{4:20 minutes to read} To successfully file a long-term disability claim, you must have some type of disabling condition and the proper medical support to substantiate it.
Most policies define “disabling condition” as an injury or a sickness. The person (or persons) qualified to state that you have an injury or a disease is usually a medical doctor. But, it could also be a psychologist or someone who has a healthcare specialty.
In order to determine if someone has the proper medical support to back up their claim, we would start by asking:
- Do you have a diagnosis? The doctor needs to identify the problem, e.g., spinal stenosis, Lyme disease, fibromyalgia, cardiac condition, bilateral carpal tunnel. If you do not have a diagnosis, I would strongly suggest that you do everything in your power to get one. It will be beneficial to you to know what is wrong and how it can be treated, and it will also help me to support your disability claim. It is very difficult to successfully pursue a long-term disability claim without a diagnosis.
- Is your doctor qualified? In addition to having a diagnosis, it is important to have a doctor who has the training and is within the specific discipline to make that diagnosis. For example, a rheumatologist is the appropriate doctor to make a diagnosis of fibromyalgia. If your primary care physician says that you have fibromyalgia, the insurance company may not accept that diagnosis from her. If you have a spinal condition, you may need to see an orthopedist or a neurologist rather than a general practitioner. Being certain that the doctor who has diagnosed you is the appropriate doctor to support that diagnosis is an important element to your claim.
- Is your doctor willing to advocate? Once you have a diagnosis from a qualified doctor, you need to find out if she is willing to cooperate with the insurance company.
- Your doctor will be asked to provide the information necessary to determine if you are disabled within the definition of your policy. She may need to fill out an attending physician’s statement (a form provided by the insurance company that requires relevant information pertaining to the claimant’s diagnosis, physical limitations and prognosis). Having a doctor willing to provide all the necessary information to the insurance company, in the desired format, is another critical component to your claim.
Be aware of the “surgeon conundrum.”
Surgeons like to perform surgery, but long-term disability claims are not their forte. After surgery, they will often tell you the problem is fixed and advise that you will be fully recovered in about six months. If you are still unable to work after six months, they usually end their involvement, unless more surgery is required. That’s just how the world works. If your long-term disability claim is being supported by a surgeon, and if it appears that you will be disabled beyond the surgery and expected recovery date, then you may encounter problems getting that doctor to support your claim.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com