Long-term disability (LTD) claims can be a lifeline for individuals facing serious health challenges that prevent them from working. However, there are numerous obstacles that insureds may face as they try to secure their benefits. One stands out as particularly formidable: proving the severity and long-term nature of the disability.
The Burden of Proof: Establishing Disability Severity and Duration
When filing a long-term disability claim, the biggest obstacle claimants face is providing sufficient evidence to demonstrate that their condition meets the insurer’s definition of disability. This challenge is multifaceted and involves several key components:
1. Medical Evidence: Insurers require comprehensive medical documentation to support a claim. This includes detailed reports from treating physicians, results of diagnostic tests, and a clear explanation of how the condition impacts the claimant’s ability to work.
2. Objective vs. Subjective Symptoms: Conditions with clear, objective symptoms (such as those visible on X-rays or blood tests) are often easier to prove. However, many disabling conditions, like chronic pain or mental health disorders, rely heavily on subjective symptoms, making them more challenging to substantiate.
3. Functional Limitations: Claimants must demonstrate how their condition specifically impairs their ability to perform job duties. This often requires detailed documentation of daily activities and work-related tasks that are now difficult or impossible to complete.
4. Long-Term Nature: Proving that a condition is long-lasting or permanent can be particularly challenging, especially for conditions that may have periods of remission or improvement.
Factors Complicating the Claims Process
Several factors contribute to making the burden of proof the most significant obstacle in long-term disability claims:
1. Strict Definitions of Disability: Insurance policies often have narrow definitions of what is a disability. These definitions may change over time, shifting from an “own occupation” standard to an “any occupation” standard after a certain period.
2. Insurance Medical Examinations: Insurers frequently require claimants to undergo examinations by their chosen medical professionals. These exams can result in opinions that contradict the claimant’s treating physicians, creating a conflict in medical evidence.
3. Surveillance and Social Media Monitoring: Insurance companies may employ surveillance tactics or monitor social media to gather evidence that could contradict a claimant’s reported limitations.
4. Pre-existing Conditions: If a claimant had a pre-existing condition, insurers might argue that the current disability is not severe enough or is unrelated to the claimed condition.
|
Common Obstacles |
Impact on Claims |
|
Insufficient Medical Evidence |
Claim Denial or Delay |
|
Subjective Symptoms |
Increased Scrutiny |
|
Conflicting Medical Opinions |
Potential for Claim Dispute |
Strategies for Overcoming the Burden of Proof
While challenging, the obstacle of proving disability severity and duration is not insurmountable. Claimants can employ several strategies to strengthen their case:
1. Comprehensive Medical Documentation: Work closely with healthcare providers to ensure all aspects of the condition are thoroughly documented. This includes not only diagnoses and test results but also detailed descriptions of symptoms, treatment plans, and prognoses.
2. Functional Capacity Evaluations: Consider undergoing a formal functional capacity evaluation to provide objective evidence of physical limitations.
3. Vocational Expert Testimony: In some cases, testimony from a vocational expert can help illustrate how the claimant’s condition impacts their ability to perform job duties.
4. Detailed Personal Statements: Provide thorough, consistent accounts of how the disability affects daily life and work capabilities. Keep a journal documenting symptoms and limitations.
5. Supporting Statements: Obtain statements from family members, colleagues, or supervisors who can attest to the observed impact of the condition on the claimant’s functioning.
The Importance of Professional Guidance
Given the complexity of proving disability in long-term disability claims, professional guidance is crucial. An experienced attorney specializing in long-term disability claims can provide invaluable assistance in several ways:
1. Case Evaluation: A lawyer can assess the strength of a claim and identify potential weaknesses that need to be addressed.
2. Evidence Gathering: Attorneys can help ensure that all necessary medical evidence is collected and presented effectively.
3. Communication with Insurers: Legal professionals can handle communication with insurance companies, reducing the stress on claimants and ensuring that all requests for information are properly addressed.
4. Appeals Process: If a claim is denied, an attorney can guide claimants through the appeals process, which often involves complex legal and procedural requirements.
The Psychological Impact
It’s important to acknowledge the psychological toll that the claims process can take on individuals already dealing with serious health issues. The stress of proving one’s disability can exacerbate existing conditions and create additional challenges. Claimants should prioritize their mental health throughout the process, seeking support from mental health professionals if needed.
Conclusion: Persistence and Preparation Are Key
Success often comes down to thorough preparation, consistent documentation, and persistence. By understanding the complexities of the claims process and taking proactive steps to build a strong case, claimants can increase their chances of overcoming this significant hurdle. At Raval Trial Law, we understand the challenges faced by individuals pursuing long-term disability claims. Our experienced team is dedicated to guiding clients through this complex process, helping them gather the necessary evidence and present their cases effectively. If you’re struggling with a long-term disability claim, contact us to learn how we can assist you in overcoming the obstacles and securing the benefits you deserve.
