If you have long-term disability coverage and experience a prolonged injury or illness that prevents you from working, you may be eligible to seek benefits for a certain percentage of your lost pay. Long-term disability benefit claims, however, are notoriously challenging, and your medical provider will play a fundamental role. If your long-term disability claim has been denied, an experienced long-term disability attorney can help.
Long-term disability coverage (LTD) may be offered as an optional benefit through an employer or it may be purchased through a private plan. When employers do carry such coverage, they are nearly always subject to the Employee Retirement Income Security Act (ERISA), which implements careful rules and regulations to help protect the rights of plan participants.
Long-term disability claims are based on evidence, and a significant portion of this evidence tends to be medical in nature. This means that having your doctor’s supporting opinion is likely to play a critical role in the outcome of your claim.
When you intend to file a claim, your medical provider will be asked to write a statement or complete a specific form that addresses your condition. The statement will need to correlate how your illness or injury interferes with your ability to do your job.
In addition to your doctor’s opinion on the matter, the administrator in charge of addressing your claim will be looking for objective evidence that supports the existence of a long-term disability. This comes down to including items like the following in your benefit claim:
Many disability insurance policies have limitations or exclusions related to disabilities that involve “self-reported” or “subjective” symptoms. This is one area where your doctor’s input will be especially important. The insurer wants to see objective medical documentation of a disability and its symptoms. It can be difficult to demonstrate symptoms such as pain, dizziness, “brain fog,” fatigue, and other valid symptoms that do not easily show on an X-ray or blood test. Your doctor can help objectively prove these symptoms in a variety of ways. Documenting the reported pain during an exam and specifying the pain that occurs during an exam is a major way that “subjective” pain can be documented. For fibromyalgia, documentation of trigger points is important. For migraines, trying to see your physician during a migraine can be enormously helpful in documenting the objective physical responses you have to the event, even though it is physically challenging to make that trek to the doctor while enduring the pain of a migraine. For chronic fatigue, there are CPET tests, or “cardiopulmonary exercise testing,” that can objectively document post-exertional fatigue and an insured’s functional capacity. For lupus and Lyme disease, blood tests can help demonstrate an objective basis for the diagnosis. For cognitive issues and “brain fog,” neuropsychological exams and cognitive functional capacity assessments objectively confirm memory and concentration issues. All of these tests require a medical professional.
Most disability insurance policies require that an insured gets “regular care” from their physician during their disability. It’s important to continue to treat with your provider throughout your disability so your insurer does not terminate your benefits for lack of care. This is true even if your disability is stable and your treating provider cannot offer new suggestions for improvement.
Since this supporting documentation will flow from the medical care you receive, sticking to the schedule of care you’re prescribed is critical and is also the surest means of regaining your health and well-being to the degree possible.
Even a well-considered benefit claim can be denied for being incomplete, which can mean needing even more documentation from your doctor. Remaining in close contact with your medical provider throughout the claims process is always well advised, and if your claim is ultimately denied, it’s important to know that you can file an appeal. Further, once you’ve exhausted your administrative remedies, you can file a lawsuit – in pursuit of the benefits to which you are entitled.
Your long-term disability benefits claim will hinge on your doctor’s input, but even cases with strong medical evidence can be denied. When that happens, it’s time to consider legal assistance.
The esteemed long-term disability attorneys at Monahan Tucker Law – serving California, Oregon, Washington, Nevada, and Arizona – take great pride in their impressive track record of successfully guiding challenging claims toward optimal outcomes that support our valued clients’ legal rights and best futures. If your long-term disability claim has been denied, don’t hesitate in contacting us for more information about what we can do to help you today.
Helping clients in California, Oregon, Washington, Nevada, and Arizona.