What Is “Insufficient Medical Evidence”?

Insufficient Medical Evidence

When an insurance company says that there is “insufficient medical evidence”, you have the option to appeal by providing more medical evidence, or consulting a lawyer to discuss your rights and possible remedies. If your doctors have provided all the medical information that is available, then appealing will not achieve anything except cause delays. You should contact an experienced disability lawyer to help you fight for the benefits you are entitled to receive.

If your claim has been denied because the insurance company says that there is insufficient medical information to prove your claim, then you should get a lawyer to challenge that. The absence of a specific diagnosis does not mean that you lack real symptoms constituting an entitlement to benefits or compensation.

Making a claim for long-term disability benefits can be a stressful and tedious process. Assembling the documentation, going to the medical examinations, and continuously following up with your provider are just a few of the steps that come when making a claim. But what happens when your claim is denied? What happens when the basis of that denial is lack of medical evidence?

Medical evidence is essential in establishing disability. Treatment providers and medical experts are often called upon to address this issue. Insurance companies are looking for “objective” evidence of a disabling condition such as test results, x-rays, MRI’s, CT-scans. Often these test results don’t provide definitive evidence, however, the more information regarding the medical reason for your disability, the higher your chance of being approved for disability benefits.

Insufficient medical evidence is often the reason given by insurers in situations where the medical documentation only lists the medical condition but does not specify how it interferes with your ability to do your job. Medical evidence can also be found insufficient if it has inconsistencies, contradictions, falsehoods, or omissions (such as previous medical conditions).

TIPS regarding your medical documentation:

Overall, your documentation must support the claim you are making, with appropriate medical history, supporting medical documents from your healthcare practitioner, and extensive information about the symptoms you are having and how they affect your work and life.

If the insurance company denied you because of a lack of “insufficient medical evidence”, this does not mean you are ineligible for benefits. Having your doctor(s) support your claim for disability is also very important, and having them prepare the Attending Physician Statement, and adding additional information beyond the form's questions, may enhance your chances of being approved.

It is very important that your doctor conduct a thorough medical examination and refer you to the appropriate specialist. Your doctor should be the one to make an assessment of your disability and provide specific information about why you cannot work. With this in mind, it is crucial that any medical information you give to your insurance company be complete and accurate. You may be tempted to understate your disability in the hopes that a smaller claim may prompt your insurance company to start disability payments. However, any information you provide about your disability will be used to make a decision on your claim, so that information should be accurate and supported by your doctor’s findings.

If your claim has been rejected by the insurance company, retaining a lawyer who understands the nature of your medical condition and has experience litigating these insurance claims is the next step. Contact Share Lawyers today.