How Can Your Doctor Help You Qualify for Long-Term Disability Benefits
March 17, 2023
What role does your doctor play in helping you qualify for long-term disability benefits? There are several factors disability insurers consider when deciding whether to approve or deny disability benefits. The medical conclusions of an employee’s treating doctor play a very significant role in an insurer’s decision-making process. This post looks at how the opinions of a treating physician can impact both an insurer’s decision to approve or deny benefits, as well as a decision made by a federal judge who was tasked with deciding whether an employee is entitled to benefits.
A recent decision issued by a federal judge in the Eastern District of New York provides an excellent illustration of the importance of an employee’s treating physician. There, an employee suffered a heart attack in 2014. Following the heart attack, the employee had to undergo multiple cardiac catheterizations over several years. After the third catheterization in 2020, due to the employee’s “increased symptoms”, his doctor advised him to stop working.”
After being off of work for a prolonged period of time, the employee’s cardiologist noted that the employee’s cardiovascular health improved after he stopped working. This information was submitted to the employee’s disability insurer who hired its own doctor to review the employee’s medical records. The insurance company, Lincoln Life & Annuity, reviewed the opinion of its hired doctor who believed the employee was not disabled and could return to work. Based on the conclusion of the Lincoln’s doctor, and ignoring the findings of the employee’s cardiologist, Lincoln denied the employee’s long-term disability claim.
After hiring an attorney, the employee exercised his right to an internal appeal of Lincoln’s claim denial. In support of the appeal, the employee submitted the opinion of his treating cardiologist who again stated that the employee’s heart condition improved due to a change “in lifestyle and occupational status.” Despite this evidence, Lincoln denied the appeal and the employee filed yet a second appeal which included reports from additional doctors who treated the employee. Those doctors agreed with the assessment that the employee could not work given his fragile medical condition.
One of the employee’s doctors concluded that the employee was “unable to perform any occupation in the national economy.” That is a broad statement that when considered with the opinions of the other treating doctors makes a compelling case for disability coverage.
This decision illustrates the importance of the opinions of treating physicians when building a disability claim. Doctors are highly trained professionals who know the limitations of their patients. Employees who seek disability benefits are wise to make sure they share all of their limitations with their physicians. Doing so will allow the treating providers to ask the appropriate questions during an examination and produce findings that support an employee’s inability to work.
When an employee who is disabled keeps his or her doctors fully informed, and abides by the recommendations offered by their treating physicians, the employee increases the chance that an insurer will approve disability coverage or that a judge reviewing the case will rule in the employee’s favor.
The decision is Frederich v. Lincoln Life & Annuity Co. of New York, 603 F.Supp. 3d 38 (E.D.N.Y. 2022).