So far this year I’ve written at least four articles about medical “proof of claim” I thought were going to be very popular and helpful. In reality, these very informative medical articles were not popular since insureds opted to read writings on more incidental topics they believe will help them with their claims. There were no articles on my blog more important than learning what “proof of claim” is, and what is expected as medical report.
Although I sometimes wonder whether my articles are just whispers in the wind, a few days later I’ll get several calls from insureds and find myself saying, “I hate it when I’m right.” This particular article is very important although I sorrowfully realize I can lead you to successful claims, but can’t make you take advantage of it.
There is now appearing significant proof that more than anything else disability claims hinge on medical reporting. This makes perfect sense since insurers now choose to outsource medical review to professional agencies armed with highly credentialed physicians bought and paid for by the insurance industry.
In the last few months I’ve been reviewing insureds’ medical patient notes, including mental health records and I can see why insurers are denying so many claims. I’m going to be honest here and say that from what I’m seeing, treating physicians are not properly documenting disability claims, or if they do, are throwing patients under the bus.
I recognize that it is not entirely the insured’s fault in the era of 15 minute office visits, but I have to also say that I’m observing insureds who think “my medical is OK”, or, “my doctor does a great job”, and “my doctor wrote a great letter.” Sometimes when I’m explaining why medical reporting needs to be better, insureds are telling me why they can’t get it.
Let me be very clear once again. Without the best possible medical restrictions and limitations, treatment plans, prognosis, statements about appropriate care and MMI, and rebuttal statements, you will not have a disability claim, or if you do, not for very long. There is a very serious Catch-22 going on here: disability insurers are now aggressively reviewing claims, at the same time treating physicians are slacking off.
Although I am not one to pull insureds away from their favored treating physicians, the reality of this situation is very clear. If your treating physicians are not doing a great job with documenting your disability claim, you need to move on to physicians who will take the time to do a thorough job. Without good, solid medical write-ups and documentation, there can be no disability claim!
There is nothing more important to continual disability benefits than this medical issue, and yet few insureds/patients actually pay attention, adopting the attitude, “it is what it is. The issue of providing the best medical evidence written by physicians with the most prestigious credentials you can afford, should be a crucial priority in the management of any private disability claim.
I strongly suggest that insureds take this issue seriously and listen to those who know. Insureds’ medical information I’m personally reviewing is sub-standard in today’s industry and wouldn’t be sufficient to continually pay claims. I don’t want to say at some point in the future, “I hate it when I’m right.”
