What Medical Evidence is Necessary to Successfully Prove a Disability Claim? - Personal İnjury Car Accident Lawyers
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What Medical Evidence is Necessary to Successfully Prove a Disability Claim?

Your doctor needs to support you in the understanding that you cannot work due to the seriousness of your symptoms

To make a successful claim for disability benefits, you must first have sought medical treatment for your injury or illness.  And, your doctor must support you and be willing to provide opinion evidence stating that they believe that your medical condition prevents you from being able to do your job.  If your current physician initially does not take your symptoms seriously, you need to convince them that your symptoms are real and disabling, because your disability insurer is unlikely to find your disability claim credible if your own doctor doesn’t provide compelling evidence of your disability.  However, if you have an unempathetic doctor who refuses to understand or believe the disabling effects of your condition, you need to get a second opinion from a doctor who is better informed.

When to seek medical treatment from a specialist

Your family doctor can diagnose and treat some medical problems, but cannot properly assess or treat all types of injury and illness.  Consequently, for many medical conditions, your disability insurance provider will expect that if you are genuinely suffering from a particular condition, you will have taken steps to get proper and informed treatment from a doctor or medical profession who specializes in your condition.  Seeing a specialist indicates that you are genuinely suffering and want to get well.  Also, the medical opinion of a specialist carries more weight with your disability insurance provider.

For some conditions, your insurer will only approve a disability claim if you are being treated by a medical specialist who is trained to accurately diagnose and treat your condition, such as a neurologist, rheumatologist or psychiatrist.  This is particularly true if you are suffering from a mental or psychological condition that prevents you from working effectively.  Mental health disorders, such as depression, anxiety and PTSD are ‘invisible conditions’ which cannot be proven through an objective medical test such as a CT scan or blood test.  And, although there is undeniable evidence showing that mental illness effects many Canadians, insurance companies are in the business of making money and are motivated to deny disability claims that are not backed up by knowledgeable medical opinion from a mental health professional, such as a psychiatrist or psychologist.

Chronic pain is another condition that can be hugely disabling and is difficult to measure in an objective medical test.  If you cannot work due to chronic pain or another condition that has invisible symptoms, it’s important to keep a diary or journal of your symptoms and how they effected you and/or prevented you from functioning in a particular task.  You may also consider asking a close family member who is able to observe you regularly to also keep a journal and record when they observe an adverse effect due to your condition. Finally, you need to schedule regular visits with your doctor and be forthcoming about your symptoms and how they effect you, and let your doctor know if your condition is worsening over time.

Medical evidence can make or break your disability claim. In fact, a common reason why disability claims are denied is when applicants fail to submit adequate medical evidence that clearly explains and supports their claim of disability. Medical records that show the diagnosis, treatment taken and on-going prognosis can back up the fact that you are disabled. Should you fail to include this in your application, don’t be surprised if the benefits are denied.

Your medical records may be provided by various sources. Your physician may have your past and current medical information, which you need to submit when filing the claim. If you’ve received treatment in other clinics or hospitals, include this as well in your filing. Contact all the facilities and treating physicians and specialists you’ve visited in advance and request for copies of your records which, you can produce when submitting your claim. If you chose to hire a long-term disability lawyer, all this will be done for you.

Working with a long term disability lawyer

Disability lawyers come in handy when you feel overwhelmed trying to get all the appropriate medical records to support your claim. Healthcare providers and hospitals are usually not as responsive as they should be to requests and this could jeopardize your claim. In fact, if the medical records are not submitted on time, your benefits could be delayed or denied.

To avoid this hassle, hire a disability lawyer who will coordinate with the healthcare providers to avoid delays in the submission of crucial evidence. The lawyer will spur the healthcare providers into action to get your claim moving forward. You just need to make a comprehensive list of all your treating physicians and the institutions you’ve visited for treatment then the lawyer will take it from there.

Medical history

Disability programs are very concerned about the opinions of medical providers who detail what you are able to do despite your disability. A medical opinion is a statement from a practitioner that clearly explains what you can do and your limitations. It could include details such as your ability to walk, stand, lift and carry objects as well as how well you can perform certain mental and cognitive activities.

The opinion of a medical practitioner who is treating you currently is important but the physician who has seen you for years will have a better understanding of your medical background compared to the one who’s seen you once or twice. Your personal doctor will be able to provide records that give a better picture of your overall health dating back several years or even to the onset of your disability. This is especially key if you want to claim for retroactive benefits. There’s a high chance that the primary physician treated you first or referred you to a specialist who you may be currently seeing.

Your restrictions or limitations

The condition may affect your ability to walk, talk, lift, hear, see, perform certain mental activities, use your senses or even adapt to certain environmental changes. Your doctor should outline all these limitations. These restrictions may affect your ability to do your job and hence are important to your case. They may vary depending on your work as well as your condition.

Acceptable medical sources

Your long-term disability policy has a list of treatment providers who are considered ‘acceptable medical sources’. This often includes the following medical providers:

  • Licensed physicians
  • Orthopaedic surgeons
  • Rheumatologists
  • Neurologists
  • Psychiatrists
  • Optometrists
  • Speech language pathologists

Other medical providers such as physical therapists, chiropractors and psychologists may not be considered ‘acceptable medical sources’’.

Any record from a registered hospital facility may also be considered helpful. If you have had a long hospital stay, records to provide the details of treatment rendered during this period can be of great use. Other records such as if you visited an emergency room or any other information from a licensed physician can come in handy. These records should portray conditions that are related to your disability.

Is your illness ongoing, permanent and consistent?

Medical records that show an on-going and consistent illness can also help to prove your case. This includes laboratory tests, MRIs and x-rays during diagnosis and treatment. Other types of tests such as blood and urine analysis, biopsies or brain scans can also come in handy as part of the medical evidence that supports your claim. It’s important to have a journal where you document your treatment journey as this will come in handy when you’re filing your claim. Make sure you discuss with your lawyer all the tests and examinations you took so that he/she can get the results and include them in your records to prove that you have an on-going disability.

How can a disability lawyer help your claim?

Your disability lawyer will also reach out to your treating physician to provide a detailed account of your diagnosis. This includes any medication that you may be on as well as the side effects you’re currently facing or have faced while on treatment. If you have had symptoms that limit you from functioning in any work environment such as extreme pain or fatigue, be sure to include this in the documentation. The medical evidence will prove this consistency and show that your illness is ongoing and impacts your abilty to work.

To conclude, the medical evidence you provide will greatly impact the success of your claim. Keep in mind that medical evidence can take many forms. The medical evidence includes: laboratory tests and finds, a medical opinion from a licensed and acceptable provider, medical records as well as evidence from nonmedical sources such as your family members or co-workers. The extent you provide this evidence will depend on your unique situation.

An experienced long-term disability lawyer can help you to include as much documentation as you can in order to prove your case. Experienced lawyers not only request for your records but also sort through them to determine what should and shouldn’t be included when filing your claim and reach out to your treating specialists for individual medical-legal preorts. He/she will ease the burden of sorting an overwhelming number of medical records and increase your chances of a successful claim.

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