How to File a Successful Long-Term Disability Insurance Claim

Here are tips on filing a long-term disability insurance claim.

Disability insurance can be a lifesaver if you have a long-term disability that prevents you from working. However, insurance companies are notorious for denying long-term disability insurance claims whenever they can. 

Claims are often denied because so many disabilities are “invisible” – that is, they involve chronic pain and other conditions that aren’t obvious because they can’t be seen on a diagnostic test. However, the disability law firm Dell & Shaefer points out that an experienced disability attorney can help overcome these issues and secure your benefits.

In a video, attorneys Gregory Dell and Rachael Alters of Dell & Shaefer explain how to file a long-term disability claim that has the best chance of being approved.

Present the Claim Properly

After talking with you and looking at your medical records, a disability lawyer should be able to immediately identify what’s missing in your records that an insurance company could use as an excuse to deny your claim.

“One of the most important things with a disability claim is presenting the claim to the insurance carrier in both a medical and legal fashion so that the claim gets approved,” Alters said. “There’s a whole gamut of disabling conditions that can pull a person out of work, so it’s really important that the lawyer who represents a client with a disability understands what those conditions are, what the symptoms are, and all of the testing that goes along with those disabilities to show the insurance carrier that a particular condition is disabling.”

For example, if you have a spinal cord injury, your attorney needs to understand that there are physical and neurological issues that go along with that, often including pain. Your attorney also should know what specific testing is required to show an insurance company that you have a long-term disability, because your doctor might not. 

“A lot of doctors aren’t trained to create medical records and order the testing that’s necessary to get approval for disability benefits,” Alters said. “It’s the lawyer’s job to instruct and guide the doctors in documenting the medical records properly and ordering the right tests so that the person filing the disability claim has the best chance of getting it approved.”

Keep Getting – and Documenting – Treatment

Even if your disability claim is initially approved, it’s important to continually document your medical conditions so the approval isn’t revoked later. 

“Claimants sometimes have this false sense of security and think, ‘I got approved, so I don’t have to go to the doctor for six months or maybe even a year’,” Alters said. “That’s wrong. Make sure you have continuity of care. Even if your condition is permanent and there’s no treatment, go to your doctor every two to three months and tell them everything that’s going on with you. If you’re in pain, let them know and don’t be a superhero, because it all needs to be in the records. If your insurance carrier sees that you haven’t been treated on a continual basis, they will cut off your benefits.”

File an Effective Appeal

Sometimes even well-documented claims are denied. If that happens to you, your attorney should know enough about your particular disability to identify mistakes the insurance company made in its analysis. 

“Call them out on their misrepresentations about what’s not in the records,” Dell said. In particular, your attorney needs to clearly explain why your claim is reasonable, even if there’s no objective test like an x-ray for some of the symptoms you’re experiencing that prevent you from working and living independently.

This is especially problematic with conditions like chronic pain. “There isn’t an objective test you can take for how severe your pain is,” Alters said. “Oftentimes, a denial letter will say that the insurance company doesn’t see any evidence that you’re in severe pain or have fatigue or have other issues that make you unable to work. This is where we have to fight back, even though the insurance company knows there is no objective test for many issues.”

Of course, there’s no guarantee that your disability claim will be approved even if you follow all of this advice. However, you will have a much better chance. 

Do you have an experience with a disability claim being approved or denied? If so, please share the lessons you learned in the comments.

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