Medical evidence is necessary to prove entitlement to long-term disability benefits. In fact, the strength of the medical evidence you submit to the insurance company can make or break your claim. Insufficient medical evidence is one of the top reasons given by insurance companies when a long-term disability (“LTD”) claim is denied.
Let’s have a look at the role of medical evidence in LTD claims and how our Barrie disability lawyers can help you gather and present a strong case.
Role of medical evidence in LTD claims
The onus is on you to prove that you are entitled to receive benefits from the LTD insurer. Typically, that means you must provide evidence to at first satisfy the insurer that you are disabled from your “own occupation” and then, after a certain period of time if you continue to be disabled, evidence that you are unable to work in “any occupation.”
You have a better chance of having your disability benefit claim approved when you provide detailed and objective supporting evidence with your LTD application. The same is true of appeals following an LTD claim denial—your appeal has a much greater chance of success when you gather new or better medical evidence to support your condition.
Types of medical evidence to support a long-term disability claim
These are the most common types of medical evidence relied on in long term disability claims:
Attending Physician Statement from the doctor most familiar with your medical condition.
Treatment records from any hospital you attended and from all medical professionals involved in your care, including your GP, specialists, psychiatrist, etc.
Results of laboratory tests, blood work, biopsies, ECGs, etc.
Imaging studies such as X-rays, MRIs, CT scans, etc.
Expert reports from specialists you’ve been assessed by to assist with your claim (for example, an opinion from a psychiatrist if your LTD claim arises from depression, anxiety, or post-traumatic stress disorder; an opinion from a pain management specialist such as a physiatrist if your LTD claim arises from chronic pain).
Quality of medical evidence is crucial
Medical evidence and records must be as objective and detailed as possible. A bare-bones note from your doctor saying you are unable to work won’t cut it. The LTD insurer needs sufficient information to evaluate the nature of your medical condition and how it prevents you from working.
Quality medical evidence should contain the following information:
The nature of your injury or illness, including a diagnosis whenever possible.
A description of the type and severity of symptoms you experience, and information about how long you have been experiencing those symptoms.
The medical professional’s clinical observations.
Details to explain the extent of your functional limitations or restrictions (e.g., tasks or activities you can’t perform or should not do, and how those limitations and restrictions prevent you from working).
Your prognosis. If the timeframe for recovery is unknown, the records should contain a statement that your condition may be permanent, or that it is expected to continue for the foreseeable future, etc.
Recommended treatment plan (e.g., medication, physiotherapy), whether your condition has responded to treatment, and whether you have been following reasonable treatment recommendations.
Any pre-existing injuries or illnesses, and any other factors that may be complicating your medical condition.
How LTD lawyers can assist in gathering medical evidence
It can be very stressful and overwhelming to try to gather all the necessary records and documents to support your claim for LTD benefits. You are already struggling with your illness or injury and the financial strain of not being at work. It can be just as stressful and overwhelming to try to figure out what you need to submit if your claim has been denied due to insufficient medical evidence. Remember that a denial on that basis doesn’t necessarily mean you aren’t eligible for LTD benefits—it may simply mean you need new or better medical evidence.
Our Barrie long term disability lawyers are skilled at gathering and properly presenting medical evidence to support LTD claims and appeals of LTD denials. One of our disability lawyers can review your case and advise you on the evidence needed to put forward a strong submission to the insurance company. If necessary, we can refer you to specialists to obtain an expert opinion to support your claim.
Your disability lawyer will also take care of requesting full copies of medical records from any hospitals, doctors, specialists, and medical professionals you’ve seen in relation to your illness or injury. In our experience, doctors’ offices and other medical facilities are more responsive to requests from a law firm than from the patient who received treatment. Getting medical records as quickly as possible is very important, as long-term disability claims and appeals can be delayed or denied if submission deadlines are missed.
Get Help From A Long Term Disability Lawyer
Barrie disability lawyers at Littlejohn Barristers will assist you by answering all your questions regarding your long-term disability benefits claim. We can help you collect and present the best evidence possible, so you get the LTD benefits you deserve.
Littlejohn Barristers has a team of lawyers who have experience in disability insurance and will review your case with you. There is no up-front fee or cost involved in any initial meeting. If you require a Barrie long term disability lawyer with extensive experience with LTD claims and LTD denials, please do not hesitate to contact Littlejohn Barristers at (705) 725-7355.