Get Your Doctor on Board Before Filing Long-Term Disability
- By Admin
- •
- 12 Dec, 2019
- •
You didn't ask to be put in this position, but you now have a long-term disability and it's time to move forward with your life. A long-term disability claim may be able to help you. But a successful long-term disability claim must include a complete medical picture if you want to have any chance of success.
Most insurance providers or government entities who review disability cases put a large amount of emphasis on the medical details. A long-term disability claim without the full support of your doctors or hospital is destined to fail. Here's how and why you should get your medical team on board with you before you move forward with your claim.
You Need to Tell Your Doctor Before You File
Don't file for disability and then tell your doctor or doctors afterwards. Once the application is on its way, your doctor may not be able to add anything to it. But if you talk to your doctor in advance, you can get them to look at your medical documentation and fill in any holes that might cause a problem.
For example, if your medical documentation is not fully legible, the person reviewing your case might send it back or just deny you because the information is not clear. This will, at the very least, lead to a delay. Your doctor can make sure your current documentation is accurate and clear to anyone who reads it.
You Need to Ask for an Additional Letter
Once the medical documentation is in order, you might think you are ready to file your claim. But if your doctor is on board with you, you could bolster your case by asking him or her to write an additional letter of support.
Filing a successful long-term disability claim is all about creating a narrative in the mind of the case's reviewer. Your doctor can spell out in a new letter exactly what all of the previous medical documentation actually means. A letter of support will give an account of how you have suffered and how the disability affects your daily life.
You Need to Continue Consistent Treatment
Long-term disability cases can sometimes take weeks or months to review. When a reviewer finally gets to your case, they may reach out to your doctors or medical team for an update. This is why it is very important to continue with your recommended treatment even after you file the claim. You want to establish a record of ongoing medical care for your disability.
If the person who reviews your case finds out that you have stopped treatment, this might be a red flag to them. They will want to know if this means you are actually getting better or are not quite as disabled as your claim states.
Talk to your doctor about your plans going forward and what you can do to ensure ongoing treatment. Continue to add new medical documentation to a dedicated file even after you send in your claim, as you might need this new data at some point in the future.
Medical documentation can make or break your long-term disability claim. This is why you need to talk to your doctor or medical team before you file. If your medical professionals know you will be filing a claim, they may be more careful or include more details when documenting your condition. You may also be able to get an additional letter of support to bolster your narrative.
Scott Shaffman Attorney at Law has years of experience assisting people just like you with long-term disability claims. If you are in the process of filing or want to appeal a denial, contact us today for a free consultation that could improve your odds of success.
The language in a disability policy can vary from one insurance company to the next. This can make it difficult to determine exactly what your disability benefits are when you have sustained a serious injury.
Two common areas of confusion in long-term disability policies are the definitions of occupation and job duties. Legal arguments in long-term disability claims often center on the definitions of occupation and job duties, so you need to be able to understand the language in your policy if you want to know your rights.
Own-Occupation vs. Any-Occupation
When it comes to defining a disability, most policies will provide benefits for either an own-occupation disability or an any-occupation disability. If your disability policy can be classified as an own-occupation policy, you will be able to obtain benefits if you sustain an injury that prevents you from performing the duties associated with your current occupation.
This means that even if you are able to obtain a position in another occupation, you can still apply for disability benefits because of your inability to continue to work in your chosen field.
Many long-term disability policies are categorized as any-occupation policies. If the language in your policy refers to any-occupation coverage, you will only be able to access benefits if you are unable to work in any capacity.
You may need to work with your attorney to have the court qualify your policy to require the insurer to provide you with benefits if your injuries prevent you from obtaining a job for which you have sufficient education, training, or experience.
The level of disability required to obtain benefits differs between an own-occupation and an any-occupation policy, so you should know which type of language is used in your policy before you file a claim.
Material Duties vs. Substantial Duties
Long-term disability insurance policies will often state that benefits can only be obtained when a claimant is unable to fulfill the material and substantial duties of their occupation. Though it sounds like these duties are lumped together, many insurance companies evaluate them on an individual basis.
Material duties are categorized as those tasks that must be done as part of an occupation. In other words, if you couldn’t complete the material duties of your job, it would be impossible to do your job the right way.
Substantial duties are important to job performance but don't encompass the entire job description. For example, if you were a sales representative who had a stroke and lost the ability to speak, you would be unable to perform the substantial duties of your job. You may still be able to interact with clients via email, however, so not all aspects of your occupation would be impossible.
There is a lot of overlap between material and substantial duties. Your attorney should be able to establish the specific duties that you fulfill at work each day if you file a disability claim. Showing how your workday differs from a watered-down and generalized job description will help you prove your claim more effectively.
The outcome of a disability claim depends, in large part, on the specific language used in the claimant's insurance policy. Occupation descriptions, essential job duties, and what defines a disability can vary from one policy to the next.
An attorney can help you better understand whether your policy uses own-occupation or any-occupation language, and whether or not your disability limits your ability to complete material duties, substantial duties, or both.
Contact Scott E. Shaffman, Attorney At Law to schedule a free consultation so you can learn more about the specifics of your long-term disability policy.
