Can You Get Denied Long-Term Disability Benefits for Weak Medical Evidence?

If you are disabled for more than six months, you may be eligible for long-term disability (LTD) benefits through an LTD insurance policy. These benefits can be a lifeline for those unable to work due to serious injuries or illnesses. However, weak medical evidence supporting the severity and extent of your condition could jeopardize your benefit claim.

The Role of Medical Evidence in Long-Term Disability Claims

One of the most crucial steps when filing for LTD benefits through an employer-provided insurance plan or a private policy is proving that your condition prevents you from performing your job. Some policies may also require you to prove that your condition prevents you from performing any job, not only your current job. The best way to prove this is by submitting robust medical evidence alongside your claim.

When evaluating your condition, the insurance company will use the medical evidence you provide to determine the following:

• The severity and nature of your condition
• How your condition affects your ability to work
• The expected duration of your condition

The insurance company may deny your claim if the medical evidence provided doesn’t give it a clear picture of your condition.

Why Weak Medical Evidence Can Hurt Your Case

When dealing with an insurance company, it’s important to remember that it’s in the business of making money by denying claims and reducing payouts. Even if you purchased an LTD insurance policy on your own instead of getting one through your employment, the insurance company will be more concerned with its bottom line than with compensating you for your condition.

Under the Unfair Insurance Practices Act, insurance companies operating in Pennsylvania must thoroughly investigate your case before issuing a denial. However, this means many insurance companies scrutinize every detail of your claim in search of something they can use against you. The more medical evidence you provide and the stronger that evidence is, the harder it will be for the insurance company to deny your claim.

Common Reasons for Weak Medical Evidence

Some of the most common causes of weak medical evidence in LTD claims are:

• A lack of objective medical results related to your condition, such as lab work, X-rays, or other types of medical imaging, can make it challenging for the insurance company to verify that your condition exists.
• Vague descriptions of your condition written by your treating doctors rather than detailed notes outlining your diagnosis and prognosis can lead to the insurance company doubting the seriousness of your condition.
• Inconsistent documentation, including conflicting statements from different medical professionals about your condition, could make the insurance company question its veracity.
• Sporadic or limited treatment history may indicate to the insurance company that your condition isn’t serious enough to qualify for LTD benefits.

How to Strengthen Weak Medical Evidence in Legal Cases

Strengthening your weak medical evidence is the best way to improve your chances of securing the LTD benefits you need. Some of the ways you can strengthen your medical evidence include:

• Visit and get medical opinions and treatment from specialists related to your condition. In some cases, expert opinions can carry more weight than those of general physicians.
• Follow your treatment plan, and don’t skip any follow-up appointments with your doctors. Gaps in your treatment history may suggest to the insurance company that you’re not taking your condition seriously.
• Ask your doctors to write detailed notes about your condition in your records. These notes should include your diagnosis, symptoms, prognosis, vocational limitations, and treatment recommendations.
• Track your symptoms by writing down how your condition affects your ability to perform daily activities. These notes may help demonstrate how your condition will impact your ability to work.

Appealing a Denial for Weak Medical Evidence

If the insurance company initially denies your LTD claim due to weak medical evidence, you can appeal its decision. Typically, your policy will outline the steps you must take to appeal the denial. During your appeal, you must provide additional medical evidence to support your claim, as the insurance company is unlikely to reconsider the denial without new evidence.

If the appeals process fails to change the outcome of your case, filing a lawsuit against the insurance company may be necessary.

Contact Our Philadelphia Long-Term Disability Lawyers

If you’re seeking long-term disability benefits in Pennsylvania, contact Capitan Law at (267) 419-7888 for a free consultation with one of our Philadelphia LTD lawyers. We’ll review your case, evaluate the strength of your medical evidence, and help you take the next steps toward seeking the benefits you need.