The primary evidence that a long-term disability (LTD) insurance carrier will rely on in determining whether you do (or, more importantly, do not) have a disability entitling you to LTD benefits will be your medical records. What providers have you been seeing for your condition? What have you been telling them about your condition, your symptoms, and your limitations? And, what have they been documenting in your records? This will be the crux of your disability case, which means the most important thing you can do when preparing to file, or after filing, a claim for LTD benefits is to make sure your medical records are accurately reflecting your current medical condition and abilities.
Knowing Your Policy's Definition of Disability Will Help You Create Supportive Records
We have discussed previously how to find and understand your policy's definition of disability and how it hinges on the policy's definition of your “own occupation.” You will need to know what physical and mental abilities are required for your own occupation. Does it require you to stand or sit for a certain number of hours? Does it require lifting of a certain amount of pounds? Does it entail crawling, crouching, climbing? Does it require intense mental focus for hours on end? Once you learn these things, you can be sure as you converse with your treating physicians that you articulate to them how your symptoms prevent you, specifically, from performing these material job duties.
Get the Right Testing and Diagnostics to Prove Your Disability
You will need good medical documentation of your diagnosed medical conditions and opinion evidence from your doctors to establish the functional limitations you suffer from as a result of your disability. Certain tests—MRIs, CT scans, x-rays and other imaging, etc.—can serve as good proof of your limitations. If you are not sure what tests would be best to help prove your disability, talk to your doctor about this or consult with an experienced insurance attorney. Making sure your records have the necessary lab and test results and imaging can be critical to proving your claim for LTD benefits.
Do Not Use Absolutes to Describe Your Limitations
When talking to friends and family members about your medical condition, it is very common for people to speak in absolutes. For example, let's say you tell a neighbor “I can never take these stairs anymore,” referring to the stairs at your condominium, which you now typically opt out of in lieu of taking the elevator because of pain you have developed after an injury to your knee. What you probably really meant to say to your neighbor was “It now hurts a good deal for me to take the stairs, so I generally take the elevator” and you may feel like your slight exaggeration was harmless. However, your LTD carrier will likely take what you told your neighbor literally. And, if they obtain surveillance footage of you taking those stairs—even assuming it's on a day when the elevator was out of commission—they may try to use evidence like this to deny your claim for LTD benefits.
The same rule would apply to absolutes in the positive, the “always” statements. For example, if you tell a co-worker “I always have Roger lift those for me because I can't.” We can assume one fateful day Roger is unable so you muscle through lifting those heavy bags because there is no other choice. If your LTD carrier finds evidence of this, they will try to use it to deny your claim. For this reason, it is best when speaking to family members, friends, and your treating physician to state your limitations and symptoms as accurately as possible and avoid absolutes, which are rarely accurate 100% of the time.
Accurately Articulate Your Symptoms and Repeat Them Each Visit
The same rule applies to how you are feeling when you visit your treating physicians. Many of us have a tendency to—when asked how we are feeling—kneejerk respond and say “I'm feeling good.” Doing this at your doctor's office may result in a visit record that says “Patient reports feeling good today” perhaps on a day when later you tell a colleague your pain level that day was high and making you feel very bad. As experienced insurance attorneys who have been helping medical and other professionals with their LTD claims for decades, we find it often surprises clients the lengths to which their LTD carrier will go to try to find evidence that contradicts their disability. For this reason, again, try to articulate as accurately as possible how you are actually feeling and what your symptoms are when you visit your doctors.
Also be sure to repeat your symptoms each visit. You cannot assume the symptoms you told your doctor the previous visit will make it into your record for that visit, or even the next visit, or that what you told one doctor or nurse at a facility will be passed on to the next. Repeating your symptoms each time you visit will ensure they make it into your record and will also enable your doctor to document the evolution of your symptoms over time, evidence that will prove invaluable in proving your disability.
Prepare Your Doctor for the LTD Claim Process
Your doctor(s) will be your biggest advocates in your LTD claim. Let me know you are planning to, or have, filed a claim for LTD benefits. They will likely be asked to fill out claim forms for your LTD carrier or they may even be contacted by your LTD carrier over the phone and questioned. If they are unaware you're filing a claim for LTD benefits they may be caught off-guard by an insurance company's cold call and unknowingly say things that negatively impact your claim because they don't know you are seeking LTD benefits. Educate and inform your doctors and medical providers so they will be prepared to help you gather the necessary evidence to support your LTD claim.
Knowing how to build a detailed, supportive set of records to support your disability and your inability to perform your material job duties is the most effective thing you can do to support your LTD claim. We find many clients do not know how to do this and often say and do things, unknowingly, that negatively impact their claim. Why not bring in someone experienced in building your record from the start? Bringing an experienced insurance attorney, like our attorneys at Taylor, Warren, Weidner & Hancock, from the beginning, from the moment you are planning to file a LTD claim is the best thing you can do to ensure you understand your rights and the process and make the best decisions. Contact us for a free, no-cost, no-obligation LTD claim review.