Disability Attorneys in New York Explains Claim Challenges

Riemer Hess assists clients, their doctors and their employers in completing the Proof of Claim forms.  While the questions on the claim forms may seem simple, an ill-considered answer by you, your doctor or your employer could sabotage your efforts to obtain LTD benefits. The challenges in submitting a claim for LTD benefits are many, and the disability attorneys at Riemer Hess know the ins and outs of the insurer’s forms, and will help you to overcome those challenges and submit the most effective and supportive claim possible.

Completing The Claimant Statement

The Claimant Statement is typically 1 to 2 pages long, and provides very little room for adequate answers to the questions. In completing the Statement, however, we do not limit ourselves to the space provided on the Claimant Statement itself.  The limited space benefits the disability insurance company, not you.  We, therefore, will prepare riders and/or exhibits which will allow you to expand upon your responses, and explain to the insurer exactly why you cannot return to work.

The Claimant Statement is your chance to explain to the insurer why you are unable to work.  We, therefore, believe the Statement should be as thorough as possible when responding to the insurer’s questions.  At Riemer Hess, we will help you develop a persuasive narrative that establishes your disability.  Disability does not mean you must be bed-ridden or confined to a wheelchair. Rather, to be found disabled, you must prove that you cannot perform the “Material Duties” of your own or any occupation. The narrative should not only explain your medical conditions, symptoms, and restrictions/limitations, but also should describe, in great detail, the “Material Duties” of your occupation, your employment history, and your educational background.

Obtaining The Medical Proof Necessary to Prove Your Claim

The importance of providing adequate medical evidence to state disability to support your claim cannot be overstated.  A doctor’s statement that you are “totally disabled” is insufficient.  Therefore, we will review the APS in detail to ensure that your doctor did not make any mistakes that could hurt your claim.  Our disability attorneys in New York will then evaluate your medical situation and help you obtain the additional proof necessary to establish your entitlement to LTD benefits. The proof may include the following:

1. Objective Medical Evidence.  Objective evidence includes MRIs, CT Scans, X-rays, blood tests, etc. Objective evidence also can include clinical physical examination findings by your physician such as swollen glands, red throat, limited range of motion, tenderness, spasms, etc. During the Claims process, Riemer Hess will help compile your entire medical history.  We will request and obtain your physician’s treatment notes and any objective test results.

We also may send you out for objective testing to help document your impairments. If you are restricted or limited because of pain and/or fatigue, we will send you to a two-day Functional Capacity Evaluation (FCE).  An FCE is a physical examination, performed by a physical therapist, to document your ability to lift, carry, push, pull, sit, stand, walk, and perform other functions necessary to one’s occupation.  If you are restricted or limited because of cognitive complaints, we will send you to a neuropsychologist to receive a battery of neuropsychological testing.  The testing is often instrumental in being able to document how your complaints of memory loss and/or lack of concentration prevent you from doing the cognitively demanding duties of your occupation.  This is particularly relevant for professionals and executives, where most of the job demands are cognitive rather than physical.

1. Residual Functional Capacity Questionnaires and Narrative Reports. To better document your disability, we may recommend obtaining a Residual Functional Capacity Questionnaire (“RFC Questionnaire) or narrative report from your physician.

The RFC Questionnaire

An RFC Questionnaire answered by your treating doctor is a great way to obtain comprehensive answers regarding your medical conditions, and supplementing often incomplete treatment notes and APS forms.  Over the years, we have developed customized RFC Questionnaires specific to all of the major disabling illnesses and injuries. The Questionnaire includes a checklist of symptoms related to your specific illness or injury; a checklist of possible medical signs and laboratory findings; a section for your physician to document your prescription medications and any side effects; a section for your physician to describe your pain and fatigue; a section where the doctor can opine as to your ability to sit, stand, walk, reach, lift, carry, etc. in a competitive work environment; and a section for your doctor to opine whether you are capable of working in your own or any occupation.  Before we send the Questionnaire to the doctor for completion we make sure that the Questionnaire contains customized information about your job duties so that your doctor could fully appreciate the tasks you were expected complete. Doctors are experts about your illnesses and treatment, not your occupation.  While this may seem like unnecessary work, our disability attorneys in New York want to make sure that all details, items, and potential items, are covered during the course of obtaining treatment.

The Narrative Report

Like the RFC Questionnaire, a narrative report can be used to supplement treatment notes and APS forms.  The narrative report will allow your doctor to describe your medical condition in detail, and explain exactly why you cannot work. We work with your doctor in completing the report, knowing that your doctor is very busy and would appreciate us doing much of the legwork.  We take our cues from the doctor and always make sure that the doctor fully agrees with the contents of the report. This can be yet another angle the  disability insurance company can use to say that you did not complete everything required for your disability claim.

Insurer Calls With Your Treating Doctor

Allowing a disability insurance company doctor or nurse to speak directly to your treating doctor is very risky.  Insurance companies often misinterpret or misrepresent these conversations.  How can we help prevent this?  We will request that the insurance company refrain from contacting your doctor by telephone.  Rather, we will ask that they put their questions in writing, and we will help ensure that your doctor submits a written response – thereby ensuring that there is no misunderstanding as to the answers.

Insurer Interviews

Insurers will often request that you submit to an in-person interview.  If an actual medical examination is not requested, the interviewer is often the only person associated with the insurer who will actually meet and observe you.  It is very important to thoroughly prepare for these interviews.  If you retain Riemer Hess, our disability attorneys in New York will inform the insurance company that the interview will take place in our office, not in your home. If the interview is in your home, the insurer will see how you live, which will then give them added areas of inquiry. The representative also may become jealous when they see your home and neighborhood.  Mr. Riemer will meet with you prior to the interview to prepare you for the typical questions asked during the interview. He then will attend the interview with you to make sure it goes smoothly.