Your Credibility And How The Insurance Company Assesses Your Complaints In Long-Term Disability Claims

When applying for long-term disability benefits, your credibility can be the linchpin of your case. Insurers scrutinize every detail, from medical records to personal statements, to ensure that claims are legitimate. Establishing and maintaining your credibility throughout the application process is crucial for securing the benefits you deserve. In this blog post, we will explore the importance of credibility and how it impacts different types of claims.

How the Insurance Company Assesses Your Complaints

Your complaints should be supported by evidence, such as medical evidence and personal and third-party statements, to validate the severity of your condition and its effects on your ability to work. The insurance company will meticulously evaluate your complaints to determine the validity of your claim. This assessment is a multi-faceted approach. Insurers look at different aspects of your situation:

Medical Evidence

The cornerstone of your claim is the medical evidence you provide. Insurers will thoroughly review medical records, doctor’s notes, diagnostic tests, and treatment plans. Consistency in your medical documentation is crucial. Discrepancies or gaps in your medical history can raise red flags and lead to skepticism about the legitimacy of your claim.

Personal Statements

Your own account of your disability plays a significant role in the assessment. Detailed and consistent personal statements about how your condition affects your daily life and ability to work are vital. Insurers compare your statements with medical records to ensure they align.

Third-Party Statements

Statements from colleagues, family members, and friends can also influence the insurer’s decision. These third-party accounts can corroborate your claims about the impact of your disability on your work and personal life. Insurers value these testimonies, especially when they provide specific examples and are consistent with other evidence.

Surveillance and Social Media

Insurance companies often use surveillance and social media to verify your claims. They may monitor your activities to ensure they are consistent with your reported limitations. Be cautious about what you share online, as even seemingly innocuous posts can be used against you.

Functional Capacity Evaluations

In some cases, insurers may request a Functional Capacity Evaluation (FCE) to objectively assess your physical and mental abilities. This evaluation, conducted by a medical professional, measures your capacity to perform work-related tasks and helps determine the extent of your disability.

The Difficulty of Proving Subjective Complaints

The insurer is less likely to question the credibility of your claim if it is supported by objective medical evidence. However, not all medical conditions are diagnosed with “objective” test results, which can make establishing a claim for long-term disability with such conditions challenging.

When dealing with subjective complaints in a long-term disability claim, your credibility is crucial. Take fibromyalgia, for example. You cannot take an x-ray of fibromyalgia or otherwise prove it with objective medical testing. Yes, the “pressure point test” is a traditional method of testing for fibromyalgia, but this test is primarily subjective as it relies on the patient saying it hurts when the doctor presses a pressure point.

Since someone with fibromyalgia may not be able to produce traditional objective medical evidence, a claimant applying for disability for fibromyalgia may have a more difficult time proving that his or her condition is totally disabling.

Another symptom that is difficult to prove with “objective” medical testing is impaired cognitive functioning. Most insurance companies will not accept a claimant’s self-reported memory loss or inability to concentrate. That is why the claimant needs to speak with his or her treating physicians about such symptoms and – if possible – undergo neurological testing, psychological testing, or a mental status examination. These types of tests can help provide the insurance company with evidence describing the severity of the claimant’s cognitive impairments.

Be honest and consistent in reporting your symptoms and limitations to medical professionals. Avoid exaggerating or downplaying your condition, as this can affect the credibility of your claim. Keep a detailed journal of your symptoms and how they affect your daily life, and make sure to communicate this information effectively to your healthcare providers. Providing thorough documentation and being forthright about your experiences can strengthen your case and help support your long-term disability claim.

The Challenges of Mental Illness Claims

If you’re seeking long-term disability benefits due to mental health conditions like bipolar disorder or generalized anxiety disorder, it’s essential to furnish the following documentation:

• Details of any in-patient treatments or psychiatric facilities you’ve attended.
• A comprehensive list of prescribed medications, their dosages, and any side effects you’ve encountered.
• Your psychiatric evaluation, as outlined in the Diagnostic and Statistical Manual of Mental Disorders.
• A testimonial from your medical treatment facility detailing your interactions with others during your admission.
• Statements from both your psychologist and psychiatrist explaining their professional opinion on why you should be eligible for long-term disability benefits.
• A completed mental residual functional capacity form by both your psychiatrist and psychologist.

The Difficulty of Proving Migraine Headache Disorders

A migraine headache disorder is another medical condition that may not appear on objective testing. However, this condition can be recorded in a symptom log. When a claimant experiences a migraine, it is not always feasible to see the doctor immediately or necessary to seek treatment in an emergency room.

That’s why the claimant should keep a migraine headache log to document the frequency, severity, and duration of his or her migraine headaches. A migraine headache claimant should also provide this completed symptoms log to his or her treating physician and ask that the symptoms log be added to his or her medical records. This will allow the treating physician to view the claimant’s symptoms and understand the severity of his or her condition.

Nationwide Long-Term Disability Insurance Claims Representation

Providing a detailed and honest account of your symptoms and limitations is key to establishing the credibility of your disability claim. It is important to be forthright and detailed in your communication with your insurance provider to ensure a fair evaluation of your claim. However, even legitimate claims are sometimes denied.

If you suspect your LTD claim hasn’t been handled appropriately, call our office at (888) 321-8131 for a free case evaluation. Although located in Florida, Ortiz Law Firm proudly serves clients facing unjust denials, delays, or terminations of their long-term disability claims anywhere in the U.S. We will assess your case and advise on the next steps to secure your rightful benefits.