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Should an Employee Submit a Detailed Statement in Support of a Disability Claim

L. Jason Cornell, Esq. Jan. 10, 2023

In order to establish a disability claim with a disability insurer, the employee/claimant must show they have a sickness or injury and that this condition has reduced the employee’s ability to function within their job. Proving the employee is disabled requires the employee to provide two general types of evidence: medical evidence and vocational evidence. Both types of evidence often come from medical and vocational professionals; however, the employee is also a major source of evidence.

In a recent case against Prudential, an employee convinced a federal judge to award her disability benefits, due in part to the medical evidence she provided, which included a detailed personal statement.  See Logan v. Prudential Ins. Co., No. 2:20-01742, 2022 WL 16836642 (E.D. Cal. Nov. 9, 2022).  The employee in Logan was a claims adjuster for an insurance company who fractured her ankle after falling from a ladder.  She ultimately had surgery on the ankle, however, she soon realized the ankle was not healing properly. 

As a result, the employee developed pain in her knee. Her doctor recommended she not spend time sitting, standing, walking, driving or climbing.  She remained in constant pain, requiring narcotics that made her sleepy, dizzy and nervous.  This was problematic, because her duties as a claims adjuster required her to focus for 8 to 10 hours per day while sitting at her desk. 

One of the ways the employee established her claim with Prudential was through providing a detailed personal statement.  Through this statement, the employee advised the insurer that she could not “sit or stand for long periods of time.”  Further, the statement advised that she had “chronic pain in her left ankle with stiffness, swelling and popping.”  She described her discomfort as “stabbing pain” in her left heel and foot, accompanied by “chronic” pain and “tightness” in her knee, with headaches and pain in her left leg, hip, arm, shoulder and neck.

After considering all the evidence, including not just the employee’s statement, but also the record evidence from the employee and insurer’s medical professionals, the court in Logan ruled in the employee’s favor and approved the long-term disability coverage.  In doing so, the court considered the statement of the employee.  Although this statement was just one of the many factors that supported her disability claim, it played an important role. 

An employee statement is one of many items known as client generated evidence. The statement can be in the form of an informal document or a formal affidavit. It is critical to establish a clear picture of the scope of the employee’s disability.  To do this, statements often will include a personal history, description of the employee’s work duties, the onset of symptoms, a detailed discussion of current symptoms, an explanation of how the employee is unable to work and why the employee is unable to return to work.