Getting your doctor on board with your documentation is a crucial step in any LTD case – here’s what to do if you’re not on the same page.
One of the most common and frustrating hurdles in a long-term disability claim arises when your physician doesn’t support the way you believe your disability should be documented. You may know you’re unable to work. You may experience symptoms daily, manage complex treatment regimens, and struggle with even basic tasks. But if your doctor doesn’t reflect that reality clearly and consistently in their records, your insurer may deny or terminate your claim.
While it’s tempting to assume your doctor will automatically advocate on your behalf, many claimants discover too late that medical and legal definitions of “disability” don’t always align.
Understand Why the Disagreement Happens
Doctors learn to treat conditions, not navigate insurance standards. Many are unfamiliar with the specific language required for LTD claims. They may also be reluctant to label someone as “disabled” without clear, objective evidence, especially if symptoms are subjective (like pain, fatigue, or cognitive dysfunction). Others may unintentionally downplay the severity of your condition in notes, saying you’re “improving” or “stable,” without realizing how insurers will interpret those terms. In some cases, your provider may disagree with your self-assessment and feel you’re capable of certain tasks or underestimate how symptoms affect you day to day.
Don’t Assume—Start a Conversation
If you notice your provider’s documentation doesn’t align with what you’re experiencing—or what your LTD insurer needs to see—don’t wait for a denial to address it. Schedule a dedicated appointment to discuss your claim in detail. Bring a copy of your LTD policy’s definition of disability and explain what the insurer is looking for. Ask your doctor to review and document not just your diagnosis, but your functional limitations: What can you no longer do? What tasks aggravate your symptoms? What are your restrictions, and how do they affect sustained work capacity?
Make sure your doctor understands that the issue isn’t whether you’re “totally incapacitated,” but whether you can reliably perform full-time work on a predictable schedule, with or without accommodations.
Clarify Misunderstandings Around Work Capacity
Many physicians assume that if a patient can perform some daily activities—such as shopping, driving, or exercising lightly—they’re capable of working. Explain that insurers often equate these activities with work capacity, even though they’re not equivalent. Walking the dog doesn’t mean you can sit for eight hours and concentrate through meetings. Preparing a meal doesn’t mean you can withstand the cognitive load of full-time employment.Ask your provider to focus their documentation on consistency, duration, and reliability: Can you perform a task repeatedly and consistently? For how long? What’s the fallout afterward? These details matter far more than whether you can perform a task once or twice.
If your provider has already submitted something that could be harmful to your claim, you can ask them to draft a clarifying addendum or letter. This supplemental document can clarify what was meant by a particular statement or provide additional context about your limitations.
Ask for Functional Assessments
If your provider is unsure how to describe your limitations in a way insurers will understand, consider requesting a functional capacity evaluation (FCE) or neuropsychological testing. These assessments offer objective insights into your physical or cognitive limitations and can help bridge the gap between clinical observations and insurer expectations. Keep in mind that a poorly done or insurer-selected FCE can hurt your claim. When possible, work with a lawyer to determine whether an assessment is necessary and who should perform it.
Educate Your Doctor on the Insurer’s Tactics
Doctors are often unaware of how aggressively insurers scrutinize language. Explain that certain phrases—“stable,” “mild,” or “responding to treatment”—can be used as justification for denying benefits. Provide examples from your LTD plan or past denials if available. You can even show them templates or checklists of functional limitation language that insurers find persuasive.
To this end, you should request copies of your progress notes, test results, and attending physician statements before they’re submitted to the insurer. Look for vague language, contradictions, or comments that might be misinterpreted (e.g., “patient appears well,” “condition improving,” “planning vacation”). Discuss any red flags with your doctor and clarify context where needed.
If the Doctor Still Won’t Cooperate
Sometimes, despite your best efforts, a provider is unwilling to support your claim. Maybe they don’t believe in the disability, don’t want to get involved, or simply lack the time. If that happens, it may be time to reevaluate whether this provider is the right fit for your care.
It’s not unethical or dishonest to seek out a provider who understands your condition and is willing to document it accurately. Failure to do so could result in the loss of your benefits.
At the very least, supplement your file with additional evidence, like written statements about your daily limitations, a log of your symptoms, flare-ups, and medication side effects, and supportive letters from specialists, caregivers, or therapists. Getting expert legal guidance to help shape your appeal can also significantly strengthen your case.
Final Thoughts
Long-term disability claims are as much about how your condition is documented as they are about the condition itself. If your doctor isn’t providing the support you need—or is unknowingly undermining your case—don’t stay silent. Have a hard conversation. Educate them on what’s required. If your doctor refuses to help or fails to update your documentation despite multiple requests, keep written records of those interactions. Emails, appointment notes, or even a personal log can show that you’ve made good faith efforts to comply with claim requirements.
And if necessary, get help from a lawyer who can guide both you and your medical team through the documentation process. Your doctor’s notes could determine whether your claim is approved or denied. Make sure they tell the full story.