Problem with the Reliability of Disability Assessments

When you are dealing with the emotional and physical effects of an injury, the financial burden usually does not become evident until you have been out of work for a while. As you struggle to make ends meet on the small amount of disability income you receive, you realize that this may be a permanent way of life. The reality hits you that you must qualify for long-term disability benefits.

Just as you accept the fact that your injury or illness is permanent and you will not be able to return to work, you receive a notice stating that your long-term disability claim is being denied. Your doctor said you could not return to work so why is the insurance company stating otherwise. The sad truth is that it could be who reviewed your disability claim.

Medical Providers Disagree About Claim Assessments

A recent study published in BMJ reveals that the outcome of a work disability claim often depends on which doctor performs the assessment more than the actual details of the claim.

After reviewing 23 studies, the researchers found substantial disagreement among the medical experts performing the assessments of the disability claims. According to one of the study’s authors, two doctors could assess the same individual and arrive at different conclusions about whether that individual was able to return to work. Of the 23 cases the study reviewed, nearly two-thirds of the assessments that took place in an insurance setting had disagreement among evaluators about the claimant’s ability to return to work.

One of the issues is who is performing the assessment. Treating physicians usually do not perform disability assessments. A major concern with a treating physician conducting the assessment is the ability of the physician to be objective. Therefore, an independent physician is assigned to conduct the assessment. However, you have a real possibility of a conflict of interest if the insurance company is paying the physician performing the assessment. Is a physician truly independent if he is hired by the insurance company who has a direct interest in the outcome of the assessment?

The authors of the study cautioned that additional research into the matter is needed. One suggestion is to standardize the evaluation process, but some researchers do not believe this is a viable option. Additional training for physicians as to their role in the assessment process and additional training in medical school regarding occupational hazards may help remedy the problem.

What Can I Do If My Disability Claim is Denied?

If your disability benefits are denied, you have the right to appeal the decision. However, appealing the denial of your disability benefits may not be in your best interest. It may be better for you to file a lawsuit against the insurance company that denied your claim. An experienced Ontario disability lawyer can help you determine your options and what option gives you the best chance of a positive outcome.

The first step in appealing a denial of a claim or filing a lawsuit is to determine why your claim was denied. There are several common reasons why disability claims a denied including:

  • You did not provide enough medical information with your initial disability application;
  • You did not complete the disability claim forms correctly or include all forms with your claim;
  • The claim was filed too late;
  • The insurance company claims you have a pre-existing condition; or,
  • The insurance company claims there is not sufficient evidence to justify that you are disabled and deserve disability benefits.

Regardless of the reason why the insurance company is denying your claim, you need to contact an Ontario disability insurance lawyer as quickly as possible. They can begin working on your appeal or lawsuit right away in order to protect your right to receive disability benefits.

Call Diamond & Diamond Now for An Appointment

The team of lawyers at Diamond and Diamond are ready to fight the insurance company on your behalf for the benefits you deserve. Call our 24/7 injury hotline at 1-800-567-HURT or visit our website to speak to someone now. We offer free consultations and case evaluations.

You may also like...