In the case of long-term disability, one critical factor that proves the validity of a claim is documented ongoing medical care. It is from this premise that most insurance providers will want adequate proof that a claimant is indeed receiving relevant and regular medical attention to support his or her claim for entitlement to benefits. Without continuity in treatment, the severity of the condition may very well be doubted as to whether or not the claimant is disabled. It is often difficult without a history of continuous treatment by a doctor to show that the disability prevents regular work duties. It is also important that regular medical visits not only provide a record of the condition’s progression but that such visits show that the claimant has been actively taking the steps necessary to manage their health-a factor possibly affecting the outcome of the case.
Why Consistency Matters in Disability Claims
Consistent treatment of a medical condition is necessary because it clearly demonstrates the persisting nature of the disability. If there are significant gaps in treatment or periods when the claimant is not seeking any care, the insurance company may look at these omissions as indicative that the condition is not as debilitating as claimed. Whereas in LTD cases, the insurers are not only looking for proof that the claimant is suffering but also for evidence that the condition persists over time. For instance, a claimant who frequently goes to their physician for pain management or physical treatment submits records that tend to develop a complete picture about the claimant’s disability. The frequent visits tend to show the applicant is, in fact, taking their health concerns seriously, and thus tend to substantiate the fact that the disability is long-term, and continuation of benefits is justified.
Working with Lawyers to Present Better Evidence
While continuing medical treatment is important, a LTD lawyer can help make this evidence better presented in the claim. A LTD law lawyer understands the intricacies involved in working with insurance companies and can assist in organizing and presenting the medical records in such a way as to present a much stronger claim. They may also counsel the claimant regarding adherence to treatment advice and also prepare all relevant documents, since the art of advocacy can greatly make a difference in a successful claim by fully exploiting each and every piece of medical evidence. This intercommunication between healthcare providers and attorneys will maximize the chances of being awarded the disability benefits one ought to receive.
Medical Evidence in Your Case
The medical documentation is considered the backbone of any LTD case. The insurance companies tend to rely very heavily on the medical records when making their decisions, and they wish to see voluminous, detailed records about the condition of the claimant-diagnosis, treatment plan, medication prescribed, and notes regarding how the condition affects the claimant’s activities of daily living and work capability. Each visit offers new proof-a sequence of events that reflects how the impairment is affecting the claimant’s functionality. The more consistent and accurate the medical records, the better the argument for LTD benefits.
Where there is a need for additional medical proof, the insurance carrier may request independent medical examinations, but standard treatment through the claimant’s own medical professionals will typically carry more weight.
Gaps in Treatment
Even a short period with no medical treatment can be highly adverse to the LTD claim. The insurance provider often views the gaps in treatment as indicative that the condition is less than chronic or one that is less serious. There are valid reasons why people miss going to the doctor, including but not limited to financial disposition and lack of transportation. These gaps in treatment provide the case with many hurdles to overcome. For this reason, communication must be largely open with healthcare providers and treatment and changing conditions reflected on an ongoing basis to the healthcare provider. In those instances where this is not possible due to circumstance, such should be documented and care sought at the earliest opportunity possible to avoid large lapses in treatment. Even when the condition improves temporarily, continued monitoring continues to be necessary to establish that the disability is ongoing.
The conclusion is that continuous medical treatment is actually crucial in instances of long-term disability. It ensures that there is necessary evidence to prove the applicant is experiencing a debilitating condition that may require ongoing care. A medical history dictates a clear narrative about how the disabling condition has affected the person’s life and ability to work. Gaps in treatment may serve to weaken that narrative, whereas consistent care strengthens the case for receiving such benefits. Claimants can have the best opportunity of obtaining long-term disability benefits by maintaining regular doctor appointments and cooperating well with lawyers.
