Proving you are disabled should not be difficult.

Practical Tips for Applying for LTD

Good Timing and Lots of Details

• If in doubt, apply for LTD and do so at least a month or two before the end of your short term disability or sick leave period.

• Your insurance policy has deadlines for applying for LTD.  You should not wait too long or your claim could be denied on that basis that you submitted it too late.  You also do not want to be waiting too long for a decision, without any income.

• When you are completing your Claimant's Statement/Plan Member's Statement, provide detailed and accurate information.  You can even add a page to ensure that you have provided the information the insurance company will need to assess your claim.  More is more.

 

Choose Doctors Wisely and Give Some Direction

• Ask your family doctor to complete the Attending Physician’s Statement (APS) for every condition that impacts your functioning and your ability to work.  

• Submit an additional APS for psychological conditions, which can be completed by a psychologist or psychiatrist or other specialist.

• Include reports/notes from other specialists for other conditions. Your family doctor should have all of your consultation reports and you can ask that they attach those reports and their records to the APS.

• Make an appointment with your doctor specifically for the purpose of discussing your LTD claim.

  • Explain the physical and cognitive demands of your job to your doctor.  It's helpful for them to understand why you are unable to do your job.

  • Remind your doctor to attach records, consultation reports, test results, etc.

  • Provide your doctor with a completed copy of your Claimant's Statement/Member’s Statement for their reference.  

  • Ask your doctor to add a short report explaining how your condition(s) prevent/limit you from doing your “activities of daily living” and the “the duties of your occupation”.   

  • Ask for a copy of the completed APS and any additional documents submitted. If your claim is later denied, it will be helpful for us to have these documents readily available to start your court case or appeal the decision.

​​

Referrals Help--Be Proactive

• The insurance company may make assumptions about the severity of your condition based on who is treating you.  For example, in mental health claims, the insurance company will expect that you are receiving talk therapy (CBT or the like); medication; and have been referred to a psychiatrist.

• Ask your doctors for referrals to specialists and for diagnosis and treatment (if appropriate).  You may need to advocate for yourself and be proactive in getting the necessary referrals. Even if you have not seen the specialist when your claim is being assessed, the fact that a referral has been made will suggest that your condition is severe.

• Be sure to advise the insurance company of  pending referrals on your claim form or in your telephone interview.

​​

Treatment is Critical

• The insurance company may make assumptions about the severity of your condition based on your treatment, such as medications and dosages; the frequency of appointments with your treatment providers; the nature of the treatment; and the qualifications of the treatment provider.

• Insurance companies will not pay your benefits if you are not receiving “reasonable & customary treatment” or "appropriate treatment" as defined in your policy.

• Follow your doctors' and treatment providers' recommendations (therapy and/or medication, etc.) and try not to miss any appointments. If you need to miss an appointment because you are unwell, be sure to make that clear when you cancel.

• If some form of treatment has been discussed or recommended but you are reluctant to proceed with it; you want to try other treatment first; or there is some other very legitimate reason why you are not proceeding with that treatment, be sure to have that discussion with your doctor and ask that they make a note detailing why you are not proceeding with that treatment.  For example, some clients prefer to wait to take medication for depression/anxiety until they have tried talk therapy. Others may have tried medication and the side-effects were severe.  If there is a family history of addiction, clients may be reluctant to take any medication.

• Seek out all forms of treatment--even alternative treatment if appropriate. Insurance companies will want to see that you are receiving medically accepted treatment but other alternative treatments will demonstrate your efforts to find relief and regain your functionality.

• Complying with treatment recommendations adds to your credibility by demonstrating that you  are doing everything possible to recover from your condition.

 

Telephone Interview/Questionnaire - More is More

• The purpose of this call is to clarify the information you and your doctors provided in the claims forms and medical documentation.  The insurance company will also be on alert for any inconsistencies in your reporting to them as compared to what your treatment providers have said.   The call could take anywhere from 30 minutes to an hour and a half.  

• They will ask not only about your condition and symptoms but also details about your daily activities. It is important that when you tell them what you can and can not do, you provide context for the activities.  For example, you may have a "good day" or a "good moment" in a day when you leave your home to buy groceries, but the activity may be so exhausting that you require a few days to regain your energy. 

• Be truthful.  Listen to the questions carefully and provide complete and accurate answers.  Do not guess, if you are not sure of the answer, particularly when it comes to questions about when you think you will be able to return to work.  You do not want the insurance company to believe that you intend to return to work by a particular date if your recovery and prognosis is still unknown. 

• You can ask for the initial interview call to be scheduled for a time convenient to you.  If you suffer anxiety, an unexpected call from the insurance company can be triggering and you may suffer an aggravation in your symptoms or you may forget to provide or explain important information. 

• To ensure consistency, have a copy of everything that was submitted to the insurance company, in front of you and review it in advance if you feel up to it. The call is not meant to be a test of your memory and you may feel less anxious having something to refer to when answering questions.

• Do not be interrupted. If you are not finished answering a question, you may stop the interviewer from moving on to the next question and provide more details.  After the call you can also email any information that you forgot or that you may have stated incorrectly. 

• Remember to focus your answers on how your conditions prevent you from working in your occupation.  The interplay between your conditions is also important to explain.  For example, if stress causes your pain to worsen and increased pain causes you more anxiety and depression, be sure to explain that to them.

 

Additional Requests for Information

• Following the interview, you may want to give your doctors a “heads up” that the insurance company will be requesting more information (usually copies of records and possibly a short report) and ask that they be sent as soon as possible to avoid delay in assessing your claim. 

• If you have not seen your treatment providers in a while, now would be a good time to make follow up appointments so that they have updated information to provide to the insurance company, when it is requested.

​

We can help you to apply for LTD.

​

Helping you with your application, means that we will already know your claim inside and out.  If your claim is later denied, we can start the litigation right away, saving you time and money.  If your claim is approved with our assistance we will do a "happy dance" with you and be proud to have played a role in the positive outcome.  We know that you will be happy to refer us on to others who need our help and that if you need us later on, we know you will come back to us for assistance.  At Mulqueen Disability Law we feel strongly that we rise by lifting others.