Insufficient Medical Evidence Leads to Long Term Disability Denial

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 insufficient 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

In this video, President David Share discusses reasons why some claims are denied because of insufficient medical evidence.

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).

To enhance the chances of your claim being approved, medical documentation should:

• Describe the nature, severity, and duration of the employee’s impairment, the activity or activities that the impairment limits, and the extent to which the impairment limits your ability to perform the activity or activities; and
• Substantiate why the condition is a disability
• Provide a treatment plan and goals that will be worked towards with the help of a health practitioner

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 "objective 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 forms questions, may enhance your chances of being approved.

Denied your long term disability claim?

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