How to Prove A Knee Disorder Disability Benefit Claim

Knee disorder claims are often challenged by long-term disability insurance companies, but objective testing and proper documentation can help get your disability benefits approved. In our knee disorder disability video, disability insurance attorneys Rachel Alters and Gregory Dell provide tips on how your doctor should document your knee limitations and how the use of outside evaluations will support your case. Contact any of our disability insurance attorneys for a free initial phone consultation to answer any of your long-term disability insurance questions.

Most disability insurance companies wrongfully think that if you have a sedentary job, like a desk job or anything that requires you to sit for at least six out of eight hours a day, then you should be able to deal with your knee pain and work. They believe that you shouldn’t have knee problems if you can sit all day. As disability insurance attorneys that have handled hundreds of knee disability insurance claims we want to share some information to give you the best chance to have your disability insurance claim approved.

In this article:

How do you prove that a person with a disabling knee condition can’t do a sedentary job?

It’s really important to work with the treating physicians on the way they document the knee restrictions and limitations so that when the carrier obtains the medical records they’ll see that the doctor is not saying that as long as the claimant isn’t standing for long periods or walking or lifting heavy objects, it’s OK for them to work. When somebody has a disabling knee condition, whether it’s caused by injury, arthritis or another chronic condition, they often cannot stand for long periods. It’s important that the treating physician states in the medical records that the claimant also can’t sit for long periods and needs to change positions often. I find that my clients who have severe knee issues need to elevate their legs throughout the day but in different positions. They need to lie down. They can’t just sit all day and be OK – they’re really uncomfortable.

If somebody is in severe pain, whether or not they’re sitting at a desk all day, they are unable to focus and concentrate on their job. So, I tell my clients to ask their treating physicians to make sure they’re documenting that they’re only able to sit in small increments of time – not for extended periods. They must elevate the leg during the day, change positions, and walk around. Most jobs aren’t going to allow somebody to lie down when they’re supposed to be sitting at a desk using a computer all day. It’s very difficult to use a computer while your leg is elevated in the air, so it makes it impossible with somebody for a knee condition to be able to work in a sedentary capacity on a full-time basis.

How important is the documentation of medical records by the treating doctor? 

It’s very important for the doctor to document as much as they possibly can in your medical records. There should be documentation that shows the pain that the claimant is in, any range of motion issues, and if there is swelling or other issues with the knees. It has to all be consistently documented in the records. Often my clients will say, “I went to the doctor four months ago. I had knee surgery. And he says there’s nothing else he can do for me, so I’m not going to go back.” That’s the number one mistake that clients make when their doctors tell them there’s nothing more to do for the knee and that it’s now a chronic condition. They tell their patients that they are going to have to deal with this pain. So, they no longer go see the doctor. The insurance carrier takes the fact that you stopped seeing the doctor as their cue that you’re cured and can go back to work. So, I tell my clients to make sure they see their doctor at least every three months. Make sure you’re telling your doctor every issue that you’re having with your knee. If it’s pain while you’re sitting in one position and it only feels better when it’s elevated, you need to tell the doctor.

I have clients who, after sitting 15 minutes in a chair, their knee starts to throb. If they had to do some sort of job where they needed to focus and concentrate, they wouldn’t be able to. They need to tell their doctors that they can’t concentrate for long periods due to their pain. If they take pain medication to alleviate the pain, and can’t focus because it causes side effects such as fatigue and drowsiness, they need to lay down and take a nap. It all needs to be in the medical records. The doctors need to document that they cannot sit for long periods and therefore cannot work in a full-time capacity due to the knee issue.

Could a disability company challenge my claim even if I have multiple doctors who have been treating me for years and support it?

They can do this in many ways. The most inexpensive way for the disability company to challenge your doctor’s opinions about your restrictions and limitations is to hire their own peer review doctors to review your medical records and determine that they disagree. They look at the test results and the medical records. Even though the claimant’s doctors say they believe the restrictions and limitations prevent them from being able to work in their occupation due to issues with their knee, they have an orthopedic doctor who reviewed the records and disagrees. This claimant can sit for six to eight continuous hours a day with no problems whatsoever. They can bend, stoop, all that’s required in a sedentary job with absolutely no problem.

My clients will ask how they can do that when they haven’t met and examined me? They’ve never even talked to my doctors. Can they just look at my medical records and render their own medical opinion which will trump my treating doctor’s opinion? The answer to that question, unfortunately, is yes. The insurance companies routinely send peer review reports to us with a denial letter stating that our doctors disagree with the treating doctors, and cut off the benefit.

What is an independent medical evaluation or an IME?

Disability insurance companies can also send claimants for an independent medical evaluation. It’s a little more costly for the insurance company, so if somebody has a little higher benefit, they will go and send them for an evaluation by one of their doctors. They are biased – they’re being hired by the insurance companies. The companies are paying the doctor to render an opinion. More often than not, when you go to an IME, the opinion is likely going to be that you could go back to work full time in a sedentary capacity. If these doctors were rendering opinions that state that claimants are disabled, they would no longer get hired by the insurance companies. So, they’re biased. I make sure that I very carefully prepare my clients for an independent medical examination to make sure that they know what to say and what not to say. Most importantly, they’re usually followed with video surveillance on the way and walking into the independent medical exam. It allows the insurance company an opportunity to know where the client’s going to be at a particular time to get them on video. I tell my clients to be very mindful that they’re being watched. After the evaluation, make sure you go home because there are many ways in which the insurance carrier can rebuke what your physicians are telling them.

Do I have to undergo knee surgery to get my disability benefits approved? 

A disability company can never make a claimant undergo surgery. That’s not something that’s in the disability policy. However, they can try and hold it against you if you don’t follow the doctor’s recommendations. I’ve had clients who are afraid to have surgery. The insurance carrier is not going to require the surgery, but often they will point out that the surgery was recommended and suggest that the claimant is not receiving appropriate care. They can’t force you to undergo surgery because no surgery is 100% going to work and guarantee that you’re going to be back to yourself. Whether it’s a knee or an elbow or a back or a neck, there are always risks involved when it comes to operating. It’s a risk-benefit analysis. If the physician can’t guarantee, which they never can, that after the surgery the patient will be good to go, there’s no real requirement that they undergo the surgery under the terms of the policy.

What is a functional capacity exam and how can it be helpful to prove a knee disability?

The FCE is a test performed by a physical therapist that we often use to give objective proof of somebody’s inability to function and perform a sedentary job 40 hours a week. It’s typically a 3 to 4-hour evaluation that’s going to test your ability to sit for long periods, how long you can stand, how much weight you can carry, and if you can bend, stoop, or climb a ladder. It’s an evaluation of all the physical functions that can be required in any typical workday. The physical therapist will interpret the data generated from the testing to determine whether, in their opinion, they believe that you could sit for long periods, stand for long enough, lift enough to be able to perform a sedentary job. These are very useful tools in proving to the insurance company that the claimant could not do a sedentary job 40 hours a week with their knee condition.

Correlating Your Occupational Duties and Medical Restrictions with a Vocational Expert

Another thing we take into consideration is the claimant’s occupational duties. You take all of the restrictions and limitations from the medical records and correlate that with either the duties of the claimant’s occupation at the time they became disabled or of any gainful occupation, if that is the definition of disability. Often, we’ll even take it a step further and retain a vocational expert, who will then coordinate everything dealing with the occupational component and the physical component as well. We work closely with the claimant, with their doctors, to obtain those objective testing results. It’s a complete package, and you have to know how to present it to the disability insurance company, especially if your claim has been denied so that you can get your benefits approved.

What do you recommend for someone who has questions about their disability insurance claim?

We encourage you to contact us for a free initial telephone consultation, where Rachel, myself, or any of our lawyers will review your disability insurance policy. Or if you’ve been denied, we’ll review a copy of your denial letter. We’ll let you know immediately how we can assist you. Our clients are located all over the country. So, no matter where you live, we’re available to assist you. We encourage you to search through our website and to look up valuable information based on your disability insurance company, your medical condition, or your occupation. You’ll find articles about cases we’ve handled or other lawsuits that have been filed.

There are reviews of insurance companies where other people share their experiences, which may be similar to yours. You’re also going to find thousands of questions and answers from all our lawyers. We want you to have all this information because it’s going to educate you about the disability insurance process. It’s a complicated process with a bit of gamesmanship involved. You have to know how the disability insurance company thinks to put yourself in the best position to get approved. After reviewing this information and having the opportunity to speak with us, I hope that you feel you’re in a better position to either get your disability benefits approved or continue your benefits. Should you need us in the future, we look forward to the opportunity to speak with you.

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(653)
Showing 8 of 653 Reviews
New York Life

New York Life is a joke!

Reviewed by Heather on October 3rd 2024   Verified Policyholder | August 2024 date of disability
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
MetLife

They FULL OF ****

Reviewed by KM on October 3rd 2024   Verified Policyholder | August 2024 date of disability
MetLife is what everyone on this review are saying. They don't contact you to let you know what's going on with your claim or to let know you need additional info. I had a... read more >
Sedgwick

Worst Company Ever

Reviewed by RobRob on September 23rd 2024   Verified Policyholder | August 2024 date of disability
If something happens to you at work you better hope you die, my son is going through HELL because this company is handling his work comp. NO RETURN PHONE CALLS, TEXTS, EMA... read more >
MetLife

MetLife for disability? Avoid the surgery unless it's life-threatening

Reviewed by Jeff on August 22nd 2024   Verified Policyholder | August 2024 date of disability
The worst company I ever dealt with, never received a call from my claim manager.
Unum

Low payments

Reviewed by Dorothy on November 30th 2023   Verified Policyholder | November 2023 date of disability
I was injured at work. I did house keeping in a hospital. I tore just about everything imaginable in my knee. I was let go from my job, because I was no longer able to do ... read more >
Prudential

Prudential verbally approved my claim and then sent me a denial letter

Reviewed by Jacquieline C. on April 3rd 2020   Verified Policyholder
I have been denied twice from Prudential for my LTD case. Back injury 2009 – knee injury 2011. Back doctor took me out of work (July 2018) due to me working 35 hrs per w... read more >
Reply
Sent on April 3rd 2020 by Attorney Jay Symonds

Jacqueline: Sounds like you have a pretty complex medical situation. And the fact that they verbally approved your claim over the phone then sent a denial letter is unu... read more >

Lincoln Financial

My knees have gotten so bad that I just had knee replacement. Meanwhile I've been waiting to receive my benefits from Lincoln Financial, and my case worker is no help.

Reviewed by Laurel M. on May 15th 2017   Verified Policyholder
I am currently out on short term disability due a total knee replacement. I started having issues back in July 2016. Out of no where my left knee started aching to the poi... read more >
Reply
Sent on May 15th 2017 by Attorney Stephen Jessup

Laurel, please feel free to contact our office to discuss your claim and how we may be able to assist you in getting Lincoln to pay your benefit.

New York Life

I don’t think it is right for New York Life to require you to apply for SSDI and even assist with the process and then after approval from SSDI drop you

Reviewed by Virgie on March 27th 2014   Verified Policyholder
I was taken out of work 3/2013. I needed bi-lateral knee replacements. I had both knees replaced in 2013. After I exhausted short term disability I was rolled over into lo... read more >
Reply
Sent on March 27th 2014 by Attorney Gregory Dell

Virgie, unfortunately, your situation is not uncommon at all. At this point you will need to file your administrative appeal of New York Life’s denial. Please fee... read more >

Answered Questions by Our Lawyers
(7)
Showing 7 of 7 Answered Questions

Q: If I had a subsequent, related injury two weeks after returning to work can the insurance company use the date of the second, injury which lowered my pre-disability earnings?

Answered on February 4th 2024 by Attorney Gregory Dell
A: Very interesting fact pattern. Your second injury if it’s the same knee should relate back to the first and ... Read More >

Q: Short term disability denial

Answered on June 6th 2023 by Attorney Gregory Dell
A: Herman:Pre-existing conditions are the number one reason for disability insurance denials. If the short term... Read More >

Q: Can LFG continue claiming I have a pre-existing condition when my doctor says I don't?

Answered on February 2nd 2019 by Attorney Gregory Dell
A: Tammie, you should review your policy language to see how pre-existing condition is defined but it is common f... Read More >

Q: Why is Hartford asking me if I have a lawyer?

Answered on October 13th 2016 by Attorney Stephen Jessup
A: TSA, if you have a lawyer an insurance company will likely not speak directly with you. Read More >

Q: I can perform my job functions, but I can't get to work due to my disability. Can MetLife force me back to work?

Answered on February 3rd 2016 by Attorney Stephen Jessup
A: Amy, one large concern, which I am sure MetLife is eluding to, is a body of case law that indicates getting to... Read More >

Q: What can I legally do if Aetna isn't paying me? I'm tired of the run around.

Answered on October 31st 2025 by Attorney Stephen Jessup
A: Arianna, It is likely that Aetna only administers the STD plan for your employer (as opposed to insuring it) a... Read More >

Q: Will I get denied due to fact I can’t afford my surgery until I get Medicare in a year?

Answered on February 21st 2014 by Attorney Stephen Jessup
A: Dave, Your inability to afford a knee surgery should have no impact on your disability insurance claim with Ci... Read More >
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A Respiratory Therapist was forced to stop working due to bilateral degenerative knee conditions which required a total knee replacement. Over time, the knee problems resulted in worsening lumbar spine problems, which required surgical intervention as well as numerous steroid injections and physical therapy treatments. The severe lumbar spine pain, as well as degenerative conditions in her knees, prevented her... Read More >

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Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our attorneys for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We offer disability insurance attorney representation nationwide and we welcome you to contact any of our lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 850 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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