city at the center of the San Joaquin Valley, one of America’s great agricultural centers.
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Wherever in this vast state they live, California residents who are unable to work because of a disability caused by illness or injury often find themselves stymied by repeated requests for medical records, including reports by specialists, X-rays and CT-scans as well as medical records kept by their primary treating physicians.
Disability insurance claims adjusters are looking for specific information in the medical records. They are less interested in a doctor’s measurement of pain or symptoms, which surprises most claimants. The adjuster is looking for information about the tasks of day-to-day living and the tasks associated with the person’s job that they can no longer perform as a direct result of their disability.
For example, a primary physician may make a note that a dentist has sharp pain and lack of feeling in her hands as the result of a cervical or neck injury. An x-ray or MRI may show that the dentist has an enormously bulging disc that is clearly the source of the problem. For most claimants, it seems as if this should be proof enough that they are disabled and unable to work.
For the disability claims reviewer, that bulging disc is meaningless unless there is specific language in the medical record that states that the claimant cannot use her hands to perform dental procedures, cannot angle her upper body to conduct a dental exam and cannot handle the many different tools and equipment used in the treatment of dental patients.
Physician training is in medicine, not in preparing medical records for disability insurance claims. When Frankel & Newfield is retained to help claimants before they file a disability claim, we work closely with the treating physicians to ensure that their medical records are reflective of both the medical problems our clients have and of the specific tasks that their patients can no longer perform.
This is especially important when the disability insurance policy is provided as part of an employee benefits package and is subject to strict evidence rules. The only information that can be considered in an administrative appeal is that which is in the insurance company’s file – and that almost always include the medical record.
If you live in California and your disability insurance claim has been denied or is being delayed, call our office and learn how we can help.Ready To Talk?
Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.
FILING A DISABILITY INSURANCE CLAIMSecrets the Disability Insurance Companies Don't Want You to know!
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