So many of the disability claimants who contact Dell Disability Lawyers have one main question: do disability insurance companies deny all disability claims? Disability insurance companies claim that they approve around 85 percent of claims; however, this statistic doesn’t tell the full story. Many claimants may be approved for short term disability benefits, only to have their claim for long term disability benefits denied. Learn more about some common situations in which a claim may be denied and what claimants can and should do to boost their odds of being approved for benefits.
A lot of disability benefit denials occur when transitioning from short term to long term disability.
One of the most confusing and frustrating parts of the disability claim process involves being approved for short term disability and then—based on the exact same documentation—denied for long term disability benefits. There are a few reasons behind this, and one is simply a matter of dollars and cents. A disability insurance company will spend far more when paying out benefits on a long term disability claim than a short term disability claim; this means the insurance company is more likely to deny (or fight) the receipt of long term disability benefits.
Another factor is the evidence presented in support of your claim. Short term disability benefits can cover everything from childbirth to a broken leg, and many of these situations allow the claimant to return to work fairly quickly. But the standard for obtaining long term disability benefits involves an inability to perform your job; the same evidence that can support a short term disability claim may not be strong enough to show that you’re unable to perform the substantial material duties of your own occupation.
The manner in which a doctor completes your attending physician form can “make or break” your claim.
Because the documentation requirements for long term disability benefits tend to be more stringent than short term disability, the attending physician form is crucial to the success of your claim. If this form doesn’t connect the dots between your symptoms and limitations and your ability (or inability) to do the basic functions of your job, your claim is likely to be denied.
Keep in mind, the forms provided by your disability insurance company tend to be biased in the insurance company’s favor. These forms may encourage your doctor to choose between “sedentary,” “light,” “medium,” or “heavy” job duties, leaving no “less than sedentary” option. Then, when the doctor checks the box for “sedentary,” the insurance company is free to presume that the claimant can still do a sedentary job, whether or not this is true.
It’s important to educate your doctor on what your disability insurance company requires as proof of disability and, if necessary, provide your own forms or treating physician statement that allows for a full explanation of your symptoms and limitations.
If a person is denied Social Security Disability Benefits will they be denied Long Term Disability?
Social Security Disability (SSDI) benefits use a completely different set of standards than long term disability insurance benefits. Claimants may be approved for long term disability benefits and denied SSDI benefits, or vice versa. However, some long term disability insurance companies tend to rely on an SSDI denial as a basis on which to deny a long term disability claim, even though most SSDI denials are eventually approved on appeal.
What are some tips for a person to protect payment of their disability benefits once approved?
After around 24 months of receiving long term disability benefits, the definition of disability under your policy will often change—instead of receiving benefits if you’re unable to perform your “own occupation,” you’ll only be able to receive benefits if you’re unable to perform “any occupation.” To protect your benefits both before and after this change of disability definition, you’ll need to generate as much medical documentation as you can. Visit your physician regularly, seek any follow-up or diagnostic testing that can provide some clarity on your condition, keep a pain journal, and gather any other evidence you can to establish that your symptoms and limitations prevent you from performing your job.
Your treating doctors must document all of your complaints and limitations in your medical records.
If a symptom or condition doesn’t appear in your medical records, as far as the insurance company is concerned, it doesn’t exist. It’s vitally important for your treating physician to include all of your complaints in your medical records to ensure that the insurance company is on notice. At Dell Disability Lawyers, our experienced attorneys have handled thousands of long term disability claims, and we know exactly what the insurance companies are looking for before they approve benefits. To schedule your FREE consultation to discuss your case with a member of our legal team, just give us a call today.