Your doctor is a key figure in your journey to getting approved for long-term disability benefits since the insurance company will depend on the evaluations and treatments this person provides to determine your eligibility for payments. While a good doctor can be immeasurably helpful in securing your benefits, a bad doctor can get your claim denied. Here are two ways this can happen and what you can do to protect yourself.
Quality of Care
The goal of every insurance company is to make a profit, so they want to pay the least amount of money on claims as possible. Thus, they want to ensure the treatments you receive will help you get better so they can stop paying out benefits at the earliest possible date.
To that end, the insurance provider will review your treatment plan to determine if it meets industry standards and that your doctor is following the best practices for their field. If the doctor is providing substandard care that doesn't properly address your condition, the company will deny your claim. For instance, if your injury requires physical therapy but the doctor only prescribes medication, the insurance company may consider that a red flag that you're receiving improper care for your injury and unlikely to improve as a result.
Unless you also work in the medical field, it can be difficult to determine whether you're receiving the best care possible. One option is to find trusted sources online and research the standard of care for your particular condition to see if your doctor is adhering to it. The research you do can also come in handy for disputing the insurance company's claim your doctor is not doing their job properly.
Another option is to seek out a second opinion from another healthcare provider, especially if you have to work with specialists. Though it may take time and cause you to incur additional expense, an evaluation from another doctor in the field could ultimately prevent you from losing your benefits.
Your doctor's documentation habits may also cause the insurance company to deny your disability claim. As noted previously, your insurance provider depends on reports from the doctor detailing your condition and treatment to help it determine whether you are eligible to receive benefits. If the doctor sends in incomplete reports, doesn't update your records, or misses deadlines, you could be denied benefits because the insurance company doesn't have the information it needs to evaluate your claim.
You have the right to access the information in your medical file, so it's a good idea to ask for copies of reports, charts, prescriptions, and other items it contains as well those sent to the insurance company. If information is missing or inaccurate, bring it to the doctor's attention so they can make the necessary changes and resubmit the paperwork to the insurance company when appropriate.
For more tips on handling a long-term disability insurance claim, contact a local disability claims firm like Iler and Iler.