In 1999, 1,200,100 Social Security Disability claims were filed (48 percent or 579,000 were denied). In 2009, ten years later, 2,816,200 Social Security Disability claims were filed (and 65 percent or 1,830,530 were denied). The number of disability applications more than doubled, while denials more than tripled. In one year, more than $23 BILLION dollars of annualized benefits were lost.
In 2011, trillions of dollars in disability claims from insurers, Social Security and the Veterans Administration will continue to be needlessly denied.
Disabled Americans diagnosed with serious medical and psychological illnesses are just beginning to process the enormity of the physical, emotional, and financial challenges they will face. This is the worst time imaginable to file a disability claim.
Insufficient preparation and improper submission of a long-term disability (LTD) claim form increases the likelihood that your claim will be substantially denied, especially when it involves a claim for chronic fatigue or other “self-reported” disability (fibromyalgia, Carpal tunnel).
Review your LTD policy. Do you only offer total disability benefits or do you provide partial or residual (long-term partial disability) benefits so you don’t have to be totally disabled to collect benefits? Hopefully it’s the latter. What is the policy’s definition of partial disability? Does it indicate your inability to perform one or more of the material daily duties of your occupation and/or does it refer to performing the duties of your occupation in a reduced capacity?
For “self-reported” disability claimants, we would like to share some “tips” to improve your chances of collecting disability benefits.
TIP #1: It has been our experience, over a three-decade career specializing in the disability insurance business, that an incorrectly completed LTD claim form increases the chances of a claim being denied, even when complete information is provided. it is sent to the insurer after the initial claim has been filed. Remember that you are applying for benefits to replace your lost wages. You will need to prepare your application for benefits with the same (or better) attention to detail as when you applied for your job.
TIP #2: You should have a focused conversation with your doctor about the specific ways you will need their cooperation as you navigate the LTD claim process. As stated: You absolutely must have your doctor’s full cooperation and agreement with you as to the extent of your disability. Complete documentation of your “self-reported” disability, supported by irrefutable evidence from your treating physician(s) (who are recognized experts and authorities in the treatment of your specific condition is absolutely essential in the initial submission of your claim).
TIP #3: Is your treating physician a specialist (an expert) in treating your specific condition? Very few are. If he or she isn’t, pay attention. Due to the specialized nature of a diagnosis, your insurer will expect your doctor to be experienced in treating your specific condition. A disability insurer seeks experience in treating any illness, especially “self-reported” disabilities. This, however, does not mean that she has to change doctors. Your primary care physician (PCP) may have already referred you to a specialist for diagnosis and initial treatment. In such a case, your PCP will likely continue your course of treatment, with an occasional update with your specialist.
TIP #4: What has your doctor’s experience been in helping other patients with “self-reported” disabilities obtain disability benefits? Have you had significant success or great difficulty? Your doctor should be your ally in the claims process, especially until you have started receiving benefits.
TIP #5: What type of test has been used to confirm a diagnosis? When “self-reported” disabilities began to be recognized as unique and difficult-to-diagnose conditions, there was considerable controversy surrounding the various diagnostic methods. Leading researchers and physicians, the Centers for Disease Control and Prevention, and the National Center for Infectious Diseases have developed several guidelines to assess your condition. (For more information, we recommend that you do a web search and read “Social Security SSR 99-2P: Your Guide to CFS Claim Success.”)
Summary
In reviewing a multitude of long-term disability claims that have been denied by insurers, one overriding theme is that the claimants’ personal physician and/or other subsequent medical documentation does not support or validate the extent of the disability. Claimants expected a certain outcome (their claim to be paid), while the medical information attached to their claim form did not validate the extent of the disability. In essence, the claimant and the doctor have simply not communicated properly. The bottom line… get it right the first time.
Copyright 2016
Allan Checkoway, RHU