If you are no longer able to fully perform your occupation due to a disabling condition, it may be time to submit a long-term disability claim. However, your long-term disability insurance company is not simply going to take your word for it. Insurance companies are always looking for loopholes to deny claims in order to limit their liability. If you are to succeed at securing the disability benefits to which you are entitled under the terms of your policy, you will need to present proper medical support to substantiate your claim.
Your Policy’s Definition of Disability
We assist clients with filing long-term disability claims to various insurance companies, including Principal, Unum, Provident, Paul Revere, Guardian, Northwestern Mutual, Equitable, Standard, Met Life, NY Life, Mass Mutual, Hartford Group, Great West, Trustmark, Lincoln Life, Cigna, Ameritas and others. Each policy has its own definition of “disability,” and it is important to carefully examine your policy. Most insurers sell “own occupation” coverage, which generally defines disability as an inability, due to illness or injury, to perform the material and substantial duties of one’s own specific occupation. However, some policies define disability as the inability to perform “any occupation,” which is generally defined as any job for which the individual is reasonably suited based on education, training and experience.
In addition to total disability coverage, some policies offer coverage for “residual” or “partial” disability. You may be eligible for partial disability benefits if you experience a loss of income due to a disabling condition that restricts your ability to perform some of the duties of your occupation or that limits the volume of work you can complete.
Getting a Diagnosis
Proper medical support begins with a diagnosis from a qualified doctor who specializes in treating your disabling condition. For instance, a diagnosis of arthritis should come from a rheumatologist, while a spinal stenosis diagnosis should come from a neurologist or an orthopedist. You will also need to inquire if your treating doctor(s) will support your claim by providing a narrative along with corroborating evidence.
The Supporting Physician’s Narrative
When you are ready to apply for total disability benefits, we will send your treating physician(s) a narrative request letter. This includes a description of your occupational duties, your policy’s definition of disability (which varies based on whether total or partial) and the date of disability. We ask your doctor to complete the claim application’s Attending Physician Statement and to provide us with a narrative report. This report should give the physician’s medical opinion and prognosis – based on his or her care and treatment of you – of how your disabling conditions and the resultant restrictions and limitations have rendered you, and will continue to render you, disabled as defined in your policy. The attending physician’s statement should detail any interventions that you have attempted, such as medication, therapies, lifestyle changes or surgery, to treat and improve your condition, and what the outcomes were.
Additional Evidence
Beyond your doctor’s diagnosis and narrative, the insurance company will seek supporting evidence of your disability and its adverse impact on your ability to work. Test results such as MRIs, CT scans, X-rays and lab tests that support your diagnosis and your symptoms should be submitted with your claim. However, some disabling symptoms, such as pain, are subjective in nature and are difficult to measure medically. For instance, nerve-related problems may not show up on an MRI, X-ray or CT scan, and when they do, these objective tests fail to capture the level of the pain or other subjective symptoms. Nonetheless, insurance companies typically require that subjective complaints be supported by objective evidence. If your disability involves subjective complaints, we will bolster your case by collecting and submitting additional evidence with your claim. This can include an analysis from a vocational expert on whether you can perform the material duties of your job. Or we may recommend that you have a Functional Capacity Evaluation or “FCE.” Other corroborating evidence can include documents that show you have a long history of performing a large volume of high-quality work as well as statements from colleagues and others comparing your activities and abilities before and after your disabling condition began.
If you have questions about your long-term disability insurance claim or you are involved in a dispute with your insurance company, contact the long-term disability insurance attorneys at Schwartz, Conroy & Hack. We have the expertise and tenacity to make sure insurance companies keep their promises to policyholders like you.