Articles Tagged with “long term disability denial”

Navigating through the process of obtaining or keeping your short-term or long-term disability includes obtaining supportive statements from your treating physicians.  Not only is it important to collect medical records for your claim but also it is imperative that you garner an attending physician statement that will support your disability.

Prior to filing for short-term or long-term insurance benefits, you should make an appointment with your doctor to discuss your decision to leave work. Once you arrive at your appointment, be sure to take the time to explain why you need their help in the claims process.  If you need a form or letter written, make sure that the doctor explains in as much detail as possible the severity of the symptoms you experience and how they impact your ability to work.

One of the most common reasons for a disability claim denial by an insurance company is due to lack of proof of disability.  Starting the process with your physician should happen prior to submitting a disability claim.  Waiting to file a disability claim until after confirming first that your physician will be willing to provide support will help ensure a positive outcome.

The O’Ryan Law Firm has represented numerous clients suffering from fibromyalgia in the disability claims process. Usually, the client contacts our office after their disability claim has been denied and all too often the insurance company or claims administrator has denied the claim because there is “insufficient objective medical evidence” to support the claim. It is improper for your disability insurance company to insist that you produce objective medical evidence to prove that you have fibromyalgia because it is impossible to supply the insurance company with objective evidence that doesn’t exist.

Fibromyalgia is a disease the Seventh Circuit has characterized as “common, but elusive and mysterious.” Sarchet v. Charter, 78 F.3d 305, 306 (7th Cir. 1996). In an evaluating fibromyalgia in the context of a disability claim, the court in Sarchet described the disease as:

Its cause or causes are unknown, there is no cure, and, of greatest importance to disability law, its symptoms are entirely subjective. There are no laboratory tests for the presence or severity of fibromyalgia. The principal symptoms are “pain all over,” fatigue, disturbed sleep, stiffness, and–the only symptom that discriminates between it and other diseases of a rheumatic character–multiple tender spots, more precisely 18 fixed locations on the body (and the rule of thumb is that the patient must have at least 11 of them to be diagnosed as having fibromyalgia) that when pressed firmly cause the patient to flinch.

According to the American College of Rheumatology:

Fibromyalgia is a chronic health problem that causes pain all over the body and other symptoms. Other symptoms that patients most often have are:

• Tenderness to touch or pressure affecting joints and muscles • Fatigue • Sleep problems (waking up unrefreshed)
• Problems with memory or thinking clearly
Some patients also may have:

• Depression or anxiety • Migraine or tension headaches • Digestive problems: irritable bowel syndrome (commonly IBS) or gastroesophageal reflux disease (often referred to as GERD)

• Irritable or overactive bladder • Pelvic pain • Temporomandibular disorder–often called TMJ (a set of symptoms including face or jaw pain, jaw clicking and ringing in the ears)

Symptoms of fibromyalgia and related problems can vary in intensity, and will wax and wane over time. Stress often worsens the symptoms.

The American College of Rheumatology provides the following criteria for evaluating of fibromyalgia:
Criteria Needed for a Fibromyalgia Diagnosis
1. Pain and symptoms over the past week, based on the total of:

Number of painful areas out of 18 parts of the body Plus level of severity of these symptoms:
• Fatigue • Waking unrefreshed • Cognitive (memory or thought) problems Plus number of other general physical symptoms 2. Symptoms lasting at least three months at a similar level 3. No other health problem that would explain the pain and other symptoms.
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Some may associate disability with physical impairments like the inability to walk or stand. However, disabilities are not limited to physical ailments and many people suffer from disabling mental health conditions. Proving that a mental health condition is disabling can be challenging because disorders like major depression and bipolar disorder may take time to conclusively diagnose.

In order to prove that a mental health condition is disabling, a person’s medical treatment must document the severity of symptoms over an extended duration. This requires that the claimant regularly treat with a psychiatrist and/or licensed psychologist. Although a therapist or counselor may treat someone for mental health problems, the Social Security Administration and long term disability insurers give more weight to the opinions of licensed psychologists and psychiatrists rather than therapists or counselors. Generally, the Social Security Administration affords more weight to the opinions of accepted medical sources, like a treating psychiatrist or psychologist, while long term disability insurance companies more freely pick-and-choose which medical opinions they rely upon to make a determination.

Severe mental health problems can also be evidenced by visits to the hospital and inpatient treatment. Some mental health listings under the Social Security Administration require episodes of decompensation. Medical records of a hospitalization can serve as strong evidence of an episode of decompensation. Moreover, the opinions from third parties, like a family member or friend, may help show episodes of decompensation. Any person who has been able to observe the claimant’s personality or behavioral health over time can provide relevant evidence revealing the severity of the claimant’s mental health condition.
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