How to Prove your Disability to the Insurance Company
It is extremely important to build a strong record of your disability while your claim for long-term disability benefits is at the first stages of administrative review by the insurance carrier. Your proof of disability will be blocked if you fail to build your proof early on, or hold back information for a subsequent appeal.
Consider the person who has a disabling condition but can't get his doctors to state it to the insurance company administrator in terms that are clear and concise. Unless your doctor comes right out and says that you are disabled; clearly identifies your symptoms; and, describes in detail how your condition prevents the performance of your material job duties -- my experience is that the administrator will always deny long-term disability benefits.
Even when your doctor has taken meticulous notes of your condition, symptoms, and treatment, it's a hard lesson to learn that long-term disability carriers notoriously cherry-pick only the neutral evidence from the medical file. For example, administrators love to highlight references to your improved health on a particular day, while completely ignoring express references to an ongoing disabling condition, and then isolating separate components of a total health condition in order to minimize their cumulative effects that are clearly disabling only when properly taken as a whole.
To prevent the long-term disability insurance administrator from using the excuse that "your own doctor didn't say that your condition prevented you from performing the material functions of your job," it is often necessary to guide the doctor (diplomatically and pointedly) to render a thorough and concise opinion. Your doctor must specifically articulate the medical science of your condition, describe his or her personal observations of your performance, and then lay-out all of the interactions of the condition, symptoms, treatment, medications, and side effects, taken as a whole, so that the insurance plan administrator will have no choice but to grant long-term disability benefits. Under no circumstances should your doctor provide your disability carrier with an opinion without reviewing a written job description and discussing your former job duties with you.
Getting a skilled disability benefits lawyer in your corner early on in the process is key. It costs nothing more to have your lawyer go to bat for you now, and it will ensure that solid building blocks are put in place to establish the foundation of your disability case should your claim proceed through administrative appeals, or ultimately to federal court under the Employee Retirement Income Security Act of 1974 (ERISA).
With an eye toward potential litigation, a Wisconsin disability benefits lawyer will invoke ERISA to get from the insurance company, all of the documents it used to initially deny your benefits. It is critical to have your opponent's data so that you, your benefits lawyer, and doctor, can work as a team to poke holes in each of the insurance company's false premises.
In conclusion, to get your long-term disability benefits you will need to: 1) motivate your doctor to clearly articulate your condition and your limitations under the disability definition set out in the policy; 2) provide your doctor with a written job description and discuss your job duties in detail; 3) blast the insurance company with every shred of information that supports your disability; and 4) build your own team of skilled professionals to develop your legal/medical case early on. By following these guidelines, you are much more likely to win your battle for long-term disability benefits.
Alan C. Olson practices disability law from his offices in New Berlin, Wisconsin, and throughout the United States. AOlson@Employee-Advocates.com
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