Helping Prove Your Disability Claim with Your Physician’s Help

We often are retained once a claim has been denied. All too often, the denial is based on a breakdown in communication between the patient’s doctors and the administrator evaluating the claim because the nature and extent of a patient’s disability is not communicated clearly by the claimant’s treating physicians to the insurance company.

Insurance companies periodically request treatment notes or claim forms to be completed by the claimant’s physicians. Even seemingly straightforward questions by the insurance company can be construed to raise questions about the patient’s disability. Oftentimes, with limited time to spend per patient, a physician will not list all the symptoms present in the diagnosis, or fails to mention the significance pain has on a patient’s abilities.

Physicians constantly express their frustration — that their priority is spending time treating the patient– not gearing their notes to please the insurance companies. Unfortunately, insurance companies latch onto any small indication by treating physicians that the patient is doing well enough to return-to-work, or is no longer disabled. A recent New York Times article states, “A doctor’s note turns into a cut-and-paste collage instead of an accurate and personalized narrative of illness; and documentation becomes an electronic and potentially dangerous version of the game ‘Telephone.'”

Entitlement to disability benefits often turns on the quality of treating doctor’s accurate and thorough responses. Too often, New Jersey disabled claimants are denied benefits due to inadvertent statements made by the treating physicians.

To avoid this scenario, provide your doctor with a statement detailing your disability and your symptoms which he or she can reference while completing forms on your behalf. It is also helpful to bring the insurance company’s forms to your visit, and together go over any questions that could be misconstrued. Consistency is vital, and an open line of communication with your doctor means less opportunity for mistake.

The Law Office of Bonny G. Rafel, LLC often acts as the liason between the treating doctors and the insurance company and can guide you through a seemingly daunting process.
Contributed by Bonny G. Rafel

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