When you have built a life defined by success and stability, a medical condition that prevents you from working can be both a personal and financial shock. The growing pile of medical bills and uncertainty about the future are already overwhelming—and battling with an insurance company can add a devastating layer of stress.
Unfortunately, insurers often exploit loopholes to delay or deny claims, regardless of the persuasiveness of the evidence provided.
At Kantor & Kantor, we frequently meet clients who feel blindsided by the demands of their disability claims. They are unsure what evidence is needed, where to gather it, or how to present it in a way that cannot be disputed. Through our years of experience, we know how to ensure that medical evidence becomes your most powerful tool.
We will help you organize your case, connect with top-tier specialists, and present compelling documentation that positions you to succeed. Our mission is to safeguard your financial stability by ensuring insurance companies fulfill their obligations.
We are people helping people, and we look forward to helping you.
Why Medical Evidence Matters
Medical evidence serves as the linchpin of any long-term disability claim. For high-net-worth individuals, proving the extent of a disability goes beyond confirming a diagnosis. You must demonstrate how your condition limits your ability to perform not only your profession but also alternative roles for which you may be highly qualified.
Insurance companies, focused on limiting payouts, scrutinize every aspect of your medical documentation. Common tactics include claiming your evidence is incomplete, inconsistent, or fails to demonstrate the severity of your condition.
Strong medical evidence answers critical questions about your illness or injury, including:
- The nature and scope of your condition.
- The expected trajectory of your recovery.
- The treatments and interventions you have undergone.
- How your symptoms impact your ability to work at the level your career demands.
For professionals, the stakes are higher. In many cases, after a certain period, you may need to meet a higher standard to continue receiving benefits. This is especially true for professionals, where policies often cover “own occupation” for the first two years and then shift to “any occupation” afterward. While medical evidence like comprehensive records, clear physician statements, and objective tests are essential, the distinction between “own occupation” and “any occupation” is often more of a vocational issue than a medical one. For example, if the insurer acknowledges your condition (like depression) but argues that you could work in a different role, such as a police academy instructor instead of a police officer, this is a vocational issue, not a medical one.
Types of Medical Evidence
To convince an insurance company or a court that your condition prevents you from working, your evidence must be detailed, credible, and comprehensive. Here are the most common types of medical evidence used to support a disability claim:
1. Physician Statements
These are detailed notes or formal letters from your primary doctor or any specialists you have seen. They should describe your diagnosis, the symptoms you experience, how these symptoms affect your daily activities, and your treatment plan.
2. Medical Records
These include all records of your medical visits, hospitalizations, treatments, surgeries, and consultations with healthcare professionals. They serve as a chronological account of your health journey and substantiate the ongoing nature and severity of your condition.
3. Diagnostic Tests
Objective test results such as X-rays, MRIs, blood tests, and other relevant examinations provide concrete evidence of your condition. These tests are crucial because they offer measurable proof of your medical issues that insurance companies find hard to dispute.
4. Specialist Opinions
Insights from specialists who have treated you can be particularly persuasive. For example, if you have a neurological disorder, a detailed report from a neurologist who specializes in your condition can provide weighty evidence about the specifics of how your disorder limits your functional capabilities.
5. Functional Capacity Evaluations (FCEs)
These evaluations are performed by occupational therapists or other physical rehabilitation professionals who assess your physical abilities in a controlled environment. An FCE can provide a detailed report on your ability to perform various physical tasks, which directly relates to your capability to work. A proper FCE will also include validity testing which can scientifically support the accuracy of the test results.
Challenges in Obtaining and Presenting Medical Evidence
Despite your best efforts, the process of collecting and presenting evidence can be fraught with challenges. Insurance companies are adept at exploiting gaps, inconsistencies, or delays in documentation. Common obstacles include:
- “Imperfections” in Medical Documentation: Insurance companies are quick to seize on imperfections in medical records. For example, if one report describes your symptoms as severe but another notes improvement, they may argue that your condition is not disabling. Sometimes clerical errors occur or physicians fail to properly document the extent or severity of your symptoms. Similarly, gaps in treatment or unexplained changes in your care plan can raise red flags.
- Medical Records Are For Treatment, Not To Prove Disability: One of the biggest fundamental problems with the LTD claims process is that it is reliant primarily on medical records which are not primarily designed to document disability. Numerous things a reasonable physician would never requirement verification of are required by LTD insurers. Further, the entire purpose of medical records is to document treatment in order to perfect further treatment, not to prove to the LTD insurer that you are unable to work. As such, medical records, even when complete, sometimes lack critical information needed to approve an LTD claim.
- Skepticism of Treating Physicians’ Opinions: Insurance companies frequently challenge medical evidence by claiming it is biased or subjective, especially when the information comes from treating physicians who are directly involved in a patient’s care. However, this is often a misleading argument used to justify relying on independent medical examinations (IMEs) by doctors of the insurer’s choosing. These doctors, who typically only review medical records, are often more skeptical of the claimant’s condition or its severity, leading to claim denials.
- Interpretation of Medical Tests: As mentioned earlier, insurance companies often rely on doctors they choose to conduct independent medical examinations (IMEs). These doctors may interpret medical tests, such as MRIs or blood tests.
- Accessing Complete Medical Records: Many patients have a long medical history spread across multiple providers, making it easy to overlook critical documentation. Additionally, some medical offices may be slow to release records or require complex authorization processes, delaying your claim.
How Insurers Exploit Evidence to Deny Claims
While insurers claim to base decisions on objective evidence, they often manipulate results to support denials. Examples include:
- Overemphasizing normal test results while dismissing abnormal findings.
- Misinterpreting your job’s requirements to argue that your condition does not prevent you from working.
- Using recovery timelines from general data to prematurely terminate benefits, regardless of your individual circumstances.
For individuals whose disabilities affect their ability to lead high-stakes careers, insurers often suggest alternative, lower-responsibility roles that fail to align with their professional qualifications or income expectations.
How Kantor & Kantor Can Help
At Kantor & Kantor, we specialize in leveling the playing field against powerful insurance companies. Our attorneys take a proactive, strategic approach to ensure your claim is supported by clear, thorough, and compelling medical documentation. Here is how we can help:
- Policy Analysis: We carefully analyze your insurance policy to identify what evidence is required and anticipate the insurer’s potential challenges.
- Medical Record Management: We handle the exhaustive process of gathering and organizing your medical history, ensuring no critical detail is overlooked.
- Collaboration With Specialists: We connect you with top medical experts to produce authoritative evaluations and statements.
- Countering Insurance Tactics: Whether it is an unreasonable request for additional evidence or a biased independent medical examination, we are prepared to protect your rights.
- Building a Case That Resonates: We present your evidence in a format that leaves no room for doubt about your eligibility for benefits.
Protect Your Financial Wellbeing
You have worked hard to achieve your success, and your long-term disability coverage is part of the security you have built. Don’t let an insurer’s tactics jeopardize your financial stability. With Kantor & Kantor by your side, you can fight back effectively and secure the benefits you deserve.
Contact our long-term disability attorneys today at 818-886-2525 for a complimentary consultation.
