Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual disability insurance policy claims, ERISA disability claims, and Social Security Disability claims.

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How Do You Qualify Medically For Long-Term Disability Insurance Benefits?

When applying for benefits, you will need to gather many documents from your doctors, but what information do you need to provide to prove that you qualify medically for long-term disability benefits?

You must provide your insurance company with medical records from only the doctors treating you for your disability. Providing medical records that are not related to your disability is irrelevant and could hurt your claim. The exact information you need from your doctor will be based on the medical condition(s) preventing you from working.

Does Your Policy Cover Your Illness/Injury?

Before you file for long-term disability, ask for a copy of your long-term disability policy. Your LTD policy will detail what disabilities are covered and how long they will provide coverage. For example, most long-term disability policies will only pay a claim for specific medical conditions for up to 24 months.

The insurance company may also require you to provide a statement from your doctors that confirms you are not abusing drugs or alcohol. Disabilities like cirrhosis of the liver have been associated with alcohol abuse. Some LTD policies will deny the claim if they suspect substance abuse.

Here are some examples of common claims:

Examples of Common Claims

Back Injury Claims

When you file a claim for a back injury, you will likely be treated by an orthopedist, a physical therapist, your primary doctor, and possibly a pain management doctor.

You will need to provide the following information:

  • Copies of CT scans, x-rays, and MRI results.
  • Radiology reports that describe the findings from your image scans.
  • Surgical records from attempts to repair your damaged back.
  • Detailed records of your pain management plan and treatment plan. This will include all prescribed medications, dosages, side effects you have reported to your doctor, and urinalysis results showing your compliance with your treatment plan.
  • Physical therapy treatment plan and therapy notes. Notes should include your progress and setbacks during therapy.
  • Statements from your doctor about your disability and your ability to work.
  • Residual functional capacity forms (more on this below).

Residual Functional Capacity Report for Physical Disability

A residual functional capacity report for a physical disability will be unique to you and your case, but here are a few example questions:

  • How much can you lift? How often can you lift it?
  • How much can you carry? How often can you carry it?
  • How far can you walk without resting?
  • How long can you stand or sit at a time?
  • Can you bend, stoop, kneel, or reach overhead?

Mental Illness Claims

When you apply for long-term disability while suffering from a mental illness such as bipolar disorder or generalized anxiety disorder, you will need to provide the following:

  • Information regarding any in-patient treatment programs or psychiatric facilities you attended.
  • A list of medication you are prescribed, including dosages and what side effects you have experienced.
  • Your psychiatric evaluation using the Diagnostic and Statistical Manual of Mental Disorders.
  • A statement from your medical treatment facility about your interaction with others during your stay.
  • A statement from your psychologist and psychiatrist explaining why they think you should qualify for long-term disability benefits.
  • A mental residual functional capacity form from your psychiatrist and psychologist.

Residual Functional Capacity Report for Mental Disability

A residual functional capacity report for a mental disability will be unique to you and your case, but here are a few example questions:

  • Can you follow simple directions?
  • Can you interact appropriately with co-workers?
  • Can you interact with the general public appropriately?
  • Will your condition become a disturbance in the workplace?
  • Can you maintain proper dress and hygiene in the workplace?
  • Are you reliable?

Claims for Multiple Disabilities

If you are suffering from multiple disabilities, you will need to provide documents that support them both. For example, if you are suffering from a back injury and depression, you will need to provide:

  • A physical RFC that describes your physical limitations.
  • A mental RFC that describes your mental limitations.
  • Statements from each of your doctors that explain how the condition they treat affects your ability to work.
  • A list of your medications with details about dosage and side effects.

Get Help with Your Long-Term Disability Claim

When applying for long-term disability benefits, your most substantial evidence will be from your doctors. Your claim will need strong medical evidence from all your treating physicians, including medical records, RFC reports from all the doctors treating you, medication lists, reports of compliance, therapy notes, and statements from your doctors. It is a lot of information to gather alone.

The Ortiz Law Firm is an experienced disability insurance law firm that can help you through the appeals process and with lawsuits. The Ortiz Law Firm only gets paid if you win. You can seek help without worrying about upfront costs or unexpected bills. Our expert team will focus on your case so you can focus on your illness. The Ortiz Law Firm has successfully represented people in disability cases across the United States. To see how we can help you win your long-term disability case, call us at (888) 321- 8131.