By Allan Check­oway, RHU

1,200,100 Social Secu­ri­ty Dis­abil­i­ty appli­ca­tions were filed in 1999 (48 per­cent or 579,000 were declined). In 2009, ten years lat­er, 2,816,200 Social Secu­ri­ty Dis­abil­i­ty appli­ca­tions were filed (and 65 per­cent or 1,830,530 were declined). The num­ber of dis­abil­i­ty appli­ca­tions more than dou­bled while denials more than tripled. In one year, more than $23 TRILLION dol­lars of annu­al­ized ben­e­fits were lost.

In 2011, TRILLIONS of dol­lars in Insur­er, Social Secu­ri­ty and Vet­er­ans Admin­is­tra­tion dis­abil­i­ty claims will con­tin­ue to be denied unnecessarily.

Dis­abled Amer­i­cans diag­nosed with seri­ous med­ical and psy­cho­log­i­cal ill­ness­es are just begin­ning to process the enor­mi­ty of the phys­i­cal, emo­tion­al and finan­cial chal­lenges they will be fac­ing. This is the worst imag­in­able time to be fil­ing a dis­abil­i­ty claim.

Insuf­fi­cient prepa­ra­tion and inad­e­quate pre­sen­ta­tion of a long-term dis­abil­i­ty (LTD) claim form increas­es the like­li­hood that your appli­ca­tion will be denied sub­stan­tial­ly, espe­cial­ly when it’s a claim for chron­ic fatigue or anoth­er “self-report­ed” (fibromyal­gia, carpel tun­nel) disability.

Review your LTD pol­i­cy. Does it offer total dis­abil­i­ty ben­e­fits only or does it pro­vide par­tial or resid­ual (long-term par­tial dis­abil­i­ty) ben­e­fits so that you don’t have to be total­ly dis­abled to col­lect ben­e­fits? Hope­ful­ly it’s the lat­ter. What’s the pol­i­cy’s def­i­n­i­tion of par­tial dis­abil­i­ty? Does it state your inabil­i­ty to per­form one or more of the mate­r­i­al dai­ly duties of your occu­pa­tion and/or is there ref­er­ence to per­form­ing the duties of your occu­pa­tion in a reduced capacity?

For “self report­ed” dis­abil­i­ty claimants, we’d like to share some “tips” to improve your chances of col­lect­ing dis­abil­i­ty benefits.

TIP # 1: It’s been our expe­ri­ence, over a three-decade career spe­cial­iz­ing in the dis­abil­i­ty insur­ance busi­ness, that an improp­er­ly com­plet­ed LTD claim form increas­es the chances of the claim being denied, even when the com­plete infor­ma­tion is sub­mit­ted to the insur­er after the ini­tial claim has been sub­mit­ted. Remem­ber you are apply­ing for ben­e­fits to replace your lost wages. You’ll need to pre­pare your appli­ca­tion for ben­e­fits with the same (or bet­ter) atten­tion to details as when you applied for your job..

TIP #2: You will need to have a focused con­ver­sa­tion with your physi­cian about the spe­cif­ic ways in which you will need his or her coop­er­a­tion as you nav­i­gate the LTD claim process. As not­ed: You absolute­ly, pos­i­tive­ly must have the com­plete coop­er­a­tion of your physi­cian as well as his or her agree­ment with you as to the extent of your dis­abil­i­ty. Com­plete doc­u­men­ta­tion of your “self report­ed” dis­abil­i­ty, sup­port­ed by irrefutable evi­dence from your treat­ing physician(s) (who are rec­og­nized experts and author­i­ties in the treat­ment of your spe­cif­ic con­di­tion is absolute­ly essen­tial in the ini­tial fil­ing of your claim).

TIP #3: Is your treat­ing physi­cian a spe­cial­ist (an expert) in the treat­ment of your spe­cif­ic con­di­tion? Very few are. If he or she is not, take heed. Due to the spe­cial­ized nature of a diag­no­sis, your insur­er will expect your physi­cian to have exper­tise in the treat­ment of your spe­cif­ic con­di­tion. A dis­abil­i­ty insur­er looks for exper­tise in the treat­ment of any ill­ness, espe­cial­ly “self report­ed” dis­abil­i­ties. This, how­ev­er, does not mean you have to change doc­tors. Your pri­ma­ry care physi­cian (PCP) has pos­si­bly already referred you to a spe­cial­ist for diag­no­sis and ini­tial treat­ment. In such a case, your PCP would prob­a­bly fol­low your course of treat­ment, with an occa­sion­al update with your specialist.

TIP #4: What has been your doc­tor’s expe­ri­ence in help­ing oth­er patients with “self report­ed” dis­abil­i­ties obtain dis­abil­i­ty ben­e­fits? Has he or she had sig­nif­i­cant suc­cess or great dif­fi­cul­ty? Your physi­cian needs to be your ally in the claims process, espe­cial­ly until you’ve begun receiv­ing benefits.

TIP #5: What type of test­ing has been uti­lized to con­firm a diag­no­sis? When “self report­ed” dis­abil­i­ties first began to be rec­og­nized as unique and dif­fi­cult-to-diag­nose ill­ness­es, con­sid­er­able con­tro­ver­sy sur­round­ed the var­i­ous meth­ods of diag­no­sis. Lead­ing researchers and clin­i­cians, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, and the Nation­al Cen­ter for Infec­tious Dis­eases devel­oped var­i­ous guide­lines for eval­u­at­ing your con­di­tion. (For more, we urge you to do a web search and read “Social Secu­ri­ty SSR 99–2P: Your Guide to CFS Claims Success).


In review­ing a mul­ti­tude of long-term dis­abil­i­ty claims that were denied by insur­ers there’s one pre­dom­i­nate theme: the claimants’ per­son­al physi­cian and/or oth­er sub­se­quent med­ical doc­u­men­ta­tion does not sup­port or val­i­date the extent of the dis­abil­i­ty. The claimants were expect­ing a cer­tain out­come (for their claim to be paid) while the med­ical infor­ma­tion attached to their claim form did not val­i­date the extent of the dis­abil­i­ty. In essence, claimant and physi­cian just have not com­mu­ni­cat­ed prop­er­ly. The Bot­tom Line… do it right the first time.

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