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Evidence in a Long Term Disability Claim

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What Kind of Evidence Do You Need To Prove a Long Term Disability Claim?

As a LTD benefit applicant, you will need to prove to the insurance company that your disability prevents you from working. They won't take your word for it, or even your doctor's word for it. You will have to prove your disability, with as much evidence as they deem necessary. And what the insurance companies deem necessary is not consistent, and often arbitrary.

Even so, you have to do your best to present an application or appeal as best as you can, with as much evidence as you can, in the hopes they approve your application or accept your appeal.

If they don't, you've set your case up to succeed in a lawsuit against the LTD insurer.

Regular, On-Going Medical Treatment Is Vital

Prevailing in a long term disability case without regular, on-going treatment is difficult if not outright impossible. Your insurance company will demand you visit and treat with your doctors at regular intervals.

There is no hard and fast rule about how often you need to see your doctors. Bug in general, you should be seeing your doctors and specialists at least once every 90 days. Psychiatric conditions such as depression or anxiety require more frequent visits with your mental health physicians.

Any tests used to diagnose and/or confirm your disability should be ordered. These include objective medical tests such as X-Rays, MRIs and CT-Scans.

You must submit all supporting evidence possible. This will improve your chances on your application, appeal or ultimately, a federal ERISA lawsuit.

The following types of evidence will support your case:

  1. Medical Records
  2. Physician Statements
  3. Your Statement
  4. Medical Exam and/or Functional Capacity Exam

Medical Records Proving Long Term Disability

This is the foundation of your case. You must collect all  the evidence from all your treating doctors and facilities, then submit them to the insurance company so it is on file.

Your medical records will consist of charts, reports, imaging, scans, tests. There is subjective evidence and objective evidence.

Objective evidence is evidence that can be independently evaluated.  These include imaging tests such as CT scans, X-Rays, MRIs, Ultrasounds, EKG, EEG, blood work, PET-scan.

In order to maximize your chances of success, you should ensure your treating doctors order all of the necessary tests required to properly diagnose your disabling condition. For example, if you suffered from a herniated disc your doctor will make a clinical diagnosis based on clinical signs and subjective (self) reported symptoms. Then they will order an MRI to confirm the diagnosis. You want to be sure the doctor's notes and charts, as well as the MRI results (and possibly the imaging itself).

Not all disabling conditions can be proven by objective tests. There are some conditions that can only be proven by subjective complaints. Such as fibromyalgia. Fibromyalgia cannot be shown by any imaging test. Most courts have accepted the "trigger point test" for proving fibromyalgia, where 11 of 18 trigger points exhibit pain when pressure is applied. This is still subjective but many federal courts accept this as proof of the condition.

However, even with a diagnosis from a doctor and the necessary documents an insurance company will still be skeptical and will be very reluctant to grant benefits.

Then you need to make sure you obtain those records and send them in. The insurance companies are looking for any reason they can use, to justify denying your benefits.

Be sure your insurance company has all of your records

Insurance companies often use the excuse of "insufficient medical evidence" to deny benefits. Claimants wrongfully believe their insurance company will diligently collect all of their medical records, and that the record will be complete. Insurance companies will request the records, however the records they receive can be incomplete.

It is your burden to prove your disability. This means you need to make sure your insurance company has all of the relevant records. You do this by asking your insurance company for a list of what they requested, and what they received. If anything is missing, especially something important, you make sure they get it before your appeal deadline.

Doctor's Statement

The opinions of your treating physicians are crucial in proving your disability claim. Don't just rely on the insurance company to read the records and form an accurate opinion. You need to ask your doctors to complete a questionnaire. A detailed questionnaire specifically tailored to your conditions. Do not rely on the forms your insurance company provides those are generic and they are designed to support a denial.

Your doctor should be willing to fill out the questionnaire for you. But there are some who don't like to. If your doctor appears to be unwilling to help, you should seek out a new doctor that will.

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