Not all medical professionals will view situations in the same manner. There is a chance that one doctor will classify a patient as completely disabled while another takes a more conservative view and thinks that the person should be able to perform at least limited duties at their place of employment. This seemingly small distinction can lead to claims under the Employee Retirement Income Security Act (ERISA) that are based on disability being denied.
The insurance companies that handle these claims often have only the medical records to review when they’re making decisions. They don’t have you in front of them, to explain exactly how your condition affects you. The medical reviewer may also simply not have the level of expertise that your own doctor or specialist has, which can make it harder for them to fully understand the impact of your condition on your life.
Because medical conditions may affect patients in different ways, injured or sick employees must ensure that they’re getting all the benefits they’re due. This can be complicated when there is misinformation in the record that the insurer is reviewing, even if that misinformation is unintentional.
One option that some parties might opt to exercise is getting a second opinion. This is beneficial if it is likely that the second doctor will note the severity of your condition and your limitations. You may even find that getting a new doctor to review your case may also help you to find new options for your medical care.
If you’re denied the ERISA benefits that you should be due because of your disability, working with an attorney during your appeal can increase your chance of a successful outcome.