Long Term Disability Law BlogAttorneys Helping Disabled Claimants Nationwide

Reason #5 for Disability Benefit Denial: Weak Medical Evidence

In a claim for long term disability benefits, the importance of your medical records simply can’t be overstated. No matter how a disability impacts your daily life, your claim is only as good as it appears on paper – which means that weak medical evidence is one of the most common reasons we see for the denial of disability benefits. How can you beef up your claim file and ensure that your medical records are as comprehensive as possible? The answer lies in communicating with your treating doctors.

Strong Objective Medical Evidence Boosts the Odds of Disability Claim Approval

The more objective evidence you have – like MRI and CT scan results, bloodwork results, or X-rays – the stronger your disability claim will be. It’s hard for disability insurance companies to argue that you’re not entitled to benefits when there is irrefutable evidence of the limitations you’re dealing with. If you haven’t already had some diagnostic tests performed, the best time to do so is before you file your claim for disability benefits.

Ideally, your disability claim file will include both this objective evidence and documentation of your subjective complaints like pain, trouble sleeping, lack of concentration or “brain fog,” or other symptoms. This provides the disability insurance carrier with a complete picture of how your condition limits you and prevents you from performing gainful work.

If Only Subjective Medical Evidence is Available — Document, Document, Document

Unfortunately, many disabling conditions aren’t the kind that show up on an X-ray. Medical conditions like chronic fatigue syndrome, fibromyalgia, and mental health and nervous system disorders prevent millions of people from working full-time but are tough to diagnose. If your disabling condition doesn’t lend itself well to objective diagnostic tools, it’s vital to document all the symptoms you’re dealing with. This means keeping a pain journal and maintaining consistent communication with your treating physicians so that they’re aware of your symptoms and can note any changes in their own records.

Your Medical Records Must Continuously Satisfy the Burden of Proof

One of the main challenges involved in a disability claim comes after the claim has been approved. Even if your long term disability insurance policy promises a “lifetime” of benefits, this is conditioned on your continual qualification for disability benefits – which essentially means that you have to re-prove you’re entitled to benefits on a monthly, quarterly, or biannual basis.

As a result, if you regularly go more than a few months without seeing your treating physician, the insurance company may decide your medical records no longer support your disability claim. While it can seem like a waste of time to visit your doctor every month or two if you’re not being actively treated for your condition, maintaining this contact is crucial to keeping your medical records strong.

All Complaints Must Be Documented in Order to “Count”

The insurance carrier has doctors on staff to review claimants’ medical records and then cherry-pick the evidence that works for them. They’re not required to give the claimant any benefit of the doubt; this means that to prevail in a disability claim, your medical records need to be as complete and unambiguous as possible.

Most doctors aren’t in the habit of creating extensive notes on how their patients’ condition impacts their ability to work – but the records the doctor creates as part of a treatment plan and the records the insurance company wants to see can be very different. It’s important to explain to your doctor that your medical records and treatment notes need to show how your condition prevents you from working.

Review Your Medical Records After Each New Appointment

The last thing any claimant wants is for their doctor to send the insurance company medical records that don’t accurately portray their condition. It’s a good idea to review the medical notes and test results that were generated at each appointment to ensure that they’re complete and free from errors. This also allows the doctor to correct or add to their notes while the visit is still fresh in their mind. Many hospital systems now keep this information online in a patient portal or print it out at the end of the appointment. If you don’t have access, just ask!

Navigating the tricky world of medical documentation can be a challenge in any disability claim. You don’t have to go through this process alone – at Dell Disability Lawyers, our disability insurance attorneys have extensive experience in working with doctors and insurance companies to document patients’ claims. Whether you’re just starting the disability claims process or are trying to appeal the denial of benefits, we can help. Give us a call today to schedule a FREE consultation with a member of our legal team.

Contact Information