Disability insurance benefits are frequently part of comprehensive workplace benefits packages. Employers provide policies to their workers that can replace their wages if they become unable to work due to medical issues.
Long-term and short-term disability coverage can protect people from financial hardship when they experience medical emergencies. Such policies are subject to federal regulations, including the Employee Retirement Income Security Act of 1974 (ERISA). Under ERISA, insurance providers have a fiduciary duty to policyholders making claims.
Those claimants also have the right to appeal unfavorable decisions and file lawsuits when companies violate their rights. Inadequate medical documentation is frequently the reason provided for a denied claim. What type of medical evidence can help support the need for disability benefits?
Diagnostic records
In scenarios involving severe illness or catastrophic injuries, diagnostic reports can provide compelling evidence. Reports and imaging results showing a complete spinal cord injury, for example, are strong evidence that a professional may not be able to work the same job and may struggle to return to gainful employment.
Functional capacity test results
There are many medical conditions that may vary in severity and presentation from one case to the next. In such cases, insurance professionals evaluating claims may have a hard time determining whether a policyholder actually qualifies. A functional capacity evaluation or similar test involves hours of testing and observation. The focus is to document the severity of the condition and how it impacts an individual’s day-to-day life. Testing records can help prove that a person with a disabling medical condition cannot continue working and supporting themselves.
Treatment plans
In scenarios involving serious injuries or illnesses, the treatment required could force a worker to take an extended leave of absence from work. Needing to undergo an 18-month chemotherapy regimen for cancer, for example, could render an individual incapable of working until well after their treatment ends. Those with crush injuries who may require multiple surgeries to correct damage to their bodies may also have a long path to recovery ahead of them. Information about the necessary treatment for an injury or illness can help affirm that a policyholder cannot currently return to work.
Those already dealing with debilitating medical conditions may feel overwhelmed by the prospect of gathering medical evidence and negotiating with disability insurance providers. Securing support when initiating an ERISA long-term disability benefits claim can take the pressure off of a person with a disabling medical condition and potentially increase their chances of success.