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Maintaining Approval of Your Long Term Disability Benefits Requires Care and Treatment


  • Disability Attending Physician Statements Are Biased Toward Claim Denial

Attorney Gregory DellAuthor: Attorney Gregory Dell

Every day our law firm is contacted by at least 10 people that were initially approved for long term disability insurance benefits and now the insurance company has notified them that after several years of paying benefits the claimant is no longer disabled. Despite reviewing thousands of these disability insurance claim denial letters throughout my career I still feel amazing frustration and anger when I read 90% of these denial letters. It is hard to comprehend how an ethical individual can even sign their name to most of these denial letters, but then I quickly remind myself that we are dealing with large insurance companies that have trained their employees to seize any opportunity to deny a long term disability claim. In order avoid the all to common denial of a long term disability denial, I always tell my clients that they cannot let their guard down and assume that the insurance company will just pay forever.

Disability Claims Examiners Are Required To Review Your Claim Monthly

Every month a disability insurance claims examiner is required to review a claimant’s claim and make a determination if benefits should be paid. The claim examiner is required to document why they are approving the claim and what steps they have taken to make sure the claimant is still entitled to get paid. The disability insurance company will constantly request updated medical records and search for something that they can use to deny a claim. Claimants are often unaware that their medical records are being reviewed. The submission of monthly, quarterly, semi-annual or annual claim forms are forms that the insurance company evaluate and require to obtain claim approval. These claim forms must be strategically completed each and every time in order to maintain claim approval. Often we see that troubles begin when a new claims examiner is assigned to the claim. We also see that disability claimants are not consistent with their medical treatment and the insurance company interprets this as the claimant is feeling better. Obviously there has been a reduction in medical treatment as there simply is not much that the doctor can do for the patient. If you are a claimant that has been receiving benefits for several years, you must see you doctor at least once every three months just to satisfy the disability insurance company minimum requirements. Sometime you can get away with 2-3 visits a year, but this depends on the extent of your medical condition and your definition of disability.

“When going to the doctor for each visit, you must make sure that your doctor is properly documenting ALL OF YOUR COMPLAINTS.” We often see medical records after a claim denial, and the medical records contain none of the information that the client tells us is disabling. Doctors are in business to treat patients and they often do not focus on documenting your medical conditions with enough specificity to satisfy a disability company. Disability insurance companies take advantage of poorly documented medical records as a basis to deny claims. When we are representing a claimant that is receiving long term disability benefits, we regularly request updated medical records and review them to avoid unnecessary claim denials. We always review the required Attending Physician Statements and we do not allow them to be submitted without our approval.

If a treating doctor refuses to cooperate in either properly documenting your medical condition or completing claim forms, which some do, then is imperative that you seek treatment from a new doctor. We continuously work with our clients and their doctors to make sure that the medical records and claim forms continue to support the disability insurance company’s requirements. Please contact any of our long term disability insurance attorneys to discuss how we may be able to assist you.



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