What You Don't Understand About Medical Evidence Could Cost You Your Disability Claim
It's not fair - it's not fair at all. The fact that most people don't understand how to gather and prepare medical evidence is part of the reason why so many denied disability claims are lost on appeal. It's a critical part of any ERISA long term disability appeal, and it doesn't just mean making a copy of your medical records.
There is so much that we don't understand about certain diseases, particularly the long-term, devastating diseases that can take you out of work permanently. Doctors and scientists are constantly working, trying to understand diseases like Lyme disease, fibromyalgia, and even chronic migraines. Traditional testing may provide little insight into these types of conditions, and few tests exist to unequivocally "prove" individuals have illnesses like these. These types of diagnoses are often reached based upon surrounding symptoms rather than conclusive tests, on excluding other causes of the symptoms.
The sad truth is: even if a doctor diagnoses your disease, you will still have difficulty getting your disability claim approved.
Here's the reality you will never read about on the face of your policy: the insurance company routinely rejects disability claims for conditions like fibromyalgia. Often, the disability insurance company requires "objective medical evidence" of your condition.
What does that even mean: "objective medical evidence?" Generally objective medical evidence is referring to tests like MRIs, test results, scans - that sort of thing. Which could be the kiss of death for your Long-Term-Disability (LTD) Claim if you have a disease that can't be definitively documented by these types of tests.
Obtaining objective proof of your condition can be difficult for some diseases. You may need medical research and analysis of medical literature and studies to help prove you have a certain disease or medical condition. You may need to provide the literature and studies to your doctor or a consulting expert physician you hire, or find an expert in the field to examine you. All of this is time consuming and expensive, but you have to do it.
If you can believe it, the insurance company may accept that the doctor correctly diagnosed your illness, but still reject your disability claim, saying you can work or that the condition is not covered by your policy or doesn't fit a term or condition of the policy. This is how insurance companies make money - they opt out of paying their claims based on narrow caveats. One would think the opinion of a treating physician would be enough for the insurance company to accept your claim, but the insurance company has their own doctors with BS evaluations (often called "Independent Medical Evaluations" which are a joke just in the title). These doctors will be all too willing to reject your diagnosis, sometimes without even meeting or evaluating you (these types of evaluations, just based on the medical records, are called Utilization Review - also a joke).
That is why hiring an attorney for your long-term disability case will be necessary if you've had your claim denied. You need someone to compile and present persuasive arguments to offset the thinly veiled bias in the law, favoring insurance companies.
If your claim was denied because your illness lacks "objective medical evidence," and your treating physicians support your claim that you can't work, bring your denial letter to us and we will take a look at it for no charge. If we think that you need legal assistance to prove your claim, we will take steps to help you get started with us.
Call us today at 202-393-3320. You denied claim doesn't have to result in a loss overall.
But if you don't get legal help, it's more than likely that it will.