The Role Of A Disability Nurse Consultant For Your Long Term Disability Claim

If you filed a claim for either a short term or long term disability as a result of a serious injury or medical condition, the insurance company will likely have your medical records reviewed by a nurse disability consultant. Many long-term disability companies, like Unum, Hartford, Guardian, and others use a nurse as a reviewer to make an initial determination as to whether your doctor's restrictions and limitations keeping you out of work are “supported” and basically whether your treating doctor has adequate reasons for keeping you out of work.

Disability Nurse Consultants Work For The Insurance Company

A lot of times, these nurse consultants are employees of the disability insurance company or are paid consultants who probably earn the majority of their income reviewing medical records for the disability insurance company.

Many times the nurse consultant will enter notes directly into the claim notes that your claim specialist and team (the insurance company's employees who determine if you are entitled to benefits under your policy), and obviously that shows how closely the nurse consultants work with a particular disability insurance company. Other times, they will write some kind of memo or report that restates your medical records.

If you receive a nurse consulting report, read it carefully to make sure the nurse has included all of the medical information and findings (many times they cherry pick this information). They often well also mention other medical information that has nothing to do with your disability claim.

We Help Our Long Term Disability Clients Stand Up To The Insurance Company

In one of our disability cases recently, the nurse disability consultant kept indicating that our client’s severe osteoarthritis did not require an assistive device for ambulation (a cane or a walker). This, of course, was not a condition of the policy and had nothing to do with whether she could do her sedentary job.

And you may be thinking; how could a nurse who has never examined you, reviewed any of your diagnostic imaging studies, or spoken with you or any of your physicians inject their opinions about your physician’s medical opinions? You’d be right – that should not happen.

We have seen cases where these nurses presume to know more than board-certified treating specialists. Unfortunately, long-term disability insurance policies, and the federal law that governs them, favor insurance companies over people who are legitimately injured or ill and cannot work. There are a number of strategies to fight a nurse disability evaluation report, including working with your treating physician and other medical experts.

Speak To An Experienced ERISA Disability Attorney

If you need help with your short term or long term disability benefits, call us today at 202-393-3320 to schedule a confidential, no obligation strategy session to see if we can help. If you have been denied disability benefits or they have been terminated by the insurance company, send a copy of the denial letter to [email protected] and we will review it for you (free of charge) and give you a plan for your appeal. But do it today. In most cases you only have 180 days to file your appeal after you’ve been denied long term disability benefits.

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