The Long Term Disability Insurance Process and Why It Can Fail

By Roger Foisy on November 17th, 2014

Many people with valid long term disability (LTD) claims are denied. Why does this happen?

Shouldn’t our system have processes in place to ensure that those who need long term disability receive it?

The unfortunate reality is that the process for receiving long term disability insurance is broken, and there isn’t a single place to lay the blame. Instead, it is a result of misinformation and misunderstanding at many stages throughout the LTD claim process.

Remember, to receive long term disability insurance, you must prove that you are unable to complete the tasks of your regular employment.

The LTD claim process operates like this:

You Tell Your Doctors About Your Injury

Your doctor examines your injury and asks you questions about it. Here, it is your job to properly explain your injury and what it prevents you from doing.

How This Step Goes Wrong

At this stage, the most common misstep is that clients do not know how to accurately describe their injury and what they’re going through as a result of it. You must take the time to fully explain your injury to your healthcare practitioners in detail.

In particular, you should focus on what your injury prevents you from doing in your regular life. What things that you would normally do; can you no longer accomplish; or, you do so less effectively because of the pain and limitations of your injury?

I recommend using the PQRST Method to accurately describe your pain to your doctor. Using it will allow you to give your doctor the information they need to create a thorough report for the insurance company. Click here to read my blog or watch my video where I describe how to use the PQRST Method.

Doctors Give the Insurance Company Information About You

The insurance company will request information from your doctor about your condition and injury. They require evidence of your symptoms and physical (or psychological) condition.

How This Step Goes Wrong

Doctors, particularly if they know you and your health history well, will often simply tell the insurance company that your condition is too poor for you to return to work. Your doctor is accustomed to coming to conclusions in their line of work. They would like to be able to report that you are not fit to return to work and move on.

Unfortunately, the insurance companies will never ask the doctor if you are fit to return to work. Instead, they want detailed records of your condition, symptoms, and the problems you are experiencing due to your injury so they (the insurance company) can draw their own conclusions.

This becomes a problem because A) you may not have described your symptoms accurately (as I mentioned in the above step), and B) some doctors do not document everything you say. They are busy and may not provide the level of detail necessary for the insurance company to find a valid claim, even if you gave  all the information to them when they examined you.

The information the doctor provides to the insurance company must be specific and detailed about your condition. The insurance company will then make the decision about whether the injury precludes you from returning to work. The insurance company needs evidence from your doctor, not conclusions.

You Tell the Insurance Company About Your Job

When you complete the application to the insurance company, you will be asked what your job is and what functions you must perform to do your job. You will be asked to detail what you are capable and incapable of doing.

How This Step Goes Wrong

If you don’t fill out this information correctly and in great detail, the insurance company may not get the information they need to accurately determine the duties of your employment. Furthermore, if you record information in the application and your employer provides contradictory information, it will destroy your credibility with the insurance company.

Employers Give the Insurance Company Information About Your Job 

Your employer is given a form to complete about the tasks of your employment, which the insurance company will cross-check with your own account.

How This Step Goes Wrong

In some cases, your employer may not have the specifics of the tasks required for your job. Ideally, every employer would have a job demands analysis (physical and cognitive) for every job, which they could provide to insurance companies when asked; however, few employers have these at hand.

The Insurance Company Makes a Decision

The insurance company’s job is to check the medical reports against your job requirements and determine if your injury substantially prevents you from completing the tasks of your employment.

How This Step Goes Wrong

When insurance companies do not have proper information describing the extent of your condition, what it prevents you from doing, and what you must do for your job, they do not have what they need to make an accurate decision with respect to your LTD claim.

They must use what they have been provided; and in too many cases, it is not enough to allow them to accept the claim. If they do not have medical reports supporting your claims or if they do not have enough specifics about the tasks of your employment, they will not be able to make a decision in your favour.

If every step in this process went as intended, insurance companies would have much more difficulty denying valid claims.

How Your Lawyer Can Help If Your LTD Claim Is Denied

If you’ve been denied long term disability insurance and you have a valid claim, one of the issues I have discussed above is likely to blame.

It’s crucial that you get your symptoms and condition recorded in a format that your lawyer can use in litigation. That means you must get your doctor to write them down  as the judge and jury usually rely on what is contained in  clinical notes and records.

When your lawyer tells the jury something about your condition, they are skeptical. When you tell the jury about your condition, they are hesitant to believe you fully. When a medical practitioner writes a record about your condition, putting the weight of their authority behind it, they will respect it.

You need a lawyer that fully understands the LTD process and will take the time to understand not only your medical condition in detail, but also the tasks of your employment. When examining insurance companies, a lawyer who does not have information on both of these pieces is not going to be able to prove the validity of an LTD claim.

Your lawyer can help you demonstrate the validity of your LTD claim, but they need the right evidence to support it.

Roger R Foisy is an experienced Long Term Disability Lawyer who has successfully helped clients receive the LTD compensation they deserved. If your LTD claim has been denied, contact us for immediate support and a free consultation.

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