The Disconnects Between Diagnosis and Disability

One of the biggest issues our clients face when filing their disability claim is the lack of clear medical opinions explicitly linking their condition to their disabling restrictions and limitations.  Physicians are skilled at diagnosing a disease or illness, but they may not be the best at explaining why the condition is disabling for the claimant.  This can especially be problematic with mental illnesses or other types of invisible disabilities.  Any ambiguities cause increased scrutiny and in-house referrals by claim examiners and are often used as a basis for a disability claim denial.  Helping your doctor connect the dots between your condition and your inability to work smooths the disability claims process and fosters a quicker claim approval with fewer questions.  We’d like to discuss two perspectives to this issue: the claimant’s and the physician’s.  We’re going to discuss what each party can do to make the disability clearer and the claims process smoother.   Continue reading

Protect Yourself Against A Functional Capacity Evaluation

In addition to IME’s (Independent Medical Examinations) insurance companies are also known to use Functional Capacity Evaluations, known as FCE’s, to analyze a claimant’s disability.  These evaluations assess the ability to perform a series of tasks which simulate customary job duties and determine the extent to which the claimant can complete these job duties on a regular basis.  FCE’s can have different focuses and purposes and be referred to as Physical Capacity Evaluations, Work Capacity Evaluations, or Disability Assessments, but they all mean the same thing: the insurance company is attempting to use a biased and flawed evaluation system to challenge the statements of you and your doctor about your ability to return to work.   Continue reading

Defending Your Claim Against the Insurance Company IME

The most important piece of evidence in a disability claim is the medical basis for the disability.  If there is strong medical proof of the severity and continuation of your disabling condition, then there’s a good chance of your claim getting approved.  However, this may not always be the case.  Many conditions don’t have clear cut tests to prove their existence, and other conditions have testing protocols that either aren’t generally accepted or aren’t always accurate.  Even if appropriate testing exists, claims examiners may try to dispute the opinion of the attending physician.

When these and other issues are noticed in the claim file and want to be explored, claims examiners will often demand that the claimant undergo an IME.   Continue reading