Your treating physician, or any doctor who has treated you for the injury or illness that caused your disability, is critical to a successful ERISA long term disability claim. But how and when do you get your doctor involved?
First - you have to read the disability insurance policy (this is the answer to a lot of long term disability claim questions...) to determine exactly how it defines disability. Chances are, your doctor has a different definition of disability or thinks of the term "disability" differently.
Does disability mean you can't do any work at all? Does it mean you can't do critical functions of your job? Does it mean you can't do the essential functions of your job? How long does it have to last? Is there a medical condition that may be excluded?
We talk to a lot of physicians and experts for our clients, and most treating physicians do want to help their patients.
But they don't know the answers to these types of questions. And without knowing that, they can actually hurt your case, even though you are legitimately disabled and can't work due to a serious injury or medical condition.
There are several things to keep in mind when talking to your doctor about your long term disability claim:
1. Doctors are busy - really busy. You may need to request and pay for extra time to see your doctor and discuss your condition because a routine visit may not give you enough time.
2. You need to give your doctor all of the important information (obviously this includes telling him the complete truth about your condition and limitations you have, but it's more than that). This may be reports of other doctors you've seen, Functional Capacity Evaluations, testing results, physical therapy evaluations. You can't assume that your doctor has seen these records or has all of this information.
3. Your doctor may need your job description - you can't assume he or she knows all of the physical aspects of what you do at work. Here's an example: Are you a security guard? Does that mean you sit at a fancy D.C. office lobby watching people swipe their fobs when they come back from lunch? Or does it mean you are a security guard at a site where you break up fights, apprehend suspects, detain people and carry a firearm? Don't let your doctor guess about this.
What if you have several medical conditions that prevent you from working, and you also have a condition that is excluded by your policy?
It's hard to talk to doctors and medical specialists - they're busy and would rather be practicing medicine than filling out forms and writing reports. But it's important to get your doctor all of the information, so it's in your medical records and you can use it in your long term disability claim.
Have you received a letter saying your long term disability benefits were denied or terminated? We'll review that at no charge and give you our thoughts on what you need to do next - but get it to us quickly, because there are harsh, unforgiving time frames to file an ERISA long term disability appeal.
Just call (202) 393 - 3320 to arrange to get it to us.