It’s no secret that getting long-term disability (LTD) benefits approved is a frustrating process, to say the least. Insurance companies will render half decisions, continuously require more paperwork and proof, and after that, deny your claim anyway. Meanwhile, your own doctor is telling you that you shouldn’t return to work, bills are piling up, and your stress level and anxiety of the future continue to rise.
Sound familiar? That’s because what is described above is the most common scenario for those who are applying for long-term disability benefits. To put it mildly, you’re in for a bit of a fight. That’s why lawyering up early in the process can ensure an expedited decision.
The long term disability attorneys at Hermann Law Group, PLLC have successfully held a number of disabled workers apply for an receive benefits. The LTD insurance company must satisfy the terms of your policy under the law. So whether or not your policy is purchased through your employer or you purchased it individually, you can get those benefits. In this article, we explain how.
LTD Insurance Companies Want Proof of Incapacity
There are a number of conditions that are very easy to prove that you have. Some conditions are much more difficult and rely on subjective reporting of your symptoms. Conditions like fibromyalgia are notorious for being a “diagnosis of exclusion”. That is to say, that when all other possible diagnoses are exhausted, a diagnosis of fibromyalgia is made. It depends entirely on eliminating all other possibilities and reports of pain in specific areas from the patient.
This means that, for a condition like fibromyalgia, a perfectly “objective” standard of proof may disclude it from possibility. In other words, there’s no way that a patient can prove they have fibromyalgia to the standard that the insurance company is looking for.
Fibromyalgia is not alone in this regard. There are a number of conditions that rely on the patient’s own description of their symptoms in order to diagnose. Many of these are psychiatric conditions. In any of these cases, your disability may preclude you from working but you’ll need to find a specialist who is willing to say that on your behalf.
The battle will be harder for those with certain kinds of disabilities (like those described above) but it isn’t impossible.
Speak to Your Doctor About Your Plan to File for LTD
The more your doctor knows about your plan to apply for long-term disability the better. Tell him early in the process if your condition impedes you from the performance of your job at work. Ask him to document everything. Insurance companies are not going to comb through your MRIs and lab results. They may indeed constitute enough proof to satisfy your claim, but if your doctor doesn’t write it down in your medical records, they will just ignore it.
Why?
When you make a claim on an insurance company, the insurance company is forced by law to respond within a certain time frame. They don’t have to say yes or no, they simply have to respond. This response is often “we need more information.” More often than not, they probably have all the information they need to approve the claim. But they’re not going to dig too deep into your reports. After all, they’re not doctors. They’re not qualified to read an MRI.
Redundancy Is the Key to Success
The insurance company will ask your doctor for your medical records, but you can expedite the process by asking for copies yourself and then making copies of those. You can fax them to your LTD insurance company, but I also recommend sending them by certified mail.
Explain Your Impairments in Personal Terms
Specificity, in this case, is the key to success. For instance, if you’re having trouble staying on your feet for an extended period of time, you can say that specifically, but you want to also describe how it’s difficult, what it prevents you from doing, and how long it takes before the pain becomes prohibitive. In other words, where does it hurt, how long does it take before you have to sit down, and how has this impacted your daily routine.
That too is necessary. For instance, your claim will be much better if you show how you no longer have the capacity to do the things you once enjoyed. For instance, if you’re claiming that you can’t be on your feet for extended periods of time but are still playing tennis regularly, that isn’t a very strong claim. In fact, it can rise to the standard of fraud. But if you loved playing tennis and can no longer play it because of your condition, it’ll be a stronger case because you’ve personally lost the ability to do something that you enjoy — not just the capacity to work.
Talk to an Experienced Long-Term Disability Attorney
Hermann Law Group, PLLC has helped numerous clients prove their case to a sufficient standard to leverage the LTD insurer to satisfy the terms of their policy. If you need help with your LTD claim, our attorneys can provide that help. Contact us today to learn more about how to get the financial relief you need.
