Just because you can't see it
doesn't mean it isn't real.
With over 20 years litigating LTD cases for Invisible Disabilities, Courtney knows how to prove these claims. We know that our clients are not choosing to be disabled. Going without an income while searching for answers and effective treatment, is not a choice. If our clients could be working, they would be. We believe them, even if their insurance companies do not.
Proving disability claims for Invisible Disabilities is our law firm's primary focus and reason for being. These are complex and difficult to prove claims. Our clients are extremely vulnerable medically, financially, and emotionally. We understand the unique challenges of helping people who are struggling with these conditions. We know what evidence and what arguments are going to be most persuasive. We even know which negotiation strategies will be most effective with which insurance company. That's powerful knowledge when it comes to proving Invisible Disabilities.
What are Invisible Disabilities
Invisible Disabilities refer to disabilities or conditions that are not easy to diagnose or visible to others. These disabilities may include:
Chronic pain conditions: Such as fibromyalgia, chronic fatigue syndrome, or complex regional pain syndrome.
Mental health conditions: Such as depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), and other conditions that affect mood, behaviour, and cognitive functioning.
Neurological conditions: Such as multiple sclerosis, epilepsy, or Parkinson's disease.
Mental Illness: Such as depression, anxiety, PTSD, panic.
Chronic illnesses: Such as diabetes, lupus, Lyme disease, Crohn's disease, or rheumatoid arthritis.
Other impairments: Such as concussion, hearing loss, tinnitus, or visual impairments that do not result in complete blindness.
Invisible Disabilities can impact a person's daily life and may require accommodations in certain situations, but because they are not visible, they may be misunderstood or overlooked by doctors, friends, family and Insurance Companies.
We know how to prove Invisible Disabilities
Proving Invisible Disabilities can be challenging. These disabilities are not always apparent or visible to others. However, there are several ways that a person can provide evidence of their condition.
Medical records: Medical records, including doctor's notes, test results, and treatment plans, can provide evidence of a person's disability and the impact it has on their life. Your doctor should attach this information to the Attending Physician's Statement when you apply for LTD.
Diagnostic testing: Diagnostic testing such as MRIs, EEGs, and other tests can provide objective evidence of a person's condition. Your family doctor should have these reports and can attach them, as well.
Psychological evaluations: For conditions such as ADHD, depression, or anxiety, a psychological evaluation can provide evidence of a person's condition. You can ask your family doctor for a referral for this or any other type of assessment.
Accommodation history: A person's history of accommodations in the workplace, school, or other settings can be used to demonstrate the impact of their disability. Any evidence that you were struggling to do your job before you stopped working, will be helpful.
Personal subjective reporting: A person's own reporting about their experience with their disability and symptoms can provide valuable evidence of its impact on their daily life. This includes details of your activities on both "bad days" and "good days". You can explain that a "good day" now is not the same as it was before you became disabled.
It is important to note that the process of proving an Invisible Disability can be very challenging and frustrating for our disabled clients and for their doctors and treatment providers. If after providing the information listed above, the insurance company is refuses to pay the claim, you will need our help and you will need it quickly.
Why are LTD claims for Invisible Disabilities denied?
There are several reasons why disability claims for Invisible Disabilities may be denied. Here are a few possible reasons:
Lack of medical evidence: Disability claims require medical evidence to prove the existence and severity of a person's condition. If a person does not have sufficient medical documentation to support their claim (which is often true for Invisible Disabilities), their claim may be denied. The insurance company may wrongly focus on "objective" evidence, and fail to properly consider the person's "subjective" evidence about their symptoms and functioning and the opinions of their doctors who based their opinions on their patients' subjective reporting.
Inconsistencies in medical records: If there are inconsistencies in a person's medical records or if the medical evidence is not consistent with the person's self-reported symptoms, their claim may be denied. Symptoms for these conditions may vary from hour to hour, day to day, month to month. The insurance company may use inconsistent reporting of symptoms and functioning as a means of questioning the person's credibility and severity of their condition and denying the claim on that basis. This can be extremely insulting, frustrating, and hurtful to our clients.
Failure to follow treatment plans: If a person has not followed the recommended or "appropriate" treatment plan for their condition, their claim may be denied. The insurance company may assume that a person's condition would improve if they were receiving treatment that they deem "appropriate" for the condition and irrespective of the person's individual condition. This is a problem because often treatment is not known, available, affordable or effective for many Invisible Disabilities. Often the person's only option is to manage symptoms with or without traditional forms of treatment.
Lack of understanding about the disability: In some cases, the disability case manager reviewing the claim may not understand the person's condition and fail to take the steps necessary to properly assess the claim. They may decide to deny it outright or they may refer the file to one of the insurance company's medical consultant. The medical consultant will provide an opinion that is based solely on a paper review of the records and without any assessment of the person. Due to the lack of "objective" evidence in the records, the opinion will not normally be supportive of the claim and a denial will soon follow based on the medical consultant's opinion.
It is important for individuals with Invisible Disabilities to work closely with their medical providers and contact us to help ensure that they have the best chance of successfully claiming disability benefits. If the claim is denied or terminated, it is important to contact us right away to discuss options for disputing the decision.
Bad faith and emotional distress in Invisible Disability claims
Our clients should never be made to feel as though they are exaggerating or malingering or lying about their symptoms or functionality. Insurance companies have a "good faith" obligation to claimants in how they assess all claims for disability, including claims for Invisible Disbilities.
Some clients are surprised to learn that there is no exclusion for Invisible Disabilities in their insurance policies. A definitive diagnosis is not normally required to be eligible for LTD benefits. The same is true for the requirement for "appropriate" treatment. Some conditions have no effective or medically supported treatment and there is no "appropriate treatment". Similarly, "objective evidence" is not always a requirement, particularly, when there is no objective evidence for determining the existence and severity of some Invisible Disabilities. We know this. The insurance companies knows this too. That's a problem for them.
Insurance companies are bound by the terms and conditions of their policies. When they assess claims for Invisible Disabilities based on terms/conditions that are not is their policies (which is what we often find they do), we can use this as evidence of them not acting in "good faith". In very badly managed claims, we can find evidence to support our clients' claims for "bad faith" damages and emotional and financial distress damages.
Damages claims are very serious claims that we spend significant time and effort working to prove them.
We know insurance companies are concerned with damages when it they assess their risk and
when they decide how to settle our clients' cases.