When many people think of a claimant who is receiving disability benefits, they picture someone who is visibly and physically unable to work. Although many claimants suffer from conditions of this nature, some of the most painful and devastating conditions include categories often referred to as “invisible disabilities.” Invisible disabilities include such conditions as CFIDS, Fibromyalgia, chronic pain and mental illnesses, such as anxiety or depression. These conditions can be every bit as severe and debilitating as outwardly obvious conditions but are often met with skepticism and distrust by disability claim professionals. Many claimants who suffer from invisible diseases encounter seemingly unending questions and problems with their long term disability claims and the claims process. We have seen people make inadvertent errors in how they’re presented their disability claims and simply give up, surrendering their rights to the disability benefits they actually deserve. Here are the three common reasons that disability claims based on one of these invisible diseases are denied.
- Lack of objective proof of the condition. One of the biggest challenges for claimants with invisible diseases is the lack of concrete or objective evidence of a specific condition that will be accepted as proof of the disability. Many diagnosis and treatments of invisible diseases rely on self-reported symptoms. People with these conditions are often overwhelmed and describe their symptoms in emotional
terms rather than providing a factual basis. Disability claims examiners often seize on this aspect to delay or deny disability claims, ignoring the clinical findings that support the diagnosis. Examiners can assert that there’s no objective proof of the condition, that the limitations are not consistent with the condition, that evidence is only self-reported by the claimant, and/or that the records review performed by their in-house physician does not support the claimed disability. To prevent these arguments, it’s important that your medical records include significant, supporting details about your condition, how it’s evidenced in all aspects of your life and the generally accepted medical basis for its diagnosis and treatment. Make sure the doctor’s notes are complete and clearly document and support the basis for the work limitations and restrictions. If there are any functional tests to evidence the impairments caused by your condition, make sure they’re in your medical records. You might even want to supplement your medical records with narratives from your treating physician or specialist that paint a clear picture of your disability and how it affects your quality of life. Also, obtaining the opinions of more than one doctor may be beneficial to both your diagnosis and treatment as well as your disability claim. Having a medical history document is a great way to help your doctors get up to speed on your condition, enabling a better diagnosis and treatment plan, as well as providing additional support for your disabling condition. - Exaggeration of limitations caused by the disability. One of the traps we see claimants fall into is an over-exaggeration of their symptoms. All of our clients are disabled and cannot work, but it isn’t uncommon to see a claimant feel that they have to exaggerate their symptoms to make their condition more convincing. This is driven by the fear that the medical records won’t be convincing and their disability benefits will be denied, so some claimants feel the need to make their symptoms even worse to try to get their disability benefits. This is a huge mistake – this tactic backfires far more often than it helps. Disability insurance companies have a host of resources at their disposal, such as in house doctors, attorneys, and private investigators. There have trained and experienced professional investigators
available to go through every aspect of a disability claim. Any opportunity will be seized to show that your application for benefits is not accurate. This can be especially true of the self-reported symptoms or effects of an invisible disability. It’s a good idea to keep journals of your daily activities, making sure to note when and how your condition limits you or prevents you from completing a task or requiring assistance. When meeting with your doctors, completing claim forms, or providing information to the insurance company, take the time and effort to make sure the descriptions of your conditions are thorough, complete, and accurate – no more, no less. - Inappropriate care and treatment for your disability. For many invisible diseases, the recommended care and treatment can vary greatly. Depending on the symptoms and side effects from treatments, to the opinions of doctors, the prescribed medications and recommended therapies differ from patient to patient. This can be another reason used to deny your benefits. All disability policies have clauses that requires you to receive appropriate care and treatment for your condition, but the term “proper care” is rarely defined. This creates an opening in which some claims examiners will criticize and dispute your care in a manner that hurts your claim. If you’re interested in alternative medical or non-medical treatments for your condition, make sure to discuss and document the entire scope of treatment with your attending physician or specialist treating you for your condition. Use the alternative treatment in conjunction with your current, traditional treatments. Also, make sure that your attending physician is qualified (or board certified) to be treating you for your condition. For example, if you are dealing with a sever case of depression and receiving prescriptions from your primary care physician, it’s important to see a psychiatrist in addition to your family doctor for treatment. Although your primary care physician may be qualified in your opinion and doing a good job of treating your condition, disability insurance companies will not view it the same way. It’s a great decision to have an expert or a specialist for your condition confirm the diagnosis of and treatment plan for your condition to support your disability claim.
Dealing with an invisible disability is hard enough without having to deal with the frustrations of the disability claim process. The subjective nature of these illnesses provides claim examiners with the opportunity to be aggressive in their claim handling and denials, so it’s important for you to protect your interests and not provide them with any more reasons to delay and/or deny your disability claim. Doing a little extra preparation before submitting the claim forms will help you be better prepared and make for a stronger disability claim. Stay on top of your records – medical, occupational, financial, etc. – so that claim examiners won’t ambush you with requests for documents you don’t have. Make sure you understand why certain information is being requested. Stay closely involved so that the narrative of your disability claim is controlled by you and your doctors, not by the claims examiner.
If you need help with your claim for disability benefits due to your invisible disease or any other kind of condition, please contact our offices at (855) 828-4100 or visit our website for a free consultation.
Royal Claims Advocates 