The 10 Biggest Legal Mistakes Physicians Make When Filing a Disability Claim (Mistake #9)
Many insurance companies tell physicians, dentist and other professionals who have filed a long-term disability claim that their claims will not be approved unless they can produce objective evidence of their disabling condition. While some policies do contain express provisions limiting coverage for subjectively diagnosed conditions, many policies do not. In fact, your policy may be less exacting and require only verifiable evidence of disability. Under such a policy, you may still be able to collect if you can show that the cumulative effect of your symptoms and limitations are disabling.
Ed Comitz’s article “The 10 Biggest Legal Mistakes Physicians Make When Filing a Claim for Disability,” published by SEAK, Inc. (2005), details ten of the most significant mistakes to avoid. The excerpt below explains why verifiable evidence of disability is important, even for subjective conditions:
MISTAKE NO. 9: Blindly Accepting that Subjectively Diagnosed Conditions Are Not Covered
Disability insurers often deny benefits by insisting that the insured’s subjective symptoms do not provide objective, verifiable evidence of disability. In many cases, there is no provision or contractual requirement mandating that the insured submit objective evidence of disability. Therefore, from the insured’s perspective, these insurance companies are merely trying to save money by generously interpreting policy language in favor of a claim termination. Notwithstanding the subjective nature of a particular condition, the insured may be able to secure benefits with ample evidence bearing on the extent and severity of his or her limitations, which is far more important than providing a definitive diagnosis.
Action Step: The severity and extent of the limitations are more important than an objectively verifiable diagnosis and must be fully communicated to a physician’s insurer.
If you are a physician or dentist suffering from a subjectively diagnosed condition, it is important to present your conditions and limitations in a precise and detailed fashion from the outset of your claim. At a minimum, this requires a supportive treating doctor who is willing to take the time to thoroughly document the extent and severity of your symptoms in your medical records.
To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.