Figuring out whether you have a viable long term disability or ERISA claim isn't easy, particularly in the world of COVID-19. How do you know whether your symptoms are disabling enough? Is it possible to predict how your claim will be evaluated?
There's so much to consider, and you need answers.
We can help. We have successfully obtained disability benefits for clients with hundreds of different types of illnesses and injuries. This article starts off with links to specific articles on numerous conditions. Each of those articles provides helpful tips on making successful disability claims.
If your condition is not listed, we also provide tips on proving disability based on several symptoms common to most conditions: pain, fatigue, weakness, cognitive impairment and medical side effects.
We also describe what type of evidence you could present to prove disability from those symptoms.
Important tip: It is not enough to prove you have a specific illness, you need to prove that you are suffering from specific symptoms and that those symptoms prevent you from performing the material duties of your occupation.
Is My Illness or Injury Disabling?
Is my Acoustic Neuroma disabling?
An acoustic neuroma may cause an array of chronic and serious symptoms that can result in long term disability. The physical symptoms of an acoustic neuroma can be extremely limiting and distressing, which may lead to secondary emotional issues, such as depression and anxiety. When filing for long term disability for an acoustic neuroma, it's important to know how to best present your symptoms to your insurance company.
Is my Amyotrophic Lateral Sclerosis (ALS) disabling?
Amyotrophic Lateral Sclerosis, often called “ALS” or “Lou Gehrig’s disease,” is an extremely disabling and frightening illness which likely will lead to long term disability. While it may seem obvious why you are unable to work as a result of ALS, your insurance company may not understand the true severity of your condition or the impact it has on your job – especially as your symptoms first begin to develop. Getting your ALS long term disability claim approved will require providing your insurance company with sufficient medical evidence.
Is my Anxiety disabling?
Anxiety disorders are a serious medical condition that may result in long term disability. However, there are certain challenges to getting approved for disability benefits with an anxiety disorder. Your insurance company must understand your anxiety symptoms and how they impair your ability to work. Knowing what evidence can be used to substantiate your claim will significantly increase your chances of approval.
Is my Arachnoiditis disabling?
Given how serious arachnoiditis can be and that it has no known cure, your diagnosis may foreshadow a period of long term disability. It is entirely possible for those with arachnoiditis to receive long term disability benefits. However, you will need to provide evidence to your insurance company of your diagnosis, the severity of symptoms, and ongoing treatment.
Is my Arthritis disabling?
Arthritis is one of the most common conditions leading to long term disability. Many people with arthritis find their range of motion too limited and joint pain too unbearable to continue working. Your insurance company will consider your arthritis a disability if your symptoms are bad enough that you cannot perform your job duties. Before your claim is approved, however, your insurance company will require evidence of your diagnosis and your ongoing symptoms.
Is my Asthma disabling?
Asthma is a chronic condition whose difficulties can cause severe restrictions and limitations - potentially leading to long term disability. Knowing how to substantiate your Asthma long term disability claim (e.g., through medical evidence, proof of treatment, etc.) will help increase your chances of approval.
Is my Back/Neck Injury disabling?
Back and neck pain is one of the most common reasons why claimants file for long term disability insurance benefits. Insurance companies routinely deny back and neck pain disability claims for lack of objective evidence. Your disability claim hinges on proving to your insurer that you have a back and/or neck injury, and the specific ways that your condition disables you from working.
Is my Bipolar Disorder disabling?
If you’re unable to continue working due to your Bipolar Disorder, you may consider filing a long term disability insurance claim. In order to receive disability benefits for Bipolar Disorder, you will need to provide strong evidence to your insurance company of your disabling symptoms and their effect on your ability to work.
Is my Cancer disabling?
Cancer is a leading cause of long term disability. However, a diagnosis of cancer itself does not guarantee that a person will qualify for long term disability benefits. For a successful claim or appeal, you must persuade your insurance company that you meet the standard of disability set forth in your policy or plan.
Is my Cardiac Condition disabling?
With disability cases involving heart disease and cardiac-related conditions, our attorneys take a two-pronged approach: first, we detail how your condition prevents you from performing your occupational duties. Then, if applicable to your case, we present evidence that the stress of working risks exacerbating your condition or even causing a heart attack.
Is my Carpal Tunnel Syndrome disabling?
It can be challenging to get approved for long term disability due to carpal tunnel syndrome. Insurance companies may be skeptical of the severity of your condition, or misunderstand the demands of your occupation and how your carpal tunnel negatively affects your ability to work. However, certain medical evidence can increase your odds of benefit approval.
Is my Chronic Fatigue Syndrome disabling?
Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis, is a serious and often misunderstood medical condition that may result in total disability. Given the subjective nature of many CFS/ME symptoms, proving your condition as disabling can be complex and challenging. To get approved for long term disability benefits for your CFS/ME, your symptoms must be supported by sufficient medical evidence.
Is my Cognitive Impairment disabling?
Sometimes referred to as “invisible” medical conditions, cognitive disorders are conditions that impair abilities such as memory, language, thinking, judgment, and emotion regulation. When filing for long term disability due to cognitive impairment, your insurer will seek evidence of your condition and symptoms. There is special testing that can help substantiate your cognitive impairment claim.
Is my Complex Regional Pain Syndrome disabling?
Complex Regional Pain Syndrome (CRPS) can cause an array of physical symptoms that can result in long term disability. While CRPS is a serious illness, it can be challenging when filing for long term disability. It's a rare illness your insurer may not be familiar with, and a number of the symptoms are considered subjective. Knowing how to substantiate your CRPS long term disability claim will help increase your chances of approval.
Is my Crohn’s Disease disabling?
Crohn's disease, a chronic and sometimes progressive disease, can become extremely disabling if your condition is moderate to severe. Your Crohn's long term disability will hinge on showing how your condition prevents you from working. Because Crohn's disease causes a wide range of symptoms, every symptom must be well-documented to demonstrate the progression of your condition.
Is my Degenerative Disc Disease disabling?
Back pain is the number one reason people file for long term disability. However, it can be difficult proving the severity of your condition to your insurance company. While the debilitating pain of degenerative disc disease is very real, pain is considered a “subjective” symptom. Your insurance company will want objective medical evidence to back up your disability claim.
Is my Depression disabling?
While depression can qualify you for long term disability benefits, there are hurdles to clear in order to get a mental illness claim approved by your insurer. Understanding what type of evidence your insurance company will look for can go a long way in increasing your chances of claim approval.
Is my Diabetes disabling?
Diabetes can be debilitating in one person and manageable in the next. Qualifying for long term disability insurance benefits will require more than a diagnosis. Your claim must be supported with convincing evidence that you meet the definition of disability laid out in your LTD policy. Since many individuals with diabetes are able to work until retirement, the challenge will be educating your insurer about how your case is different.
Is my Ehlers-Danlos Syndrome disabling?
Ehlers-Danlos Syndrome (EDS) is a complex and serious condition that affects each individual differently. If your EDS is severe, the restrictions and limitations brought on by your condition may preclude you from even sedentary work. In order to get approved for long term disability for EDS, your diagnosis, symptoms, and treatment must all be well-documented and supported with objective medical evidence.
Is my Epilepsy disabling?
Even with treatment, the serious symptoms of epilepsy can make it impossible to function in a work environment. Before filing an epilepsy long term disability claim, it is essential to understand how best to corroborate your claim. That way you’ll have the best chance of approval with your insurance company.
Is my Fibromyalgia disabling?
Because the symptoms of fibromyalgia are largely subjective, filing for long term disability can be a challenging process. Often insurance companies are skeptical of claims based on self-reported subjective symptoms. However, there is objective medical evidence and testing you can gather that will help substantiate your fibromyalgia claim.
Is my Heart Condition disabling?
If symptoms of heart disease are making it difficult or impossible for you to do your job, your employer-provided long term disability policy may provide benefits. Heart disease can be a debilitating ailment and is a common reason for disability claims. However, you'll need more than a diagnosis to get approved for long term disability benefits.
Is my HIV/AIDS disabling?
It's easy to assume that a diagnosis of HIV/AIDS automatically qualifies a person for long term disability insurance benefits, but establishing your HIV status is only the first step. The more difficult task lies in proving that your condition is “disabling.” This means demonstrating that your condition has progressed to the point that it prevents you from performing the material duties of your job. This can be done through information from your doctors, yourself, and other third parties.
Is my Huntington's Disease disabling?
Huntington’s disease is a relatively rare genetic condition that causes progressive degeneration of nerve cells in the brain. While devastating, your long term disability claim will need to be supported by more than a diagnosis to be approved. Your insurance company will wonder why why you could work one day but not the next. Medical evidence will be required to show how your Huntington's symptoms have progressed and explain how they interfere with your ability to work.
Is my Irritable Bowel Syndrome (IBS) disabling?
If you suffer from Irritable Bowel Syndrome (IBS), you’re familiar with how painful and difficult it can be. You may find your IBS impairing your ability to work – to the point of long term disability. In order to get approved for long term disability benefits due to your IBS, it’s important to know how best to put forth your claim with your insurer. Beyond a diagnosis, your insurance company will want to know your personal symptoms, their severity and frequency, and the ways in which they impair your job performance.
Is my Ischemic Heart Disease disabling?
If you have ischemic heart disease, you may be considering going out on disability. However, you’ll need more than a simple note from your doctor to get your insurance company to award benefits. Your insurance company will require not only evidence of your diagnosis and symptoms, but evidence that your condition interferes with the demands of your occupation as well.
Is my Kyphosis disabling?
Back injuries are one of the most common reasons that people file disability insurance claims. Kyphosis is not usually the direct cause of significant disability, but like scoliosis, it can cause discomfort, pain and lost productivity when it happens in conjunction with other serious conditions or injuries. Understanding how to substantiate your kyphosis disability claim with medical evidence can increase your chances of benefit approval.
Is my Leukemia disabling?
Given that Leukemia is a very serious cancer, you would think approval of long term disability insurance benefits would be a simple process. However, to receive benefits your claim must still be supported by sufficient medical evidence and proof of appropriate treatment.
Is my Lyme Disease disabling?
Most victims of Lyme disease suffer an unpredictable combination of physical and/or cognitive symptoms. Proving a long term disability claim for Lyme disease comes with many challenges, from getting the insurance company to acknowledge your diagnosis to effectively demonstrating the severity of your symptoms and how they prevent your from working. It is vital to understand what evidence your insurance company will seek in order to approve your Lyme disease disability claim.
Is my Macular Degeneration disabling?
Macular Degeneration is the leading cause of vision loss in the United States. As your condition progresses, it may become difficult or downright impossible to perform your work duties - leading to long term disability. However, your insurer may not understand the significance of your symptoms or the impact they have on your job. A combination of evidence - medical and your own documentation - can help you win your disability claim.
Is my Mast Cell Activation Syndrome disabling?
Mast cell activation syndrome (commonly known as “MCAS”) is a chronic medical condition caused by your body’s mast cells overproducing chemicals called “mediators.” The mast cell mediators induce symptoms of an allergic reaction, such as skin hives, low/high blood pressure, wheezing, and in severe cases, anaphylactic shock. These MCAS reactions are often triggered by exposure to environmental factors.
MCAS is not a well understood condition in the medical community, and while there are various treatment options, there is currently no cure. If you have MCAS, you may experience symptoms with enough severity and frequency to interfere with your ability to work.
Is my Mental Illness disabling?
Most long term disability insurance policies limit benefits to 12 or 24 months when your disability is caused by a mental illness. Under these provisions, benefits will stop after one or two years even if you remain totally disabled. As a result, many insurance companies try to characterize a physical disability as a mental disability, or ignore that the mental illness is secondary to the physical disability. Beware of this trap.
Is my Ménière's Disease disabling?
Individuals with Ménière's Disease may experience episodic vertigo, balance issues, headaches, dizziness, tinnitus, and hearing loss. The symptoms can be exhausting and disorienting, often resulting in long term disability. Your Ménière's also may lead to disabling cognitive symptoms and secondary emotional issues, such as depression. It can be challenging to effectively establish the range of your symptoms to your insurance company. To file a successful long term disability claim, you must support your claim with sufficient medical evidence and proof of appropriate treatment.
Is my Multiple Chemical Sensitivity disabling?
MCS is a poorly understood illness. Much of the medical community has yet to officially recognize it as a viable syndrome, and many of the associated symptoms are considered subjective. Because of this, MCS is an especially difficult condition to prove as disabling. Knowing how to substantiate your MCS long term disability claim (e.g., through medical evidence, proof of treatment, etc.) will help increase your chances of approval.
Is my Multiple Sclerosis disabling?
Multiple Sclerosis (MS) is chronic, progressive disease of the central nervous system. Despite the obviously serious nature of Multiple Sclerosis and the profound impact it may have on a person’s life, obtaining long term disability benefits can be an uphill battle. Because the symptoms of MS vary and may take a long time to progress, many people with MS can work for years after their diagnosis. Your insurance company will require strong medical evidence to support your claim that the disease has progressed to the point that you are no longer able to work.
Is my Myasthenia Gravis disabling?
Receiving long term disability benefits for myasthenia gravis can be a difficult process. Myasthenia gravis is difficult to diagnosis, can have fluctuating symptoms, and your insurance company may not think your condition has progressed enough to be disabling without the correct medical evidence and supportive documentation from yourself.
Is my Obsessive-Compulsive Disorder (OCD) disabling?
Obsessive-compulsive disorder (OCD) varies in severity on an individual basis. For severe cases, the compulsions involved can impact your ability to function in everyday life to the point of long term disability. Because obsessive-compulsive disorder (OCD) is more often characterized as a mental illness rather than physical, it can make getting long term disability approval more complicated.
Is my Osteomyelitis disabling?
Osteomyelitis is a serious bone infection that can, if untreated, cause life-threatening complications and permanent physical impairment. If you have experienced osteomyelitis and any associated conditions that have affected your ability to work, you may qualify for long term disability insurance benefits. However, it's important to understand what evidence will be needed to substantiate your osteomyelitis disability claim with your insurance company.
Is my Pain Syndrome disabling?
Chronic pain and pain syndromes can make it impossible for sufferers to work. However, insurance companies regularly disregard complaints of pain on the basis that they are subjective. Knowing what evidence to provide your insurance company can help you assemble a claim or appeal that establishes the credibility of your condition.
Is my Parkinson's Disease disabling?
Parkinson's is a devastating disease with no cure. However, due to the somewhat unpredictable clinical presentation of Parkinson’s, a diagnosis alone is not usually enough to receive long term disability benefits. Instead, the insurance company will look to see how your particular symptoms impact your ability to work.
Is my Peripheral Neuropathy disabling?
The symptoms of peripheral neuropathy (paresthesia, muscle weakness, and more) can be serious enough to preclude you from work. When you file your long term disability claim for peripheral neuropathy, your insurance company will want more than just records of your symptoms - they will require proof of your diagnosis and treatment as well.
Is my POTS Syndrome disabling?
Postural orthostatic tachycardia syndrome, commonly referred to as “POTS”, can severely limit your ability to sit or stand for prolonged periods. As POTS Syndrome remains little understood by the medical community, it can be challenging to get a long term disability claim approved. Your POTS diagnosis and symptoms, as well as your restrictions and limitations, must be well-documented with objective medical evidence.
Is my Scoliosis disabling?
Whether you are a life-long sufferer of scoliosis and you have finally developed side effects from the condition, or if you have suffered an injury that led to scoliosis, you may qualify for disability benefits.
Is my Spinal Stenosis disabling?
Spinal Stenosis is a back condition causing severe lower back pain. If your lower back pain is worse when sitting or standing for long periods, or you are having leg numbness or weakness that affects your ability to work, you may need to file a disability claim.
Is my Spondylolisthesis disabling?
Pain brought on by spondylolisthesis can greatly affect your ability to bend, stoop or lift - and consequently, diminish your ability to work. In order to substantiate your spondylolisthesis as a disability, your claim will need to include proof your diagnosis, symptoms, and treatment.
Is my Stroke disabling?
A stroke may lead to long term physical and/or cognitive deficits requiring intense rehabilitative treatment. Even with treatment, a stroke may cause enough damage and residual symptoms to cause a permanent disability. Your insurance company will require objective medical evidence of all symptoms--physical and cognitive--in order to approve your disability claim.
Is my Tinnitus disabling?
Time and time again, insurance companies erroneously deny legitimate tinnitus long term disability claims due to lack of substantial hearing loss. Yet the most disabling cases of tinnitus often have nothing to do with hearing loss. Knowing how to prove the disabling nature of your tinnitus beyond hearing loss will help increase your chances of long term disability benefit approval.
Is my Traumatic Brain Injury disabling?
Even with intensive treatment, a traumatic brain injury may cause symptoms that are severe enough to cause a permanent or long term disability. Your insurance company will require evidence of your physical and cognitive symptoms in order to approve your long term disability claim.
Is my Vision/Hearing Loss disabling?
In order to qualify for disability benefits for either impaired vision or hearing, your impairment must be significantly advanced. Medical and vocational evidence will be required by your insurance company to get benefit approval.
Are My Symptoms Disabling?
Insurance companies are very quick to argue that a diagnosis does not equal disability. In other words, just because you have cancer, multiple sclerosis, or depression, does not mean you are disabled. In fact, many people work even while suffering from life threatening illnesses. What makes you disabled are your symptoms, not your illness.
There are thousands of different illnesses and injuries, but when it comes down to it, most people become disabled because of only a handful of symptoms. These are pain, fatigue, physical limitation, cognitive impairment, and medication side effects.
Is my Pain disabling?
Everybody knows what pain is. Yet everyone experiences pain differently. People experience pain differently based on many factors including genetics, gender, psychological factors, and social factors.
There also are different types of pain. There is acute pain, which is often sudden or severe. This type of pain is usually short term. It is usually caused by an injury, such as a cut or a broken bone. There also is chronic pain, which is persistent. It can last for months or years.
Pain can interfere with your ability to focus and to function in your daily activities. In short, it can be disabling and the reason to apply for disability benefits.
Because pain is experienced differently by each person, it is often problematic as a basis for a disability claim. Although pain cannot, by the science of today, be objectively measured, there are a number of things you can do to increase the credibility of your complaints of pain.
How do you prove your complaints of pain for a disability claim? There are several things you can do: (1) objectively document the cause of your pain; (2) keep records of your pain; and (3) obtain all appropriate treatment.
- Objectively document the cause of your pain. You can do this by obtaining an MRI or other objective test of your underlying injury or illness. For instance, if you have pain in your lower back, you can obtain an MRI of your lumbar spine. If it shows severe spinal stenosis, you will be indirectly documenting your subjective complaints of pain. The MRI is supportive of pain because it objectively documents spinal stenosis, which is a well known cause of pain.
- Keep records of your pain. You can do this by keeping a diary of your pain. This is helpful because it provides specificity of your complaints. Each time you experience pain, you should document its severity on a scale of 1-10 (with 10 being the worst); the cause of the pain; what increased the pain, and what you were doing at onset. The more detailed the diary the more credibility it brings to your claim.
- Obtain all appropriate treatment. Depending on the cause of your pain, there are usually a number of treatments to help minimize your pain. For instance, medication, physical therapy, nerve blocks, etc. If you complain of intractable pain but do not exhaust methods for treating your pain, the insurer will believe that your pain must not be so bad.
Pain also can be the cause of, or coexist with fatigue, weakness, and cognitive impairment.
Is my Fatigue disabling?
Everyone feels fatigued at some point. But, with some illnesses and injuries, fatigue can become every bit as devastating as pain. Fatigue is not just feeling tired, it is lacking the energy to do even simple tasks. It is extreme exhaustion. It can feel like having the flu. It can come on suddenly, or after exertion. It can be intermittent or it can be chronic. It could last for days or weeks after physical or mental exercise.
Fatigue like pain can interfere with your ability to focus, and could cause cognitive impairment.
How do you prove your complaints of fatigue for a disability claim? You can (1) objectively document the cause of your fatigue; (2) objectively document the fatigue; and (3) keep a fatigue diary.
- Objectively document the cause of your fatigue. Many illnesses are known to cause fatigue. If you obtain objective proof that you have been diagnosed with such an illness, it explains why you are fatigued.
- Objectively document your fatigue. Your complaints of fatigue may be able to be corroborated by either a Functional Capacity Evaluation (FCE) or Cardiopulmonary Exercise Testing (CPET). These tests are expensive but are helpful in assessing your stamina, energy demands, and ability to perform physical tasks.
- Keep a fatigue diary. A diary is helpful. In the diary, you should record the details of how fatigue has affected your day. For instance, "today, I could only get out of bed and sit on the couch, etc." Another tool that can be useful is the 9-item Fatigue Severity Scale (FSS). This could be completed on a weekly basis. It is a subjective measure of fatigue and how it affects your activities of daily living.
Are my Physical Limitations disabling?
Many illnesses and injuries cause physical limitations that may prevent you from performing the duties of your occupation. A very common example is a lower back injury that limits your ability to sit, stand, walk, squat, climb, etc. Another example is an eye disease such a Macular Degeneration, that limits your vision and therefore your ability to read, use a computer, etc.
These types of limitations are disabling because they prevent you from performing the physicality of the job, whether that be sitting, walking, standing, reading, hearing, speaking, using a computer, driving, traveling, etc.
Proving Physical Limitation
How do you prove your complaints of weakness for a long term disability claim? You can (1) objectively document the cause of the limitation; and (2) objectively document the limitation itself.
- Objectively document the cause of your limitation. Many illnesses are know to cause physical limitations. If you obtain objective proof that you have been diagnosed with such an illness, it will help explain why you have the resulting limitation.
- Objectively document the limitation. Many limitations could be objectively documented. For instance, if you have limitations in vision or hearing, there are objective tests to document those limitations. Many limitations also can be documented by a Functional Capacity Evaluation.
Is my Cognitive Impairment disabling?
Many disability claims are based at least in part on cognitive impairment. If you are a professional or executive, even mild deficits in concentration, memory, and/or processing speed, can prevent you from effectively performing the duties of your occupation. All you have to do is lose half a step.
Fortunately, unlike pain and fatigue, cognitive deficits are more easily proven.
Proving Cognitive Impairment
How do you prove your complaints of cognitive impairment for a long term disability claim? You can prove cognitive impairment by being tested by a psychologist or neuropsychologist.
- Mental Status Examination. A Mental Status Examination is designed to detect severe impairment. The examination includes: appearance, behavior, speech, mood, affect, thought process, thought content, cognition, insight, and judgment. It is quite possible to pass a Mental Status Examination but still have sufficient difficulties to be unable to handle the cognitive demands of your occupation. Most of the time to prove a long term disability claim, further testing is required.
- Neuropsychological Evaluation. Neuropsychological testing is the gold standard for providing cognitive impairment. Stated simply, without neuropsychological testing, it will be very difficult to establish a disability based at least in part on cognitive impairment. Learn more about Neuropsychological Testing.
Are my Medication Side Effects disabling?
Many illnesses medically require the taking of prescription medications. When those medications are medically necessary, side effects from those medications can serve as the cause of a disability. For instance, when someone has an illness that causes great pain, often pain medications such as oxycodone are required in order to control the pain. While the medication may lessen the effect of the pain, it could prevent you from working because it can cause drowsiness.
To prove disability as a result of medication side effects you will need to establish that the medication is medically necessary, and that there are not other forms of effective treatment that do not have similar side effects.
Proving Medication Side Effects
How do you prove your disability is caused by medication side effects? You can prove medication side effects by: (1) demonstrating that the side effects are known side effects of the medication; and (2) having them noted by your doctor or other testing.
Common medication side effects will be noted by the medications manufacturer. They can also be found by searching the medication at PDR.net.
Does My Medical Evidence Prove Disability?
Your disability claim is only as strong as the medical evidence you submit in support. Insurance policies all require "proof of claim." Proof of claim consists of a claimant statement, employer statement and a physician statement. On the physician statement form, insurers will ask your doctor to state your diagnosis, indicate your restrictions and limitations, and give an opinion as to whether you are able to work.
How the doctor completes the form can be critical, and can impact the success of the claim from the very start. Therefore, care must be taken in completing these forms. Many doctors, who are simply too busy, will delegate the task of completing these forms to nurses or non-medical personal. Often mistakes are made. You are well advised to thoroughly review these forms before they are submitted to the insurance company.
Doctors keep treatment notes as a reminder and record of physical exams and office visits. In the past these often were handwritten and illegible. More and more, however, treatment notes are recorded electronically. Often the system is in a question/answer format that the doctor just completes.
Insurance companies view treatment notes as the single most important piece of evidence. This is because they are kept contemporaneously. They feel because they are contemporaneous they are more accurate and possibly less biased. Insurer's worry that in non-contemporaneous documentation, such as narrative reports, doctors are more likely to exaggerate symptoms in an attempt to help their patients get disability benefits.
Because treatment notes are so important, you are well advised to do what you can to make sure that the treatment notes accurately reflect ALL of your symptoms and conditions. Often at an office visit, a patient only will discuss the most pressing issues.
For instance, a patient may talk to the doctor about the pain in the right foot because that is the most pressing pain, and not talk about the pain in the right hand because in comparison that is not as important. If that is the case, the treatment notes will mention the pain in the right foot, but have no mention of the pain in the right hand.
This can be a problem later when you need to assert disability about the right hand. Even though you had pain in the right hand on that office visit, it is not mentioned in the treatment note because you did not mention it. This could adversely affect you claim. The insurer will conclude that the pain in your right hand could not have been that bad on that day because if it was you would have mentioned it to the doctor.
What should you do? You need to mention ALL of your symptoms and conditions to your doctor on each and every office visit. If you have a lot of symptoms and conditions, we recommend that you write them down and bring the list with you when you attend the appointment. Feel free to give the list to your doctor at the appointment.
Because subjective symptoms can be self-serving, the insurer always wants to see objective evidence. Indeed, if a condition can be established by objective evidence, and you don't furnish such objective evidence, the insurer is likely to deny your claim.
What is objective evidence? Objective evidence is a test or film that can be replicated and cannot be manipulated. Examples are:
- blood and urine tests
- EMGs, Nerve Conduction Studies, EEGs
- CTs, SPECT scans, CAT scans
- Neuropsychological (cognitive) testing
- Functional capacity evaluations
Clinical findings are an important source of objective evidence. Through clinical tests and observations your doctor can objectively verify your condition without having to rely solely on your subjective complaints. Examples of clinical findings are:
- heart rate, blood pressure, temperature
- Trigger points
- Range of motion
- swollen glands, rash, swelling, infection
- observation of pressured speech, appearance, thought process
Residual Functional Capacity Questionnaires
Lawyers often will prepare questionnaires for a treating physician to complete. These questionnaires are very helpful to the doctor because they set forth a series of yes/no or multiple choice questions that a doctor could quickly answer. These questions address the relevant facts needed to prove a diagnosis and disability from the specific condition.
Here are samples:
Physician Narrative Reports
A physician narrative report is important because this is where the treating physician could describe your condition and explain why it is disabling. A good narrative report is based on a review and assessment of all relevant test results and existing treatment notes. Its where the doctor explains what a test result of "x" means, and explains why it is relevant to your ability to work. Without the report, a test result often remains unexplained. An unexplained test result is of diminished value for your claim.
Here is a sample Narrative Report Outline.
Insurance companies often are dismissive of subjective complaints, which they feel can be faked or exaggerated. Subjective complaints, however, often form an important part of a claimant's disability claim particularly for illnesses like chronic fatigue syndrome and depression, which cannot be objectively verified with MRIs and other radiological evidence.
There’s a lot you can do to improve the chances of a successful disability claim. The most important thing you can do is document your diagnosis and document the effect that your symptoms are having in preventing you from working.
If you’ve thinking of applying for long term disability benefits, you should consult with a qualified long term disability attorney as soon as possible. Making a disability claim is difficult and complicated. A qualified ERISA long term disability attorney can help increase your chances of claim approval.