How Do You Prove You Are Disabled Under a Disability Insurance Policy?
If you are filing a claim for short-term or long-term disability benefits, you need to be prepared. The insurance company will never take you at your word and pay your case. Instead, you will need compelling evidence that shows that you are disabled and meet all your policy’s criteria.
It is not easy to build up a disability insurance claim, especially when you are dealing with life-changing medical conditions or injuries. Unless you carefully collect all your medical records and other supporting data, you will never get the benefits you deserve. In this article, our respected disability attorneys explain the fundamentals of proving a disability claim.
What Does “Disability” Mean?
“Disability” can mean many different things. According to the Merriam-Webster dictionary, a disability is “a physical, mental, cognitive, or developmental condition that impairs, interferes with, or limits a person’s ability to engage in certain tasks or actions or participate in typical daily activities and interactions.”
In the context of a disability insurance claim, “disability” means something different. When disability insurance companies and lawyers refer to “disability,” they are focusing specifically on your ability to work.
Your disability insurance defines disability in one of two ways. If you have an “own occupation” plan you are disabled if you cannot perform the duties of your job. Or, if you have an “any occupation” policy, you will need to prove that you cannot do any type of work.
Are There Differences Between How Social Security and Insurance Companies Evaluate Disability?
Many people confuse disability insurance with Social Security disability. However, they are very different systems. Employers and individuals can purchase both short-term and long-term disability insurance policies. These policies will pay a monthly benefit if you meet their specific terms and conditions.
On the other hand, the Social Security Administration (SSA) is a federal agency that provides government-funded benefits for people who meet certain criteria. Generally speaking, you are eligible for SSA benefits if you are unable to work for at least twelve months due to a documented medical impairment or you meet one of the Social Security “listings.” While qualifying for Social Security disability benefits is a highly technical process, it is very different than the insurance company’s analysis. In fact, people sometimes qualify for long-term disability benefits but cannot receive Social Security benefits (and vice versa).
Bryant Legal Group does not handle stand-alone Social Security disability claims. If you have questions about an SSA claim and do not have an associated LTD case, we encourage you to
What Evidence Will You Need to Prove My Short-Term or Long-Term Disability Claim?
Disability insurance companies are for-profit companies that are worth billions of dollars. It is not in their best financial interests to pay out claims, so they have rigorous standards that make it difficult for people to file successful claims. You should never assume that the insurance adjuster will collect all your medical records or fully investigate your claim.
It is up to you (and your legal team) to do this work and build up your claim. You must prove that you meet the criteria set out in your insurance policy, providing extensive evidence that supports your claim for short-term or long-term disability benefits.
This might include:
- Medical evidence, including records from your treating doctors, therapists, and medical providers
- Detailed statements from your medical team that outline your limitations and diagnoses
- Information about your work history, training, and qualifications
- Job descriptions
- Information about your daily activities and abilities
Generally speaking, objective information (like diagnostic testing reports) will carry more weight than subjective information (like a doctor’s note that reports your fatigue and mental fogginess).
RELATED: Disabilty Insurance Roadmap
Do You Need Expert Witnesses in Disability Insurance Claims?
Expert opinions are essential in disability insurance claims—especially those of your treating doctors and medical providers. Additionally, your claim might require insight from vocational experts who can discuss your past work and ability to do other jobs and respected medical consultants. These experts can help flesh out your case and address specific medical and vocational issues that might impact your eligibility for benefits.
For example, a specialized physical therapist or doctor can run you through a functional capacity evaluation, which can identify your precise physical and mental abilities. Then, a vocational expert can use this data and your work history to determine whether you can do your past job or any other type of competitive employment.
Even the most sophisticated disability claimants rarely have access to teams of expert witnesses who understand how disability insurance, medicine, and vocational assessment intersect. However, a skilled disability lawyer knows how to leverage expert testimony and build up convincing disability narratives that are supported by evidence.
What’s an “Independent Medical Examination?”
During your disability insurance claim, the insurer might schedule an “independent medical examination” (also called an IME) for you. Despite their name, these exams are rarely independent or neutral. Instead, the insurance adjuster is sending to a physician or mental health provider that reliably finds weaknesses and problems in disability claims that they can use to weaken your case.
While you cannot simply skip an IME, you can go in prepared.
- Assume that the insurance company is building a case against you, and consult with an experienced disability insurance lawyer
- Do not exaggerate your symptoms during the examination
- Bring a trustworthy witness with you to the IME
If your insurance company has ordered an IME for you, do not panic. These exams can be stressful, but with the help of an attorney, you can go in prepared and ready to protect your case.
How Much Time Do I Have to Collect Evidence in a Disability Insurance Claim?
Different types of disability insurance claims have different deadlines for evidence collection.
- Individual policies: you can submit new evidence at any stage of your claim, including during a jury trial.
- Employer-sponsored plans: under ERISA (Employee Retirement Income Security Act of 1974), you have a limited time to submit your evidence. Once the insurance company makes its final decision, you can no longer present new evidence—no matter how important or relevant it is. Therefore, it is essential that you provide the insurance company with all your medical records, expert opinions, and other information during the insurance company’s administrative appeal.
Do not wait until the insurance company closed its case before you consult with a disability insurance lawyer. Too often, people delay hiring an attorney—and lose out on opportunities to build up their evidentiary record. The sooner you meet with an attorney, the more likely it is they can help you.
Bryant Legal Group: Fighting for Disabled Individuals Across Chicago and Illinois
At Bryant Legal Group, our practice focuses on disability insurance law. We have a long history of standing up to disability insurance companies, helping disabled professionals get the benefits they deserve. We have recovered millions in benefits for our clients, and we can help you understand your disability insurance options.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.