The Long Term Disability Claims Rep Says I Have to Show Proof of Disability to Continue Benefits. What Does That Mean?

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Proof of Disability in Long Term Disability Claim

After you have been awarded long term disability benefits, most long term disability insurance companies require you to show proof of ongoing disability, Proof of Disability in Long Term Disability Claim in DCand sometimes it is called "proof of loss".  Some of that will depend on your specific long term disability policy, but there are some common requirements, such as:

  • the long term disability company (Mutual of Omaha, Hartford, Guardian, Reliance, etc) will have internal guidelines for reviewing your claim.
  • the insurance company can require you to provide proof of disability at certain points (usually every 45 - 90 days or so)
  • the insurance company can require that you are under the care of a physician
  • the insurance company can send you to one of their doctors for an evaluation

How Do You Prove Disability in Your Long Term Disability Claim?

The first thing to do is to make sure your doctor understands the physical and mental aspects of your job, so that your doctor can address all of the relevant  restrictions and limitations from your medical condition or injury.  Its a common misperception, but your doctor doesn't necessarily have to say you are "disabled" or that you can't work at the job.

But the doctor does have to provide the limitations on your functioning (and those limitations or restrictions should lead to the conclusion that you can't do that job).  Here's an example of how restrictions and limitations match up with your job duties:

As a bank manager, your duties may include things like supervising employees, verifying cash counts, making decisions, using judgment, interacting with the bank's customers, scheduling deposits.   But a severe concussion has impacted your ability to think clearly, to make decisions, to process information quickly, to remember things clearly and to follow directions.

The physician treating you for post concussion syndrome should be able to address whether you are able to make decisions at a pace appropriate for a bank manager, whether you have memory loss, altered or affected judgment.

Usually your long term disability insurance company will have a form for the doctor to complete.  And its important that you meet with your doctor to make sure the doctor understands all of your symptoms and problems with functioning.  And that should also appear in your doctor's records.

Is Proof of Loss Different than Proof of Disability?

That really depends on your long term disability policy.  Some insurance companies use the terms interchangably, or as an initial determination of whether you are disabled according to the policy.  So proof of loss may require you to provide:

  • Evidence of your income, such as tax returns or W-2s
  • Medical information - doctor's reports, diagnostic tests, treatment notes, etc.
  • Evidence of Other Income Benefits (social security disability for example)
    •  Most policies will also require you to apply for Other Income Benefits like social security disability because they can use those to reduce the amount of long term disability benefits thay have to pay.

In addition, the long term disability insurance company can have you examined by a physician or other specialist of their choice (such as a vocational rehabilitation counselor or functional capacity evaluator) or interview you, as part of the Proof of Loss determination.

How Can a Long Term Disability Attorney Help You Prove You are Disabled?

As long term disability attorneys based in Washington, D.C., we talk to people who are struggling with keeping up with the insurance company's endless demands on them and their doctors to continue to prove they are disabled - often a consulation with a long term disabilty attorney can get you on the right track.

And a common way to deny long term disability benefits is for the insurance company to say you do not have sufficient limitations or restrictions, so aren't disabled as defined by the policy.

If your long term disability benefits are denied or terminated by the insurance company, you only have one chance to appeal - getting a long term disability attorney, one experienced with working with physicians and other experts you'll need to prove your claim, is a smart choice.

Call us today at (202) 393 - 3320 with your questions on long term disability benefits in D.C.  We're here to help.

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer