What Role Does My Treating Physician Play In My Long-Term Disability Claim?

Upon the filing of a claim for your long-term disability (LTD) benefits, one of the first things your insurance company will do will be to contact your medical providers—as identified in your application for LTD benefits or other information you submitted when filing your claim—to obtain copies of your medical records for review.  Your LTD carrier will often hire their own in-house nurse or doctor to review your records and make an independent determination as to your eligibility for LTD benefits.

Will My LTD Carrier Speak to My Treating Physician?

It is not uncommon for the long-term disability insurance examiner who handles your case to contact the doctors and hospitals listed on your application to talk about your claim for disability benefits. They may also send your treating physician a medical assessment form to fill out relating to your medical condition and limitations. If this occurs in your case, you should ensure your doctor completes it. To prepare your treating physician for contact or other inquiries from your LTD insurance carrier, it is best to advise your doctor of your decision to file a claim for LTD benefits and prepare them to speak to your LTD carrier about your medical impairments and limitations.

Preparing Your Treating Physician To Be an Advocate for Your LTD Claim

long-term disability insurance claim

Before filing a claim for LTD benefits, it will help for you to make a specific appointment with your treating physician to talk to him or her about your decision to stop working (or limit your hours/duties) and file a claim for LTD benefits.  Discuss, with specificity and accuracy, your symptoms and limitations and how these impact your ability to perform the material duties of your job.  It will help to have a copy of your job description for this appointment so your treating physician will be familiar with the material duties of your job.  Although your treating physician's opinion is not the final word, making sure your doctor will support your decision to file for disability benefits will increase your chances of an approval.

How a Treating Physician Can Inadvertently Hurt Your Claim

Unfortunately, simply because your treating physician or the Social Security Administration determines you are disabled, this will not be binding on your LTD insurance carrier, particularly a private, non-E.R.I.S.A. carrier.  However, even if your treating physician is supportive of your decision to file for LTD benefits, if he or she is not well-versed in LTD claims, they could say things or answer questions in a way that is detrimental to your claim.  Insurance companies often look for treating physicians who are unfamiliar with the intricacies of LTD claims and try to get an answer or information from them that will ultimately and inadvertently hurt their patient's best interests by leading to the denial of their LTD claim. Even when a treating physician's medical opinion is that a patient is disabled, small misunderstandings can trigger a denial with big consequences.

For example, if your treating physician states you are disabled but that you can perform “sedentary work” without fully understanding the LTD carrier's definition of sedentary work, which may prove too rigorous or painful for your medical condition and limitations.  A physician may also delay a finding of disability in hopes that a certain treatment she prescribed will improve your condition.  Such a delay may suggest to your LTD insurance company that your treating physician is not confident in her finding that you are disabled.  When treating physicians make inadvertent missteps like this, LTD carriers tend to rely on their opinions because they are helpful.  However, the inverse is often true when your treating physician makes a confident, well-documented finding that you are, in fact, disabled. 

LTD Carriers Often Ignore Treating Physicians

Unless your treating physician has inadvertently negatively impacted your LTD claim, your LTD insurance company will probably ignore or downplay her medical opinions. LTD carriers tend to rely more heavily on the opinions of their own retained experts who conduct peer reviews of your treating physician's findings, particularly when the peer review conclusion results in an opinion favorable to your LTD carrier. 

Federal law affords LTD insurance companies “deference” when deciding to approve or deny LTD benefits.  Meaning, a judge can only overturn a denial of LTD benefits if the LTD insurance company acted downright unreasonably in denying benefits.  Because of this afforded deference, a LTD insurance company is not required to dismiss its own internal findings in the face of a contradictory opinion from your treating physician.  This simply becomes a “battle of the experts” and does not, in and of itself, amount to an unreasonable decision by your LTD carrier.   

Free Consultation

We never charge any fee or cost for an initial consultation to explain your rights. If you’ve been injured in a car accident or have question about an insurance claim, contact us.