This article provides an overview on how to maximize your long-term disability (LTD) claims and the crucial role your doctor plays in supporting them. It explains how insurers evaluate medical records, the impact of incomplete notes, and how to prepare for appointments and Independent Medical Assessments (IMEs). By understanding these processes, readers can better navigate their LTD applications, ensure accurate documentation, and maximize their chances of approval.
Introduction
Navigating a long-term disability (LTD) claim can be overwhelming, especially when your health requires your full attention. A key factor in a successful claim is having clear, thorough, and objective medical documentation. Your doctor plays a crucial role in documenting your medical condition, restrictions, and limitations, information that insurers rely on to approve or deny your claim.
With the right preparation, collaboration with your doctor, and knowledge of insurer processes, you can strengthen your LTD application and protect your rights.
How to collaborate with your doctor for a stronger LTD claim?
After submitting along-term disability (“LTD”) application, your insurer will request medical records to evaluate your claim. Clinical notes from your primary care provider are commonly requested as the starting point to understand your medical diagnosis and accompanying restrictions and limitations.
It’s critical to collaborate with your doctor to ensure your medical condition and restrictions are accurately recorded by your doctor.
To ensure your medical condition is accurately recorded:
- Clearly explain how your condition is impacting your ability to function
- Discuss if certain medications are causing side effects
- Share day to day physical and/or mental issues
- Ask for your doctor’s support to remain off work if you’re medically incapable
The definition of disability in most LTD policies directly evaluates whether restrictions and limitations arising from your medical diagnosis stop you from doing your job.
Having your doctor’s support is important for your LTD claim. A doctor’s detailed and supportive notes displaying the complete picture of your overall condition, is critical because insurance companies approve or deny your claim based on objective medical evidence.
How insurers evaluate doctor reports for LTD claims?
Obtaining a detailed medical report from your doctor carries significant weight. A long term relationship with your family doctor allows the doctor to better understand your medical history, current condition, medical restrictions and allows the doctor to properly comment on your inability to work.
Insurers who receive a doctor’s report and dismiss it risk the report ending up before a judge if you choose to proceed with a lawsuit to challenge the improper denial of your benefits. Judges don’t like when insurance companies ignore or discredit objective medical documentation.
Why “incomplete” medical notes can harm your claim?
Incomplete medical notes are harmful to your LTD claim because they don’t provide the insurance company with the full story of your medical condition.
Example:
A claimant is suffering from anxiety and depression which is causing issues with concentration, insomnia and fatigue. If the doctor’s diagnosis and notes are limited to anxiety and depression and omits the accompanying symptoms, the insurance company will penalize the claimant (you) because they don’t have information explaining the extent of your symptomology. Comprehensive documentation ensures your full medical picture is considered.
Incomplete medical notes make it easier for the insurance companies to deny your claim.
Preparing for medical appointments
In advance of your medical appointments, ensure you:
- Have a list of things you want to talk to your doctor about – key symptoms, limitations and questions
- Bring any forms you need completed for your LTD claim
During the appointment, you should:
- Review the list before leaving the doctor’s office, to ensure nothing is missed
- Ask your doctor to confirm they’ve recorded the complaints and diagnosis in their notes.
This preparation ensures your medical records accurately reflect your condition.
What you need to know about Independent Medical Assessments (IME’s)?
Your LTD insurer may schedule you for an Independent Medical Assessment (“IME”). An IME can take different forms depending on your primary diagnosis. For example, if the insurance company requires clarification on your mental health condition, they would likely set up a psychological IME.
IME assessors are privately contracted doctors used by the insurance company. They are paid by the insurance company to complete an assessment of you and the assessment can take 1-2 hours. As part of your LTD policy, you are required to attend the IME. Refusal means your benefits are cut off.
Be aware, these IME assessors are not on your side. They’re hired and paid by the insurance company to challenge the medical information and potentially support a denial of your claim. It’s important to be alert and cognizant during these assessments and to be clear about your medical condition and restrictions and limitations.
Tips for IME’s
- Attend as required by your LTD policy
- Clearly explain your restrictions and limitations
- Understand that the assessor works for the insurer, not you
Being prepared can prevent misunderstandings and ensure your condition is accurately represented.
Frequently Asked Questions
Why is my doctor’s support important for a long-term disability claim?
Insurance companies rely heavily on objective medical evidence. A supportive doctor ensures your condition, restrictions, and limitations are accurately documented, which strengthens your claim.
What should I discuss with my doctor for an LTD claim?
Talk about daily challenges, side effects of medications, physical and mental limitations, and your inability to work. Bring any forms required for your claim.
What happens during an Independent Medical Assessment (IME)?
An IME is conducted by a doctor hired by the insurance company to assess your condition. You must attend, and it’s important to clearly explain your restrictions and limitations.
Can incomplete medical notes affect my LTD claim?
Yes. Missing details about symptoms, side effects, or limitations can result in claim denial because the insurer doesn’t have a complete picture of your condition.
Should I hire a disability lawyer for my LTD claim?
Consulting a disability lawyer early can protect your rights, help navigate doctor appointments and IMEs, and challenge insurers if they deny your claim.
Legal support for LTD claims
LTD claims are difficult to navigate. Many people have never started an LTD claim before because they’ve never needed to. When a medical condition changes your life, you need time to focus on treatment and recovery. It’s important to seek legal counsel early to ensure you don’t prejudice your rights during your claim. The disability legal team at Whitten and Lublin offer free consultations for LTD matters and can assist with:
- Helping you navigate through doctor’s appointments
- Responding to IME’s
- Challenging the insurance company for wrongful denial
There is no substitute for quality representation. Contact us online or call 416 640 2667.
