What Evidence Do You Need for a Successful Long Term Disability Claim?
To succeed in a long term disability claim, you need more than a diagnosis — you need comprehensive, consistent, and credible evidence that proves your inability to work.
If illness or injury forces you to put work on hold for an extended period, long-term disability (LTD) insurance can provide the economic injection you require. It is not, however, as simple as telling your insurer that you cannot work — you have to establish it. You have the onus of proof, and the strength of proof can see your claim accepted or refused.
A long-term disability lawyer can help you understand exactly what kind of evidence you will need, how to present it effectively, and how to address potential gaps before they stand in your way. Here we outline the kinds of evidence that can strengthen your case.
- Detailed Medical Records
Your medical records are the basis of your LTD claim. Insurance companies base their determination in large part on these records to ascertain whether your condition constitutes "disability" under your policy.
Good medical records will include:
- Proper diagnosis through and with qualified health care providers.
- Laboratory objective test information (MRI, X-ray, blood work, etc.) that proves your diagnosis.
- History of treatment, including treatments, drugs and surgeries.
- Notes by your physician that identify your limitations, your prognosis, and symptoms.
Your records must remain consistent throughout. Inconsistent or vague notes can give grounds for the insurer to dispute your claim. A long-term disability lawyer is able to review your records and suggest additional documentation if required.
- Physician Support Letters
Aside from regular medical records, a thorough letter from your doctor can prove very effective. The letter should clearly outline:
- Your health condition and its impact on the performance of work performance.
- Specific restrictions (e.g., lifting, unable to be up on your feet too long, mental restrictions).
- How long is your disability expected to last?
The majority of claims are denied because all the insurer is saying is that the medical evidence does not link your diagnosis to your inability to work. A physician's report bridges this gap. Your attorney can assist your doctor in ensuring the letter is complete and directly addresses the insurer's demands.
- Specialist Evaluations
Though what a family doctor has to say is valuable, specialist ones carry greater weight — especially for more complex or obscure diseases. For example:
- A multiple sclerosis/brain injury specialist.
- An expert in lupus or rheumatoid arthritis.
- A doctor psychiatrist (severe depressive disorder or an anxiety disorder).
Specialist reports are more detailed and are less likely to be rejected by insurers. A lawyer will recommend which specialists to consult and help coordinate these evaluations.
- Functional Capacity Evaluations (FCEs)
An FCE is a series of physical or mental examinations designed to establish your ability to perform work-related tasks. This assessment may address:
- Lifting and carrying ability.
- Endurance to stand or sit.
- Fine motor skills.
- Memory, focus, and problem-solving abilities.
An FCE can provide objective proof of your limitations, dispelling claims that you can still perform your job or other work.
- Reports by Vocational Experts
A vocational expert reviews your education, work experience, and job skills to determine if you can realistically perform any occupation given your condition. They also consider the employment market in your area.
This is especially useful if your LTD policy changes to a new definition of disability after a certain amount of time — perhaps from being unable to perform your job to being unable to perform any job.
- Personal Statements and Symptom Diaries
While medical records are important, your description of your daily symptoms adds valuable context. A symptom diary can:
- Record the stage and amount of symptoms.
- Present the effects of your disability on routine activities.
- Record medication or treatment side effects.
With the help of these personal descriptions, medical reports give a fuller image of your disability. A long-term disability lawyer may assist in the arrangement and phrasing of documents in order to appeal to the heart of the insurer or the judge.
- Third Party Witness Statements
Witnesses, including family members, friends, co-workers, or supervisors, will be sufficient to verify your testimonies regarding your limitations. Examples of issues that can be seen in these witnesses are:
- How has your performance on the job changed when you stopped working?
- How does your condition affect your home life?
- Safety concerns regarding your work responsibilities.
The more credible and detailed the statements are, the better your case will be.
- Compliance With Treatment Plans
Your insurer will most likely reject your claim if they believe you're not following the treatment you've been prescribed. Evidence of your cooperation — i.e., appointment visit records, prescription refill records, and therapy attendance — can be used to establish that you're making every effort to recover.
If you have a legitimate reason not to comply with a particular treatment (e.g., if side effects are too strong), this must be properly recorded by your physician. Your lawyer can ensure that such reasons are put into your claim file.
- Documentation of Attempts to Work or Accommodations
If you tried to go back to work or perform modified tasks but could not sustain them, document this. Pay stubs, letters from HR, and written performance evaluations can substantiate that you made good faith efforts but were unable to perform the requirements of the job.
Why a Long-Term Disability Lawyer Makes a Difference
Gathering all this evidence can be overwhelming, especially in the presence of health ailments. A long-term disability lawyer can:
- Understand exactly what proof your insurer and policy require.
- Interact directly with doctors, specialists, and vocational experts to obtain strong reports.
- Coordinate and present evidence in an understandable, convincing manner.
- Prepare for and eliminate any weakness in your case prior to the insurer.
Solid evidence is the determiner of a successful long-term disability claim. Yet comprehension of how to obtain, present, and substantiate that evidence often requires professional legal counsel.
Final Thoughts
To succeed at a long-term disability claim, you require something more than a diagnosis- you must have long-term, coherent and reasonable evidence that witnesses your inability to work. The medical records, specialist examination, functional examination, personal statement and vocational report play major roles in a compelling case.
Having a long-term disability lawyer on your side ensures that no details are neglected, thereby increasing your chances of approval and protecting you against improper rejection. When your well-being and income are at stake, investing money in the proper evidence — and proper legal guidance — is what truly counts.