With increasing frequency, insurance companies like Cigna, Unum, MetLife and Prudential are denying long-term disability (“LTD”) claims due to discrepancies between what the claimant/treating physician is saying on the claim forms and what is stated in the medical records. Essentially, the insurance company will say that the symptoms being described for purposes of the LTD claim are not reflected in the treatment records, so there’s no proof that these were ongoing problems.
This often occurs because of one main reason: people always want to put their best foot forward. When the doctor starts the appointment with “how are you feeling?” it’s in our human nature to simply reply “I’m doing okay.” Generally, no matter how we’re actually feeling, we don’t want to be viewed as a complainer so we may tend to downplay our symptoms, even to the extent of telling our doctor that everything is fine…when it’s clearly not. Usually, when we respond this way, we mean that everything is okay considering the circumstances we find ourselves in, or sometimes just that “things could be worse.” But, that’s not how it later appears in medical records. Instead, what this often leads to is medical records showing “no active complaints” or “patient is improving” or “symptoms have subsided,” which gives the insurance company all the ammunition they need to deny the LTD claim.
So, be clear with your doctors about everything you’re experiencing. Don’t hide your symptoms. Be detailed, and offer real-life examples. Don’t just say “I’m having memory problems.” Give examples of having lost something, or forgot something you’ve never before forgotten. Instead of “I’ve been very fatigued lately” explain what you were doing (like shopping, or picking up a child, or gardening, etc.) and how your fatigue interupted or prevented you from finishing the activity. Also, check with your doctor or the doctor’s staff, to make sure everything you’re telling him/her is making it into your records.
Not only will this give you a better chance at success with your disability claim, but far more importantly, it will lead to better medical care. Your doctors can most effectively help you if they know what you’re experiencing. So be open and honest about everything you’re feeling, and resist the urge to say “I’m fine.”