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Has Your Insurance Company Denied
Your Disability Claim?

Whether an insurance company, employer, union or other ERISA governed
plan has denied your insurance claim, we can help.

In LTD Claims, Why Do the Symptoms NOT the Diagnosis Determine the Claim?

As a Rhode Island insurance denied attorney, I’m often asked if any particular diagnosis will guarantee a claimant disability benefits. A medical diagnosis does not automatically qualify you for long term disability benefits. Thousands of long term disability claims are denied by insurance companies each year, even though the claimants are legitimately diagnosed with serious illnesses or injuries.

People often assume they will get long-term disability benefits because they have been diagnosed with a serious illness, such as cancer or heart disease. However, a medical diagnosis by itself does not explain the severity of your medical condition. More importantly, a medical diagnosis does not explain your physical or cognitive limitations, which limit or restrict your ability to work.

What You Need to Prove

All long-term disability policies define what it means to be disabled. To be approved for long-term disability benefits, you must meet the definition that is in your policy. Private LTD policies often define disabled as an inability to perform the material duties of your occupation (“own occupation” policies). Employer-provided LTD policies usually define disabled in the same way initially. Then, after two years, the definition changes to an inability to perform any occupation to which you are suited by your age, education, and experience. Some LTD policies define disabled as an inability to perform any occupation to which you are suited (“any occupation” policies).There are many variations in the exact definition.

The Evidence You Need to Prove It

A workers’ compensation rating or a two-sentence letter from your treating doctor saying that you are disabled and cannot work is not enough. To win your claim, you need to link your medical condition to work impairment. You must establish your “restrictions” and “limitations.” “Restrictions” are activities that you should not do. “Limitations” are activities that you can do, but not as often, or as long, or as intensely as a person without your condition.

A medical diagnosis does not explain your limitations or restrictions, but your symptoms do. Symptoms are the manifestation of your illness or injury—pain, fatigue, shortness of breath, stiff joints, and so forth. For example, some of the symptoms of diabetes are blurred vision, frequent infections, and pain, numbness, and tingling in hands, feet, or arms. All of these symptoms can affect a person’s ability to perform the material duties of his or her job or other jobs.

To prove your symptoms and how they give rise to your restrictions and limitations, you will need to submit medical and vocational evidence to the insurer. Medical evidence includes your medical history, medical records and laboratory test results, and statements from your doctor. Vocational evidence consists of your job description from your employer and from the Dictionary of Occupational Titles or O*NET, and your education, training, and work experience. In addition to these items, your Rhode Island insurance denied attorney may suggest you undergo additional medical tests, a functional capacity assessment, or a vocational assessment.

Contact a Rhode Island Insurance Denied Attorney

When your symptoms make work difficult or impossible, it’s time to get help from a Rhode Island insurance denied attorney. Jonathan M. Feigenbaum can help you put together a strong case supported by the evidence insurers require to issue a favorable decision.

Whether you have not yet filed for disability benefits or your claim has been denied, call a Rhode Island insurance denied attorney for A COMPLIMENTARY CONSULTATION at 617-357-9700 or toll-free at 866-396-9722.


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