A disabling injury or medical condition can affect a worker’s ability to continue to work during the lengthy recovery period. Many workers anticipate the potential impact with long-term disability insurance. However, most workers are not familiar with the process of pursuing claims under LTD insurance policies. Medical records are important in LTD claims at every stage of recovery.
In some instances, the insurance company may not seem to agree with a person’s treating doctor. The insurance providers have their own physicians who read the documents provided in the insurance claim. Moreover, the insurance company medical review may include a patient’s entire medical file. Without ever speaking with the patient, the insurance company doctors may decide a condition does not qualify for benefits. Moreover, after initially providing LTD benefits, the insurance companies often decide to terminate benefits, even when the patient’s primary doctor says the person is not yet able to return to work.
Insurance Companies Keep Tabs On The Records All Along The Way
All along the way the insurance companies review a claimant’s medical record, including notes the doctor may make while examining, or even speaking to a patient. Similarly, the insurance companies may reach out to a treating physician to obtain new or additional information during the recovery period. Unfortunately, simple notes in the file can be misinterpreted as to a patient’s overall condition. For many people, it is human nature to put on a positive exterior, even when speaking with their doctor.
Communications are often made in context. For instance, doctors often open with the question, “how are you doing today?” When a condition is not improving, or even may be deteriorating, it is often tempting for people to say they are doing well. A simple note in the file about these conversations may mischaracterize the true facts.
Therefore, it is a good idea for people to make sure to also include a review of their current symptoms that are keeping them out of work to help ensure that the notes reflect the true status of the condition. Expressing current symptoms, such as continuing pain, will help your doctor to make notes concerning the continuing issues that you are experiencing. The insurance companies may try to emphasize that you did not report pain, or other continuing symptoms during a doctor’s appointment. The insurance companies may try to exploit the lack of continuing evidence in the medical record to discontinue benefits.
It is important for people to help their doctors to keep the medical records up-to-date and complete all along the way. Insurance companies are in business to make a profit, and discontinuing benefits reduces their exposure to costs. People who are facing difficulty obtaining initial benefits, or who have seen benefits unjustly discontinued before they are able to return to work should speak with an experienced LTD insurance benefits lawyer to learn their options.