After you experience an injury or sickness that affects your ability to work, obtaining disability benefits can be as difficult as trying to recover physically. Even if you have purchased disability insurance or have long-term disability insurance (LTD) coverage through your employer, you may not fully understand how to tap into those benefits when the time comes. What steps can you take along the way to ease this process?

As is often the case, the first steps you take are often the most important. The first visit you make will be to your doctor’s office. You trust your doctor to make the right decisions and give you the right advice about your medical condition, but how that translates from the doctor’s office to the insurance company may not always be to your benefit.

Insurance companies do their diligence. Do you?

Insurance companies need to ascertain that your condition meets their qualifications for coverage. How they do so depends on the information conveyed by your doctor regarding your specific physical, mental and cognitive restrictions (what you can’t do) and limitations (what you are limited in doing) and how those findings would preclude you from working at your job or in any occupation.

It is not enough for your doctor to write a conclusory statement that you are “disabled” or should be “off work” for some time. Nor is it necessary that your doctor specifically state you are “disabled” when the limitations in your ability to function would obviously impede your ability to work. But as your doctor works to make you better, you need to do your diligence too in communicating your needs to your doctors and staying on top of the necessary paperwork.

Three things to keep in mind

  • How you feel today may not be a reflection of your overall condition. Most medical conditions produce good days and bad days. If you see your doctor on a good day and say you are not feeling any pain, this may not reflect how you feel every day. If notes such as “feeling better” or “stable” end up in your medical records, insurers may take those notations out of context, although several courts have acknowledged that such isolated information cannot be construed as that you are “able to work.”
  • Your doctor should be advised to be wary of the “ambush” interview. During the course of the claim, your doctor may be contacted by a physician or nurse who is either employed by or is working at the direction of your insurance company. The doctor should be instructed to demand authorization to release information and should also be told to request copies of any statements attributed to him or her and be given the opportunity to correct misinformation.
  • Ask for a copy of your medical records. It is okay to ask for a copy of your records as you progress through treatment so you are aware what the doctor sees, and what the insurance company could see. It is usually not enough to view the information available on a patient portal because critical narrative information from your records is generally not made available for viewing – request the complete office visit notes. This will allow you to follow up and clarify any statements that may not clearly convey the overall state of your health. But always remember to be honest and forthright about your symptoms so the doctor understands and can administer appropriate treatment. If you lose your credibility with your doctor, you cannot expect the doctor to be your advocate to the insurance company.

Fight denials and bad faith

Insurance companies do not always see your claim the same way you do and they and their consultants may disregard critical information contained in the medical records. Ensuring that your communication and records are in order and that critical information is presented in such a way as it cannot be overlooked are important steps you can take to ensure you are compensated for your LTD claim.

If you believe your insurance company is acting improperly in denying your claim, speak to an experienced LTD attorney at DeBofsky, Sherman & Casciari, P.C.

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