When you file for ERISA long-term disability, it is extremely important to have complete and up-to-date medical documentation in your file.

There have been claims that get denied simply because one thing did not make it into the employee’s claim file.

Medical Records

Having ample medical records supporting your claim is the most important thing you can do to support your case.  If you have medical documentation from several medical professionals, make sure that when you turn in your long-term disability claim file, you include every piece of literature from them even relating to your condition(s).  
Here is a checklist to help you…Medical professionals you may need to collect medical documentation from:

  • * Primary care doctor
  • * Emergency room
  • * Urgent care
  • * Imaging
  • * Lab
  • * Psychologist/psychiatrist (if a mental condition)
  • * Physical therapist
  • * Occupational therapist
  • * Any specialist such as neurology, orthopedics, etc.


Opinion or Notes from Your Treating Doctor

Many people know that you need to submit your medical documentation but what they do not realize is that a letter from your treating doctor or even just notes is just as important. 
For example, if you regularly “walk” into your doctor’s office barely able to move due to extreme pain that is uncontrolled by prescription medication, your doctor should be documenting that. 
Or, if you are experiencing severe side effects from medication that is helping your condition, but it is severely impeding to your ability to work, your doctor should also be noting that.
Beyond observations, you should remember that you are and will be your own best advocate in working with doctors.  Not all doctors will do a complete physical exam or accurately document your conditions during your visit.  Not every condition you present with may be necessary for them to administer care in their specialty.  Regardless, you should communicate your overall condition.   You need to convey to your doctor it is important for you to have a complete physical exam and that you have accurate and thorough documentation of your physical or mental condition during your visit, regardless of the purpose of the visit. 

Be Honest and Think About the Medicine Too!

When you go in for a visit with your doctor, you need to be upfront and honest about how you are feeling and how your condition is affecting you (we just covered this above).  However, you also need to be honest about any side effects you may be having from any of your prescription medications.  If your doctor asks you how you are feeling and you say you are fine even though you may be in extreme pain, your doctor will not be able to document that and it will hurt your claim. 
If your doctor asks how you are feeling, and in response, you state that your condition or ailment has cleared up or is not bugging you anymore, that may be all they note.  But, if your medicine (used to get you to that state) has side effects, those side-effects are very important and may, in fact, be more of an impediment to working than the original condition.  An example, leg pain is your condition.  It’s difficult/impossible to work when it’s acute, but when it’s treated you don’t have any more pain.  However, the treatment doesn’t allow you to drive, makes you dizzy, and you break out in sweats occasionally.  You could argue the treatment makes it MORE impossible for you to work than your condition.  The lesson here…report beyond your condition – to include how the treatment makes you feel too.  

Visit Your Doctor Regularly

Even if your initial claim gets approved you need to continue to visit your doctor on a regular basis and follow any instructions your doctor has given you.  If at any time, the insurance company feels you have improved, they can take your benefits away.
For example, if your doctor tells you not to walk more than a few hours a day or lift anything over 10 lbs, you need to follow those instructions.  The insurance company will argue that your condition improved if they can prove that you did not follow these instructions even one time.   Then, they can discontinue your benefits.
If you have questions about what medical documentation you need for your LTD claim, or just need guidance, please feel free to contact us.