A letter from your doctor or physician stating you are disabled and unable to work will not guarantee that your long-term disability (LTD) claim will be approved. However, depending on the form and substance of the letter, such a letter can significantly improve your chances of being approved.
In most LTD cases, generic letters from physicians will have little impact on the insurance company’s disability decision. This is because doctors submit letters so short and lacking in detail in most cases that the letter’s value to a disability examiner is practically non-existent. For example, if all the doctor does is summarize your medical diagnoses and conclude that you are disabled and unable to work. That letter will not assist the claims handler in understanding why you are unable to work. Unfortunately, this type of letter is the most common from disinterested physicians.
So, what makes a good letter? We know that a detailed statement from a doctor knowledgeable about a claimant’s medical problems can make all the difference as to whether or not a disability claimant is approved for disability benefits. A good statement goes beyond reciting the patient’s medical diagnoses; It gives an opinion on the patient’s functional limitations.
This type of statement is called a “medical source statement” or “residual functional capacity” evaluation. These medical source statements help the evaluation process because most insurance company claims adjusters are not medical professionals. They rely on the medical professionals to identify the claimant’s level of impairment; therefore, adjusters give weight to the detailed opinions of medical professionals, particularly those directly involved in the claimant’s medical treatment. The claims examiner should accept a treating doctor’s medical source statement as true and accurate unless they have good reason to reject it (such as where the doctor has no credibility or is not a specialist familiar with the claimant’s particular illness or injury).
To help a long-term disability case, the doctor’s medical source statement should be:
- Detailed;
- Objective; and
- Assess the claimant’s physical or mental capacity and the limitations resulting from the claimant’s medical condition and problems.
The statement should explain why the patient has certain limitations (for example, the patient cannot stoop because of a herniated disc in the back) and be supported by the medical evidence in the claim (for example, include an X-ray or MRI showing degenerative discs). There is a form that accomplishes these goals, known as an RFC form. (RFC stands for residual functional capacity.) To learn more about RFC forms and download a free one for your doctor, see our page on residual functional capacity forms.